AFTER A DECADE of relentless hospital closures and consolidations, and with even more essential services threatened with elimination – obstetrics and mental health at Norwood Hospital and pediatrics at Tufts Medical Center – a fundamental question hangs over the Commonwealth: our system is- 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 Ministry of Public Health reviewed the impact of the closure and deemed the services “necessary to preserve access and health status in a particular service area”. . The fact that we have a full record of closures despite DPH recommendations against them speaks to the urgent need to strengthen our public health laws.
The Massachusetts Nurses Association’s 23,000 nurses and healthcare professionals are calling on Beacon Hill lawmakers to take meaningful action. Legislative action must include substantial improvements to the current shutdown process administered by the Department of Public Health as well as disincentives to the elimination of less profitable services in favor of more financially lucrative ones. Hospitals earn millions of dollars from licensing. The state should ensure they provide the necessary services, especially when closures have a disproportionate negative effect on minority and under-resourced communities.
- When Tufts announced plans to close its 128-year-old children’s hospital, executives said a low count. However, doctors and nurses at Tufts told the boston globe their units are regularly occupied. The newspaper also reported that 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 in February 2020, leaders asserted a shortage of psychiatrists. The wards were open to low-income patients and included New York’s only child psychiatry beds in Worcester. A year later, Trinity sold the hospital to a for-profit corporation.
- When Steward Health Care eliminated maternity wards at Morton Hospital in Taunton in 2018, Steward had already laid the groundwork by understating the pediatric census and closing that ward five years earlier. The closure of the maternity ward 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 property debt and used cuts to essential services to pay off its debt. Berkshire Health Systems purchased the remains of North Adams Hospital but refused to restore all services.
- When UMass Memorial Health Care announced in 2019 the closure of the pediatric unit at Clinton Hospital, an urgent care unit in Fitchburg and the cardiac rehabilitation unit in Leominster, leaders spoke about the issues income related to the service of low-income patients. The resulting consolidation of profitable services has led to reduced access for local communities.
- When Partners HealthCare closed Lynn Union Hospital in 2016, the union representing hospital workers, 1199SEIU, lambasted Partners for raising billions “while shamelessly trying to get rid of low-income seniors and patients who don’t ‘not increase their bottom line’.
Each closure is not an isolated event. As at Morton, the closures often build on previous closures, creating compounded access reduction. Hospitals close one service, claim reduced activity and close others. By the time the public is notified, it is too late; the decision had been made months earlier at a board meeting. This futility is concealed from the public by a regulatory process that encourages people to speak up without really giving them a voice.
Planned closures of essential health care services trigger Public Health Department hearings. Lately, these hearings have been held by telephone, although in the past people filled gyms and town halls seeking to protect patients and communities.
Nicole, a mother from western Massachusetts, told DPH one evening in April 2020 that her son was first hospitalized at age five for behavioral issues. He had received treatment at Providence Hospital in Holyoke, which was far better than traveling up to two hours away. Nicole urged officials to protect a service vital to the mental health of her then 9-year-old son. “Sending my child to another facility completely out of our area…it’s just ridiculous,” she said.
On May 15, 2020, the DPH called 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 that their interests do not matter. The Commonwealth must put the needs of patients and the community at the forefront of this decision-making process.
Katie Murphy is president of the Massachusetts Nurses Association.