Editorial: Give DPH some sway over cuts to medical services

Dec 12, 2023

Following a disturbing hospital-industry pattern, the UMass Memorial Health system recently announced that it plans to close the maternity ward at Leominster Hospital in the fall, drawing condemnation from the public and area legislators.

UMass Memorial Health Alliance-Clinton Hospital President Steve Roach blamed "industry-wide workforce shortages" and "a declining birth rate" in the region for shuttering the popular birthing center.

Lawmakers released a joint statement calling the closure an "unjustified decision," which is "completely unacceptable and cannot stand." The statement referenced high maternal mortality and that losing the unit "jeopardizes the health and safety of mothers and their newborns in our community."

The legislators said the impending closure shows an "unacceptable pattern" of "gutting healthcare services in North Central — and two Gateway Cities — of the critical healthcare services we need most."

"Enough is enough," said state Sen. John Cronin and state Reps. Natalie Higgins, Meg Kilcoyne, Mike Kushmerek, Kimberly Ferguson, Margaret Scarsdale and Jonathan Zlotnik.

If the closure decision stands, women in labor will be compelled to travel much farther to give birth, with some inevitably forced to deliver in the Leominster, Fitchburg, or Clinton emergency rooms.

Anxiety mixed with anger during a demonstration Tuesday night in Leominster denouncing news of the closure.

Many on hand said the decision would put the economically marginal in a very difficult position — forcing them to pay costs for travel in a time of crisis.

While some people blamed a faceless corporate entity for the decision to shutter the hospital maternity ward, Cronin, a Fitchburg Democrat who attended the protest along with other legislators, pinned the blame on one person, Dr. Eric Dickson, the CEO of UMass Memorial Health.

Added Cronin, "This was a complete failure in leadership to have made this decision without consulting the North Central delegation."

In regards to fighting the proposed closure, Cronin said, "We are asking Dr. Eric Dickson to withdraw the notice of closure and come to the table with us and tell what UMass needs to keep it open in the community. It's not asking for a lot."

The decision has also been slammed by the 23,000-member Massachusetts Nurses Association. In a statement, Miko Nakagawa, a nurse at Leominster Hospital and co-chair of the nurses local bargaining unit with the MNA, said the decision shows a "blatant disregard of our patients and our region."

UMass Memorial Health has notified the state Department of Public Health that it plans to close the labor and delivery unit on Sept. 22, but state regulators must first review the plan.

However, the present state of Massachusetts laws governing situations like these doesn't give DPH the authority to override a closure decision.

The Mass.gov section covering the steps that must be taken in medical facility closures clearly states that the "DPH cannot legally require a hospital to keep a service open."

As previously mentioned, the Leominster case follows a familiar, decades-plus pattern of reducing medical services for our least economically mobile populations.

According to a March 2022 Commonwealth Magazine report, a review of public records indicated that since 2009, more than 30 hospitals or units have closed in Massachusetts.

In most cases, they did so even though the Department of Public Health examined the closures’ impact and deemed the services "necessary for preserving access and health status in a particular service area."

The Commonwealth report provided examples of service reductions primarily hitting low-income populations.

• 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.

• When Trinity Health in February 2020 announced the closure of 74 child and adult psychiatric beds at Providence Behavioral Health Hospital in Holyoke, executives claimed a lack of psychiatrists. The services, which had been open to low-income patients, included the only child psychiatric beds from New York to Worcester.

• When Steward Health Care eliminated maternity services at Taunton's Morton Hospital in 2018, it had already laid the groundwork by undercounting the pediatric census and closing that service five years earlier.

As the article suggests, these closures aren't isolated, unrelated events.

As in the Leominster and Morton hospitals’ cases, closures often build on previous related closures, creating a compounding reduction in access. Hospitals eliminate one service, claim reduced activity, and close more. By the time the public is notified, the die's been cast.

Given the current legal landscape, even if our lawmakers receive an audience with that UMass Memorial Health CEO, their persuasive efforts will likely fall on deaf ears.

To find a more permanent solution, they should enlist the support of like-minded lawmakers, individuals and organizations, including the MNA, which previously has lobbied Beacon Hill to insert more patient-friendly language into a substantial rewrite of the legislation that governs these situations.

Only then will we have a viable antidote to pricing out medical services for the most vulnerable among us.

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