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birthing center

State finalizing maternal health care access reports

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BOSTON — Facing a deadline next week, state public health officials are working to finalize reports about statewide access to maternal health care, as well as access to essential services in northern Worcester County.

Public Health Commissioner Robbie Goldstein said Wednesday that the reports and policy recommendations are based on public feedback sought through recent listening sessions throughout the state, including in Athol, Fitchburg, Leominster, Brockton, and Springfield.

“DPH staff have been working diligently to be responsive to this request from the governor’s office, and we look forward to delivering these critical reports,” Goldstein told the Public Health Council Wednesday.

Healey ordered the reviews in September following the controversial closure of a maternity ward in Leominster, but her administration later faced sharp scrutiny over its commitment to addressing the maternal health crisis and engaging with the public.

“Our administration is deeply concerned about the Leominster closure and health care access generally across northern Worcester County. We are committed to ensuring that all Mass. residents have access to high-quality health care, including safe and equitable maternal care,” said Healey in a statement released on Sept. 22. “That’s why I’m ordering a review … of essential health services in the Northern Worcester County area following the closure of the UMass Memorial Leominster maternity unit.”

For the maternal health review, Healey asked officials to focus on health equity and outcomes and to consider expanding the workforce, such as through doulas and nurse midwives, Goldstein said.

In a press release, the DPH said that their goal was to listen and learn from people in regions throughout the state and to “develop strategies to optimize the experiences and outcomes” for anyone affected by the closure of maternal wards and other health care facilities over recent years.

Goldstein made no mention Wednesday of the criticism lodged against the Healey administration by the Massachusetts Nurses Association over the “hastily arranged” listening sessions that the union said lacked public outreach and sufficient notice.

“We are extremely disappointed that the Administration has provided such short notice to participants regarding the Maternal Health Listening Sessions. This is not a process designed to gather substantive feedback,” Katie Murphy, president of the MNA, said last month. “This is a vitally important issue and should get the time and attention it deserves – not this hastily put together process with no advance notice.”

The Northern Worcester County listening sessions took place Oct. 24, 25 and 26 in Athol, Fitchburg and Leominster, respectively.

Both DPH reports, one for the whole state and another just for North Worcester County, are due next Wednesday, Nov. 15, Goldstein said.

Brendan Lewis contributed to this article.

Editorial: Healey’s maternity closure response too little, too late

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Closing the barn door after the horse has bolted.

Or in this case, applying some window dressing to the state’s inability to prevent Leominster Hospital’s maternity unit from closing.

That’s all we can take from Gov. Maura Healey’s decision to order reviews of access to maternity care in the Northern Worcester County area, as well as a review of “prenatal, postpartum and birthing services across the state,” now that UMass Memorial Health made good on its vow to shutter that vital service on Sept. 23.

“Our administration is deeply concerned about the Leominster closure and health care access generally across Northern Worcester County. We are committed to ensuring that all Mass. residents have access to high-quality health care, including safe and equitable maternal care,” said Gov. Healey in a statement.

For all those who did their best to forestall or preempt that closure, including everyday citizens, health-care professionals, and members of the Twin Cities’ and Worcester’s Statehouse delegations, the question to Healey should be: why did you wait until after the fact to insert the governor’s office into this crisis?

The above-mentioned groups and many other organizations and coalitions did their best to pressure the state to stop the closing of the maternity ward, right up to that Sept. 23 termination date.

In one last attempt to persuade the governor to intervene, many supporters held a vigil on Sept. 21, to no avail.

Both the statewide and Northern Worcester County reviews must be completed by Nov. 15. In addition to Health and Human Services Secretary Kate Walsh, state Undersecretary for Health Dr. Kiame Mahaniah and DPH Commissioner Robbie Goldstein will oversee this process.

These reviews will undoubtedly confirm what the Department of Public Health has already concluded: the maternity unit closure leaves a gaping hole in health-care coverage in the Twin Cities area for expectant and new mothers, especially minorities and those on the lower rung of the economic ladder.

We’ll leave it to Katie Murphy, president of the Massachusetts Nurses Association, which has long lobbied the Legislature to give the DPH more authority over medical-services closures, to accurately characterize the governor’s dime-late-and-dollar-short review edict:

“Claiming now that the state will monitor the situation after the closure, to acquiesce to the UMass system which has acted in bad faith throughout this process is akin to saying you will count the bodies on the ground after the plane has crashed — a plane you were warned was unsafe to carry those passengers.”

Ayer chapter fits muddled Mass. migrant story

The state’s seemingly seat-of-the-pants response to simultaneously housing the flood of newly arriving migrants and its existing homeless population has blindsided host communities, leaving them without much of a say in this process.

The town of Ayer’s situation fits an all-too familiar pattern.

The newspaper recently reported that as of a meeting held Sept. 19, Ayer officials were still in the dark about details concerning the state’s arrangement with a private nonprofit to relocate 30 migrant families in a town motel.

All Ayer Town Manager Robert Pontbriand could say with any confidence on that date was that he knew little or nothing about how this all transpired, emphasizing that it remains a “fluid process.”

It seems the town of Ayer was notified – told — on Sept. 8 that the state had partnered with Fitchburg-based Making Opportunity Count (MOC) to house migrant families in an Ayer motel, releasing a public notice days later.

The shelter stems from the emergency declaration made previously by the governor, in accordance with the state’s right-to-shelter law. Pontbriand said the number of families equals approximately 150 people, and in response to residents asking if the town is funding the shelter, the town manager said it’s not.

“We’re really trying to stress that it is on the state and federal level; we happen to be, for lack of a better term, the host community,” said Pontbriand. “The motel is a private entity that has contracted with the state, which is contracted with the nonprofit to administer.”

Given that Gov. Healey has already publicly vented her frustration about the lack of federal financial support in sheltering this ever-increasing migrant population, we’d advise the town manager to tone down expectations of any aid from Washington.

And while Ayer might not be directly supplying funding at this point – pending possible education costs – the town has taken preemptive steps it otherwise wouldn’t have taken in anticipation of these new arrivals.

Since the town was notified about the migrant shelter, town departments have been working to prepare.

“The town’s inspectional staff; building, fire, Board of Health have done their inspections. There were some issues that MOC and the state are addressing to ensure everybody’s safety,” Pontbriand said.

It’s now Ayer’s responsibility – through its police and fire departments – to maintain that additional public safety.

All 80 of the state’s designated shelter communities could probably share similar stories, chapters of a repeating theme that still remain to be written.

Editorial: Maternity closure a call for lawmakers to empower DPH

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UMass Memorial Health’s unwavering decision to close the Leominster Hospital maternity ward sends a clear signal to Beacon Hill that the Department of Public Health needs more leverage to bear in these situations.

And that can only happen through the Legislature, which must provide the DPH with the authority to make shuttering a vital medical service a difficult, pains-taking process.

If that were currently the case, UMass Memorial Health probably wouldn’t have released Monday’s statement that it’s going forward with the planned Sept. 23 closure.

As we previously predicted, as long as UMass Memorial Health followed the current protocol, the state was powerless to alter the closure’s course.

“We submitted our final correspondence to the Massachusetts Department of Public Health (DPH). Having fully complied with the regulatory process for the closure of essential services, it still is our intent to close the unit on Sept. 23, 2023,” words contained in a statement from Dr. Eric Dickson, CEO of UMass Memorial Health, and Dr. Tiffany Moore Simas, chair of Obstetrics and Gynecology, UMass Memorial Health.

The announcement came only hours after the Worcester legislative delegation joined with the legislative delegation in North Central Mass. to request a delay in the closure.

“While the maternal mortality rate is increasing, particularly for women of color, the planned closure of the Leominster birthing center would run counter to our efforts as a state to address health disparities,” said state Sen. Robyn Kennedy, a Worcester Democrat.

That, like previous petitions, fell on deaf ears.

UMass Memorial Health also said it has a specific plan to provide 24/7/365 curb-to-curb transportation for patients needing non-emergency maternity services at alternative locations.

The promise falls short of providing expectant mothers transportation in emergency situations, leaving that critical missing piece up to them.

Worcester area and Twin Cities legislative delegations must join with other like-minded lawmakers, individuals and organizations – especially the 23,000 strong Massachusetts Nursing Association – to press for a substantial rewrite of the regulations that govern medical-facility closures.

Bills currently introduced in the House and Senate would be a solid step in that direction: “An Act Relative to The Closing of Hospital Essential Services,” or S.736/H.1175, and “An Act Relative to Hospital Profit Transparency and Fairness,” or S.790/H.1179.

The proposed legislation would extend the notice period in advance of a closure or discontinuation in services and instruct the state attorney general to seek an injunction requiring a care corporation to maintain services during the notice period. It also would prohibit the “closure of beds, units, or facilities during any declared state of emergency pertaining to health care.”

The Leominster maternity closure represents just the latest removal of medical services in communities of vulnerable populations.

It’s time to stand up to the powerful medical-community lobby and put people first over profits.

Legislators: Board of Trustees should halt birth center closure

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LEOMINSTER — North Central Mass. Legislators are hoping to tap the power held by the Board of Trustees at UMass Memorial Medical Health, urging them to intervene in the maternity ward closure.

“We write today to ask the UMass Memorial Medical Health Board to intervene to stop the proposed closure of the birthing center at the HealthAlliance Clinton Leominster Campus,” the letter stated. “Our community’s expectant mothers, newborns, and families will suffer harm  because of the incompetence of the [UMass Memorial] leadership throughout this process.”

According to a letter signed by state Sen. John Cronin, and six other North Central Mass. state representatives, the delegation is asking the trustees to halt the proposed closure of Leominster Hospital’s labor and delivery unit.

The letter states that UMass Memorial’s closure plan submitted to the Department of Public Health (DPH) is inadequate and “a chilling, inexcusable failure.” The state Legislators also spoke about UMass Memorial’s inability to produce a plan to address non-emergency patient transportation, as well as several other areas that lack detail.

“To date, [UMass Memorial] has not conducted an analysis on the impact for the region’s ambulances  and has not completed a transportation plan to mitigate nonemergency patient  transportation,” the letter stated about some of the issues highlighted in a DPH letter a week ago.

In addition to state Sen. Cronin, D-Fitchburg, the letter is signed by Reps. Meghan Kilcoyne, D-Clinton, Michael Kushmerek, D-Fitchburg, Kimberly Ferguson, R – Holden, Jonathan Zlotnik, D – Gardner, Margaret Scarsdale, D-Pepperell, and Natalie Higgins, D-Leominster.

Referring to the state funding received by the UMass Memorial Health system in recent years, the delegation said the the health care company should be doing better to show the state specifically how they will provide access to maternity services after the closure Sept. 22.

“This delegation appropriated more than $100  million taxpayer dollars over the past three years to stabilize essential services in the [UMass Memorial] system,” the letter states. “Considering this, we find it unacceptable that Dr. Eric Dickson and the [UMass Memorial] leadership refuse to work with us in any capacity to maintain this essential service in two Gateway Cities and the North Central region. That is a leadership failure. How can  government justify subsidizing a healthcare system whose leaders refuse to work with stakeholders to maintain essential services?”

While staffing issues do exist in health care, the Legislators said that UMass Memorial was not being entirely honest when using that as a reason to close the maternity ward.

“This legislative delegation understands that workforce challenges throughout the  health care sector are real. However, [UMass Memorial’s] efforts to hire for staff positions at the birthing center were neither exhausted nor made in good faith,” the letter states.

DPH: Maternity ward should not close until plan complete

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LEOMINSTER — Delivering the anticipated response to UMass Memorial Health’s maternity ward closure plan, the state Department of Health said they found it to be inadequate, addressing similar issues raised by the city, the medical community and concerned organizations.

Lacking sufficient detail in regard to their transportation and community engagement plan especially, the DPH said until UMass Memorial Health has a “fully developed and implemented access plan” – and the state deems it as such – that it should not expect to close the maternity on the planned Sept. 23 date.

“[UMass Memorial Health] should not contemplate closure of the [maternity ward] until the [DPH] deems the essential service process complete,” said Stephen Davis, the DPH’s division director, nearing the close of the letter. “Based upon the information provided to date, the [DPH] does not believe the hospital’s closure plan is adequate, particularly as related to transportation and community engagement.”

The state is giving UMass Memorial Health 10 days to submit a new plan that addresses all of the comments raised in the DPH response, dated Sept. 1. The original closure plan was submitted to the DPH on Aug. 22.

“We thank the Department of Public Health for taking the full development of a plan seriously and
for looking out for the most vulnerable in our community,” said Mayor Dean Mazzarella in an official city letter Friday afternoon.

Earlier this week, the city of Leominster, through law firm Greenberg Traurig, urged the state agency to use its licensing and regulatory power to delay or restrict the closing of the maternity ward. They said the state should “demand compliance from a hospital the department licenses.”

“With the DPH response today, the process goes on to ensure that the health and well being of expectant mothers and their newborns will be protected no matter what the final outcome of the process is,” said Mazzarella.

In area of the letter focused on alternative solutions, the DPH letter states that they would like to see more data on why the maternity ward needed to be closed in the first place and what exactly is needed for staffing in order to keep it open.

“The [DPH] is unclear how many of these positions would be required to continue operating the [maternity ward] based on current volume statistics,” Davis said in the letter.

In the area of the letter on transportation needs, Davis said that, using the original closure plan, the state doesn’t see how they could close the maternity ward in time.

“From the hospital’s Aug. 22, 2023 letter, it does not appear the complete [transportation] plan would be available for [DPH] review prior to the indicated closure date of Sept. 23, 2023,” Davis said the letter.

The state gave several areas of comment to UMass Memorial Health based on their first closure plan. The areas include assessment of transportation needs, location and service capacity of alternative delivery sites, protocol that describes how patients will access the services at alternative delivery sites, ambulance service availability, transfer during labor, emergency department volume, engagement with community groups, staffing and alternative solutions.

City urges legal action on UMass Memorial plan

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LEOMINSTER — This week, the city’s opposition to the maternity ward closure took a more legal tone.

Pairing it with an official letter from Mayor Dean Mazzarella, the city retained a law firm to send an official letter to the state commenting on the all of the specific regulatory power that can be used to prevent or stay the closure before the planned date of Sept. 23.

Following the state’s official findings that deemed the birthing center an “essential service,” UMass Memorial HealthAlliance is still closing the ward on Sept. 23 but will enact a plan they submitted to the state on Aug. 22 to ensure continuing service to the area.

The city, through their legal representation from Greenberg Traurig, said that the state Department of Public Health (DPH) has the “power to stand behind its own regulations and demand compliance from a hospital the department licenses.”

The letter was addressed specifically to Stephen Davis, Director of the Division of Health Care Facility Licensure and Certification at the state DPH.

The letter provides several legal options, with accompanying Massachusetts legal codes, that the DPH should employ in order to either delay the closing or restrict the closing until a “compliant” plan is submitted.

Specifically, the city wants the state to require that UMass Memorial Health withdraw its notice to close and resubmit it – thereby restarting the 90-day period before they can close the maternity ward – or require them to delay the closing of the ward until a time when the hospital submits a “compliant” plan to the state and affords the state an “opportunity to offer comments and improvements.”

It also states that the DPH can revoke or refuse to renew Leominster Hospital’s license to operate, saying they are showing that they lack “responsibility and suitability to operate a hospital,” the legal letter said, quoting regulatory language.

“In short, the city believes that the department has the statutory and regulatory power to suspend or revoke the hospital’s license,” the letter continued.

The legal letter concluded that the state should be able to rely on its regulations to ensure compliance and that, if UMass Memorial Health is allowed to close the birthing center in Leominster, then more hospitals will “follow suit.”

“It is not an exaggeration to say that if the department cannot stand behind its own regulations on hospital closures, then the department can expect other hospitals to follow suit and similarly ignore the department’s requirements,” read the legal letter to Davis. “The citizens of the Commonwealth would be swept along in a race to the bottom, subject to the whims of unelected boards of purported charities, who can make any decisions they want and take any actions they want without the slightest oversight from state government.”

The letter closes by adding the organizations that have joined in support of those opposing the closure of the maternity ward.

“The effort to stop the closing of the maternity ward has gained the support of the Massachusetts Nurses Association, the March of Dimes, the Worcester NAACP, and local, state and federal elected officials. Thousands have signed a petition to stop the closure. The city of Leominster has retained the firm of Greenberg Traurig in this matter,” the legal letter closing out.

A letter from Leominster Mayor Dean Mazzarella also accompanies the letter from Greenberg Traurig.

Referring to the 17-page plan that had been required by UMass Memorial Health and submitted recently to the DPH, Mazzarella said that the submission wasn’t really a plan but just a promise of a plan.

“The regulations don’t call for a plan to submit a plan. The regulations call for a comprehensive plan on how expectant mothers are going to access services from prenatal through postpartum care in our region. The hospital failed miserably at the task.” said Mazzarella.