California State Health Director Sandra Shewry yesterday announced proposed changes to the state's nurse-to-patient ratio regulations, citing concerns about their effect on patient care and the state's fragile health care system. Since the mandatory ratio went into effect Jan. 1, 11 hospitals have had to close their emergency department or psychiatric unit, or shut their doors entirely, and four have asked for permission to suspend the use of available beds because they cannot provide enough nurses to meet the ratios. Yesterday's proposed changes would give emergency departments greater flexibility in meeting the ratio, and ease the current interpretation of the law, which requires hospitals to maintain the ratio at all times, even when nurses take brief restroom breaks or phone calls. The changes also would delay a scheduled decrease in the number of patients allowed under a nurse's care - from six patients to five at a time - from 2005 until 2008, while the California Department of Health Services conducts a study on the law's impact. California Healthcare Association spokesperson Jan Emerson called the changes "reasonable, common-sense modifications" that will "protect patients' access to care." CDHS yesterday filed its changes with the state Office of Administrative Law, which has 10 days to reject or accept and enact them.