DPH Issues Finding Declaring Child Psychiatric Unit at Cambridge Health Alliance an Essential Service

CAMBRIDGE, Mass., May 28, 2013 /PRNewswire-USNewswire/ -- The Department of Public Health has just issued its findings regarding the proposed plan by Cambridge Health Alliance to close its nationally recognized child psychiatric unit for the care of young children with acute mental illness (The DPH letter text appears at the end of this release.) The DPH finds that this unit provides an essential service that is "necessary for preserving access and health status in the Cambridge Hospital's service area, which for the children and adolescents it serves extends throughout Eastern Massachusetts."

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The DPH based its finding on the testimony of dozens of mental health advocates, physicians, nurses and parents of former patients who spoke in passionate opposition to the closing at the hearing on May 8, where the only people speaking in favor of the unit's closing were two officials from Cambridge Health Alliance. The DPH letter cites a number of serious issues related to the proposed closure plan, including that Cambridge Health Alliance:

• had failed to consult with members and leaders of the community that it serves to assess the impact of reducing beds on patients and families in need, and possible alternatives to reduction of necessary services;
• would, under its plan, reduce the number of beds available for younger children and thus increase time spent waiting in area emergency departments throughout the Commonwealth;
• would through the reduction of its beds, and the provision of child and adolescent psychiatric services on one unit rather than its two distinct child and adolescent psychiatric units, place younger patients at risk; and,
• would, through the reduction of its beds, force families to find services outside of the hospital's service area, thus reducing family involvement and support for children in need.

The DPH letter calls upon Cambridge Health Alliance to provide a detailed plan as to how they will address these concerns and maintain access to services for these children, which will then be reviewed by DPH and the Department of Mental Health.

In the wake of the announcement by Cambridge Health Alliance (CHA) of their plan to close 11 child psychiatric beds, specifically beds dedicated to the care of children age 3 – 9, the Massachusetts Nurses Association/National Nurses United had announced its strong opposition to this plan as it represents an abandonment of a population of children who need the care provided by this award-winning program.

"We greatly appreciate DPH's findings that this is an essential service, and that the loss of this service will deprive children throughout the region the care they deserve," said Betty Kaloustian, RN, chair of the MNA local bargaining unit at Cambridge Hospital, which represents the nurses who work on the unit.  "Our hope now is the CHA changes its plans and the state officials do whatever is necessary to ensure that this service remains open for these vulnerable children." 

Currently, Cambridge Health Alliance operates two separate units for the care of children and adolescents with acute mental illness:  a 13-bed Child Assessment Unit (CAU) for children ages 3 -12; and a separate 14-bed Adolescent Assessment Unit for children 12 -19. The CHA plan is to consolidate these units, reducing the 27 beds currently available to children to just 16 beds – a 40 percent cut to their bed capacity for children with mental illness. The new combined unit will serve children from 9 – 18, which will mean younger children aged 3 – 8 will no longer have access to care at the facility.  In fact, 45 percent of the children seen on the CAU are between the ages of 4 – 8.

The decision comes at a time when there is a critical shortage of all types of mental health services and beds in the commonwealth, particularly beds for children and adolescents.  In fact, the legislature has formed a special Mental Health Commission this year, which was created specifically to respond to this growing crisis. As a result of this crisis, more than 40,000 patients a year, many of them children and adolescents, are being boarded in our hospitals emergency departments waiting from several hours to several days for treatment beds, and the waits for children and adolescents are even longer.

Text of Department of Public Health Letter

On May 8, 2013, the Department of Public Health ("Department") held a public hearing in response to the notification received from you on behalf of Cambridge Health Alliance's Cambridge Hospital ("Cambridge Hospital"), regarding Cambridge Hospital's intent to discontinue in substantial part the provision of inpatient child and adolescent psychiatric services effective July 8, 2013.  As a result of its review, including testimony presented at the hearing, the Department has made a finding that the inpatient child and adolescent psychiatric services Cambridge hospital has proposed to substantially reduce are necessary for preserving access and health status in the Cambridge Hospital's service area, which for the children and adolescents it serves extends throughout eastern Massachusetts.

At the hearing held by the Department on May 8, 2013, numerous participants, including providers, community members, parents of patients and former patients, and elected officials, expressed concern that the reduction of these services will negatively impact the care provided to patients.  Of concern to a number of those who testified was that Cambridge health Alliance:

• had failed to consult with members and leaders of the community that it serves to assess the impact of reducing beds on patients and families in need, and possible alternatives to reduction of necessary services;
• would, under its plan, reduce the number of beds available for younger children and thus increase time spent waiting in area emergency departments throughout the Commonwealth;
• would through the reduction of its beds, and the provision of child and adolescent psychiatric services on one unit rather than its two distinct child and adolescent psychiatric units, place younger patients at risk; and,
• would, through the reduction of its beds, force families to find services outside of the hospital's service area, thus reducing family involvement and support for children in need.
  

Accordingly, under 105 CMR 130.122(G), Cambridge hospital is required to prepare a plan that details how access to these services will be maintained.  The plan must be submitted to the Department within 15 calendar days of this letter and include the following elements:

(1)   Information on utilization of the service prior to proposed reduction;

(2)   Information on the location and service capacity of alternative delivery sites;

(3)   Travel times to alternative service delivery sites;

(4)   An assessment of transportation needs post reduction of services, and a plan for meeting those needs;

(5)   A protocol that details mechanisms to maintain continuity of care for current patients of the reduced service; and,

(6)   A protocol that describes how patients in Cambridge Hospital's service area will access the services at alternative delivery sites.

In addition, please include in your plan a proposal for delivery of alternative services that might reduce the demand for inpatient psychiatric services and thereby mitigate the impact of the reduction in access proposed by Cambridge hospital.

Please ensure that your response to this letter addresses the concerns listed above, and is specific as to what steps Cambridge Hospital will take to mitigate the impact of the reduction of beds and services.

Under the provisions of 105 CMR 130.122(H), the plan Cambridge hospital submits to the Department will be reviewed in consultation with the Department of Mental health to determine if the plan assures access to the essential services in question following Cambridge hospital's substantial reduction of these services.

SOURCE Massachusetts Nurses Association/National Nurses United