Defying DPH, hospitals keep shuttering ‘necessary’ facilities

AFTER A DECADE of ceaseless hospital closures and consolidations, and with yet more essential services facing elimination – obstetrics and mental health at Norwood Hospital and pediatrics at Tufts Medical Center – a fundamental question looms over the Commonwealth: Is our system supposed to protect public health or hospital finances?

Since 2009, more than 30 hospitals or units have closed in Massachusetts, according to a review of public records. In most cases, they closed even though the Department of Public Health examined the closure’s impact and deemed the services “necessary for preserving access and health status in a particular service area.” That we have an extensive record of closures despite DPH recommending against them speaks to the urgent need to strengthen our public health laws.

The 23,000 nurses and health care professionals of the Massachusetts Nurses Association are calling on Beacon Hill lawmakers to take meaningful action. Legislative action must include substantial improvements to the current closure process administered by the Department of Public Health as well as disincentives to eliminating less profitable services in favor of more financially lucrative ones. Hospitals make millions of dollars from licenses. The state should ensure they provide necessary services, especially where closures have a disproportionately negative effect on minority and under-resourced communities.

• When Tufts announced plans to shutter its 128-year-old pediatric hospital, executives claimed low census. However, Tufts doctors and nurses told the Boston Globe their units are routinely busy. The newspaper also reported the hospital treats a high share of low-income patients on Medicaid.
• When Trinity Health announced the closure of 74 child and adult psychiatric beds at Providence Behavioral Health Hospital in Holyoke n February 2020, executives claimed a lack of psychiatrists. The services had been open to low-income patients and included the only child psychiatric beds from New York to Worcester. A year later, Trinity sold the hospital to a for-profit company.
• When Steward Health Care eliminated maternity services at Morton Hospital in Taunton in 2018, Steward had already laid the groundwork by undercounting pediatric census and closing that service five years earlier. The maternity closure had dire consequences, with reports of women giving birth on the side of Route 24 on the way to Brockton.
• When North Adams Regional Hospital closed in 2014, its parent company had taken on nearly $65 million in real estate debt and used cuts to essential services to pay its debt. Berkshire Health Systems bought the remnants of the North Adams hospital but refused to restore full services.
• When UMass Memorial Health Care announced in 2019 the closures of Clinton Hospital’s pediatric unit, an urgent care in Fitchburg, and Leominster’s cardiac rehabilitation unit, executives cited revenue issues from serving lower-income patients. The resulting consolidation of profitable services led to reduced access for local communities.
• When then-Partners HealthCare closed Lynn Union Hospital in 2016, the union representing hospital workers, 1199SEIU, blasted Partners for amassing billions “while shamelessly attempting to rid themselves of low-income seniors and patients who don’t boost their bottom line.”

Each closure is not an isolated event. Like at Morton, closures often build on previous closures, creating a compounding reduction in access. Hospitals close one service, claim reduced activity, and close more. By the time the public is notified, it’s too late; the decision was made months earlier in a board meeting. This futility is concealed from the public by a regulatory process that encourages people to speak out without truly giving them a voice.

Planned closures of essential health care services trigger Department of Public Health hearings. Lately, these hearings have been held over telephone, though in the past people packed gymnasiums and town halls seeking to protect patients and communities.

Nicole, a mother from western Massachusetts, told the DPH one evening in April 2020 that her son had first been hospitalized at age five for behavioral issues. He had received care at Providence Hospital in Holyoke, which was much better than traveling as many as two hours away. Nicole urged officials to protect a service vital to her then 9-year-old son’s mental health. “To send my child to another facility completely out of our region … it’s just ridiculous,” she said.

On May 15, 2020, the DPH deemed Providence’s 74 psychiatric beds a “necessary” service. On June 30, the beds closed. By allowing these closures, our public health system is telling already vulnerable people their interests do not matter. The Commonwealth must put patient and community needs at the forefront of this decision-making process.

Katie Murphy is president of the Massachusetts Nurses Association.