Doctor Clavreul's statements are so out of synch with reality that I don't know where to begin. First of all, the Patient Safety Act now before the Massachusetts Senate calls for the establishment of a standardized acuity system for all acute-care facilities, above and beyond the outside limits on a nurse's patient load being scientifically determined by the Department of Public Health. Front-line nurses themselves know what constitutes a safe limit, and use the organizations that they run, such as CNA and MNA, to fight against administrators and their stupid practice of minimally staffing and hoping for the best, or using mandatory overtime to flex up in times of greater volume. In the mid-80s in Massachusetts, during that decade's cyclical nursing shortage, a staff nurse grieved an unsafe staffing situation, went to arbitration and won on the basis of the hospital's not staffing according to its own acuity system. A few weeks after that judgment came down, the acuity system disappeared. These administrators need to be held accountable. Six patients a day die in Massachusetts hospitals from preventable infections and mishaps, and only appropriate staffing levels will save them. - Sandy Eaton, RN, Quincy, Massachusetts