Some hospitals around Santa Clara County and California say they are having to turn ambulances away from emergency rooms for hours at a time because they don't have enough staffing to meet new standards requiring more nurses at the bedside.

The hospitals also are filing scores of requests asking for relief from the strict standards -- but state health officials aren't granting it.

Nearly nine of 10 California hospitals reported being out of compliance with the new state rules, which took effect Jan. 1, according to an informal survey by the California Healthcare Association, a hospital industry group. Of the 150 hospitals responding to that survey, nearly half said the new rules are forcing their emergency rooms to divert ambulances to nearby hospitals.

The emergency room diversions and hospital pleas for leniency are a key part of the contentious atmosphere surrounding the new staffing rules, which aim to improve patient care and prevent nurse burnout. While local health authorities say it's too early to tell how patients are being affected, public health experts worry when hospitals divert ambulances because that can compromise patient care and overwhelm nearby emergency rooms.

Emergency rooms in Santa Clara County turned away ambulances for a total of 243 hours between Jan. 3 and 16. More than 40 percent of those hours ``on diversion'' were attributed to the new nurse staffing standards, according to the county's Emergency Medical Services Authority. That's more than double the amount of time ambulances were diverted during the same two weeks last year.

Emergency rooms on diversion must remain open to walk-in patients and life-threatening emergencies brought in by ambulance. California now requires one nurse for every four patients in emergency rooms.

Dr. David Ghilarducci, Emergency Medical Services Authority medical director, cautioned that the impact of the new rules on emergency rooms remains unclear.

Some hospitals may not choose to turn away ambulances, even if they have too few nurses in their emergency rooms to meet the new rules. Others may not report staffing problems as a reason for going ``on diversion.''

Hospital executives maintain that a statewide nursing shortage makes it nearly impossible to meet the new standards all the time.

Emergency room doctors and nurses must ``either provide the care and be in violation of the law, or they make the very difficult decision of turning patients away,'' said Jan Emerson, spokeswoman for the California Healthcare Association.

Union officials counter that the hospitals have had years to prepare for the rules and charge that hospitals are exaggerating their plight.

But for a patient in an ambulance turned away, the political quickly becomes personal. County records show Regional Medical Center of San Jose, San Jose Medical Center and El Camino Hospital in Mountain View were most likely to divert ambulances because of staffing problems.

In the second week of January alone, Regional Medical Center of San Jose turned away ambulances for 26 hours -- citing nurse staffing problems for 24 of those.

At San Jose Medical Center's trauma unit, which treats gunshot wounds and other life-threatening emergencies, staffing concerns forced the center to turn away ambulances for seven of the 12 hours it was on ``diversion'' in the second week of January.

Leslie Kelsay, spokeswoman for both Regional Medical Center of San Jose and San Jose Medical Center, said temporary overloads of patients, as well as nurse staffing concerns, accounted for many of those hours. Sometimes, diversions occur because of too few nurses in other hospital units; emergency rooms cannot transfer patients to those units without breaking the rules, Kelsay said.

``When we go on diversion, we start fully staffed, we call in everyone who was on standby and everyone else we could find who wasn't on standby and still we are not able to meet the ratios,'' Kelsay said.

Chuck Idelson, a spokesman for the California Nurses Association, said blaming staffing ratios for emergency room diversions ``is disingenuous.''

``A large part of this is political,'' Idelson said. ``There've been diversions for years due to inadequate staffing.''

On another front, many California hospitals are asking the Department of Health Services for ``flexibility'' allowing them to put fewer nurses at the bedside. Although there are no fines for breaking the staffing rules, a pattern of non-compliance can threaten Medicare and Medi-Cal payments.

As of last week, 67 hospitals had requested easing the staffing standards, health department spokeswoman Lea Brooks said. Most requests are still being considered, but so far, the answer almost always has been no.

Fifty-four complaints have been filed alleging inadequate nurse staffing, but investigators found that patient care was compromised in only one of those cases, Brooks said.