MNA: DPH Issues Ruling Declaring Maternity Unit at Steward Morton Hospital an Essential Service That Must Be Maintained

TAUNTON, Mass., March 1, 2018 /PRNewswire-USNewswire/ -- The Department of Public Health has just issued its ruling regarding the proposed plan by Steward Health Care to close its Obstetrics and Neonatal Care Program at Morton Hospital, a popular service that has existed for more than 100 years for families in Taunton and surrounding communities. (The DPH letter text appears at the end of this release).

"As a result of its review…the Department has made a finding that the Obstetrics and Neonatal Care Program provided by the hospital is in fact necessary for preserving access and health status within the Hospital's service area,"  according to Stephen Davis, the DPH official who wrote the letter to Steward Health Care's attorney. 

The DPH based its finding on its review of the issue and the testimony at a public hearing held on Feb 16, where hundreds of community members packed a hotel ballroom to voice their opposition to the closure.  At the hearing dozens of community members, parents of patients, former patients, nurses, physicians and elected officials opposed the closing and expressed concern that elimination of these services will negatively impact the care provided to patients. The DPH letter cites a number of serious issues related to the proposed closure plan, including:

• The hospital "did not make a good faith effort to find and recruit pediatric hospitalists."  The hospital claimed their failure to negotiate a new contract with their previous provider of these services, and their failure to find an alternative provider was the primary rationale for their decision to close the service.  At the hearing, the DPH heard testimony from physicians and others contradicting this claim, citing a number of alternative provider options that Steward refused to pursue. 
  
  
• The hospital "has failed to communicate effectively with community groups and health care coalitions regarding its vision for the Hospital and post closure of the OB program as it relates to maintaining other essential services at the Hospital."  At the hearing, testimony was provided by all sectors of the community, including members of the City Council, members of the interfaith community, the school committee and others about Steward's failure to address their concerns about the impact this decision will have on the community.
  
  
• The hospital must provide information as to "what the Hospital has done to assess the special needs of opioid dependent newborns and their mothers; what needs have been identified; and how the Hospital and the alternate delivery sites identified by the hospital will address those needs and ensure access by parents from the from the Taunton area." Those testifying at the hearing pointed to the fact that Taunton is one the communities hardest hit by the opioid epidemic, and has the highest rate of children born to addicted parents.  In fact, the Taunton Opioid and Substance Abuse Task Force cast a unanimous vote to oppose the closure of the unit.   
  
  
• The hospital must provide DPH "with detailed information as to what options exist to meet the transportation needs of patients in the community, particularly in regard to low income families and public transportation, what needs have been identified, what resources will exist after the proposed closure to address the needs identified, and what resource will exist after the proposed closure."  Many at the hearing raised concerns about the dangers for mothers and newborns forced to travel outside the community for care, as well as the hardship this presents to poorer families who lack their own means of transportation. 

"We greatly appreciate DPH's findings that this is an essential service, and that the loss of this service will deprive families throughout the region access to essential care they need," said Jacqui Fitts, RN, a nurse in the maternity unit and chair of the MNA local bargaining unit at Steward Morton Hospital, which represents the nurses who work on the unit.  "Our hope now is that the unit remains open to continue to provide excellent care for our families and the state officials do whatever is necessary to ensure that this service remains open for these vulnerable patients."

As part of the DPH ruling, the hospital has 15 days to provide DPH with its plan to maintain access to this vitally important service, and if it proceeds with a closure, how alternative sites can meet the needs of the community.  Given the testimony at the hearing and the DPH findings, there is no viable alternative to keeping the service open that will not deprive this community of the maternity services it needs. 

The next question is whether Steward will honor the DPH's ruling that this is an essential service and honor the commitment it made to the state and the community not to close any services when it sought permission to buy the hospital.  Two years ago Steward closed the pediatric unit at Morton Hospital over the objections of the DPH and in violation of its previous commitment.   It also has failed to honor any of the commitments it made to DPH to maintain access to pediatric care following that closing.  Steward also closed Quincy Medical Center in direct violation of its written commitments to the state, which were the basis upon which the state had granted permission for Stewart to take over the formerly publically owned non-profit hospital and convert it to for profit private ownership.

The MNA, which has filed legislation to provide DPH with greater authority to prevent the ultimate loss of this service, is hoping the legislature will act soon to provide DPH with the ability to protect this and other essential services. State Senator Marc Pacheco, (D Taunton), along with other area legislators are aggressively working to strengthen the law governing the closing of essential services. 

"It makes little sense if the Department of Public Health, the state agency tasked with protecting access to needed care for communities, can make a decision that a service is needed to protect that community; yet lacks the ability to ensure hospitals they license maintain that service," Fitts said.  "Corporations like Steward, who profit from their license from the state to provide needed public health services must be held accountable for delivering those services, particularly when the lives of mothers and newborns are at stake."

Text of Letter from DPH

On February 16, 2018, the Department of Public Health ("Department held a public hearing in response to the notification received from you on behalf of Morton Hospital ("Hospital") regarding the proposed closure of its Obstetrics and Neonatal Care Program ("OB Program") effective April 19, 2018. As a result of its review, including testimony presented at the hearing, the Department has made a finding that the Obstetrics and Neonatal Care Program provided by the Hospital is in fact necessary for preserving access and health status within the Hospital's service area.

Accordingly, pursuant to 105 CMR 130.122(F), the Hospital is required to prepare a plan that details how access to the services provided by the OB Program at the Hospital will be maintained for the residents of the service area.  The plan must be submitted to the Department within 15 calendar days of receipt of this letter.  The Hospital's plan must include the elements specified in 105 CMR 130.122(F) as listed below:

1. Information on utilization of the service prior to proposed closure;
   
   
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 closure and a plan for meeting those needs;
   
   
5. A protocol that details mechanisms to maintain continuity of care for current patients of the discontinued service;
   
   
6. A protocol that describes how patients in the Hospital's service area will obtain the services at alternative delivery sites.

Throughout the essential service closure process the Department has heard from concerned stakeholders including Hospital staff, community leaders and area residents that the Hospital did not make a good faith effort to find and recruit pediatric hospitalists. Based on the testimony submitted by Hospital leadership, the Hospitals decision to close the OB Program was driven by Massachusetts General Physician Organization's decision to end its contract to provide pediatric hospitalists to cover the OB Program, and the subsequent unsuccessful recruitment of replacement pediatric hospitalists.  Hospital leadership has been clear it has been their operational decision to operate the OB program at standards above those outlined in 105 CMR 130.630 for Level 1 Community based Maternity and Newborn Services and that they will not operate the OB program without long-term pediatric hospitalist coverage.

In light of this and other concerns voiced to the Department by members of the community at the public hearing held on February 16, 2018, and testimony submitted to the Department in writing, in addition to the above your plan must address the following issues:

1. Engagement with Community Groups and Health Care Coalitions:  Based on testimony submitted to the Department and presented at the February 16, 2018 hearing, community leaders and area residents are concerned that the Hospital has failed to communicate effectively with community groups and health care coalitions regarding its vision for the Hospital post closure of the OB Program as it relates to maintaining other essential services at the Hospital.  Your plan must include a detailed plan for ongoing engagement with community groups and health care coalitions related to the Hospital's plan to maintain other essential services.
   
   
2. Training and Competency of staff:  Based on testimony submitted to the Department and presented at the February 16, 2018 hearing, your plan must include information as to how the Hospital will evaluate competency of staff expected to remain with the Hospital after the proposed closure of the OB Program; the ability of remaining staff to meet the needs of patients who present at the Hospital in labor or in need of care to address pregnancy or post-partum related issues; and what will be done to ensure trained and competent staff will be available at all times to respond to the needs of such patients in the future, particularly but not limited to the Hospital's emergency department.
   
   
3. Special Needs of Opioid-Dependent Newborns:  Based on testimony submitted to the Department and presented at the February 16, 2018 hearing, your plan must include information as to what the Hospital has done to assess the special needs of opioid-dependent newborns and their mothers; what needs have been identified; and how the Hospital and the alternate delivery sites identified by the Hospital will address those needs and ensure access by parents from the Taunton area.
   
   
4. Cultural and Linguistic Needs of Populations Served:  Due to the diverse cultural and linguistic needs of the populations served by the Hospital, your plan must include information as to what the Hospital has done to assess the cultural and linguistic needs of the populations it currently serves; what needs have been identified and to what extent the alternate delivery sites, identified as likely to provide care after the proposed closure, will be able to address those needs.
   
   
5. Transportation Needs of Populations Served:  Based on testimony submitted to the Department and presented at the February 16, 2018 hearing, your plan must include detailed information as to what options exist to meet the transportation needs of patients in the community, particularly in regard to low income families and public transportation; what needs have been identified; what resources will exist after the proposed closure to address the needs identified; and how that information will be made available to patients.
   
   
6. Impact on Staff:  Based on testimony submitted to the Department and presented at the February 16, 2018 hearing, your plan must include information on the number of staff impacted by the proposed closure; and the Hospital's plans to mitigate that impact on these current employees.
   
   
7. Associated Community Services:  Based on testimony submitted to the Department and presented at the February 16, 2018 hearing, your plan must include information as to how the need for associated post-partum services such as lactation counseling will be assessed, offered, and available to the community either at the Hospital, or if not offered at the hospital, how community residents will be able to access these services

Under the provisions of 105 CMR 130.122 (G), the plan the Hospital submits to the Department will be reviewed to determine if it appropriately assures access to the essential service in question following the closure of the OB Program at the Hospital.

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