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UMass HealthAlliance Clinton Hospital-Leominster campus

Gov. Healey orders ‘immediate’ reviews as birthing center closes

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LEOMINSTER — With the closure of the maternity ward now passing, Gov. Maura Healey has ordered two specific reviews to be completed by November that will look at access to maternity care in the Northern Worcester County area as well as a review of “prenatal, postpartum and birthing services across the state.”

“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. “That’s why I’m ordering a review of maternal health services across the state, and a review of essential health services in the Northern Worcester County area following the closure of the UMass Memorial Leominster maternity unit.”

The order comes after UMass Memorial Health Care confirmed to the Department of Public Health (DPH) that it could not delay the closure of the obstetrics inpatient service at its Leominster campus due to unsafe staffing shortages, despite state efforts to delay the closure, according to Gov. Healey.

The Massachusetts Nurses Association, the city of Leominster, the North Central Mass. and Worcester legislative delegations, and many other organizations and coalitions have continued to request that the state intervene and stop the closing of the maternity ward. On Thursday, Sept. 21, many held a vigil to try to provide a show of support and asked that the governor assist.

One state official commented on the upcoming reviews and the difficulties ahead.

“We know that there is much work to be done to address racial and regional inequities in maternity care and health care across the state. We are committed to reviewing all of the factors impacting health equity, including maternal care, to improve health outcomes,” said Health and Human Services Secretary Kate Walsh, who is among the three state department heads running the reviews. “This review process will help guide policy decisions as we work to improve the health equity and outcomes for all people across the state.”

In regard to both the statewide and the Northern Worcester County review, the governor said both must be completed by Nov. 15, 2023. In addition to Walsh, state Undersecretary for Health Dr. Kiame Mahaniah and DPH Commissioner Robbie Goldstein will be handling the reviews.

UMass Memorial Health released a statement commenting on the difficulty of the decision but the necessity to carry it out.

“I know this has been a very difficult journey for our caregivers — both at HA-C and at the Medical Center — as well as for our patients and the communities we have pledged to serve. Closing a service that has been a part of the fabric of the community isn’t easy — in fact, it’s heartbreaking,” said Dr. Eric Dickson, MD, President and CEO of UMass Memorial Health, in a statement. “Keeping a birthing center open without adequate obstetrical coverage is not in the best interest of our patients and is something we are not willing to do, regardless of the political pressure and damaging headlines. Sometimes the right thing to do — and I know this is the right decision for our patients — is the harder thing to do.”

The Massachusetts Nurses Association made an official response to the news of the continued closure.

“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,” said Katie Murphy. “We are deeply disappointed that the governor and her administration has failed to intervene to protect the most vulnerable mothers and newborns throughout all of Worcester County.”

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.

Plan offered to mitigate Leominster maternity ward closure

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LEOMINSTER — UMass Memorial Medical Center officials intend to work with transit officials to help redirect patients to other area hospitals, especially UMass Memorial Medical Center’s campus in Worcester, if they follow through with a Leominster maternity ward’s closure.

The health care system on Tuesday submitted a 17-page letter with state regulators outlining steps it would take to mitigate the impact of shuttering the birthing center, a proposal that has drawn intense blowback from elected officials and organized labor groups.

Rebecca Rodman, senior counsel at Husch Blackwell LLP, wrote on UMass Memorial’s behalf that there are four other hospitals in the area – the center’s primary Worcester campus, Saint Vincent Hospital in Worcester, Heywood Hospital in Gardner, and Emerson Hospital in Concord — that also offer inpatient maternity services and have “sufficient capacity” to absorb patients that today use the HealthAlliance-Clinton facility in Leominster.

To help with transportation needs, operators of the facility plan to contract with the Montachusett Regional Transit Authority to provide non-emergency medical transport to “birthing people identified with transportation barriers” and family transportation to the Worcester campus. That option would not cover emergency transportation for people giving birth nor for medical prenatal and postpartum appointments with community OB/GYN providers.

The Department of Public Health previously deemed the Leominster facility an “essential service,” a decision that required UMass Memorial to craft the plan filed Tuesday, according to the Worcester Business Journal.

Hospital officials told DPH in their latest correspondence that “financial support alone is not enough” to stave off closure of the site, pointing to persistent staffing challenges as a key factor.

“To maintain the current service — the Hospital would need to recruit numerous additional nurses, surgical technicians, OB/GYN physicians, and anesthesiologists,” Rodman wrote. “However, there are not enough births locally to support an increase in local OB/GYNs. New OB/GYNs are primarily taking jobs in a setting like the Medical Center in Worcester, where they can be active enough that each practitioner can assist with between 170-220 births per year to maintain skills and thus quality of care delivered.”

DPH has 10 days to review the plan, which prompted criticism from community groups that have opposed the proposed closure, and offer additional feedback.