MNA: UMass Memorial Response to DPH Essential Service Finding Shows More of the Same - A Callous and Disingenuous Plan to Deprive Northern Worcester County Residents of Local Access to Safe Maternity Care

17-page response fails to address or adequately respond to any of the concerns cited By DPH based on testimony provided by residents, public officials, nurses, physicians and advocates at public hearing on August 9 regarding how UMass can ensure access to care, provide health care equity for the most vulnerable residents impacted, as well as for the corporation to provide valid evidence to justify what the community contends are false claims UMass made to justify the closing

UMass's plan for vulnerable mothers, including those who are poor and of color and most at risk, is to force them to take nonexistent public transportation, call 911 for an ambulance and if there are negative impacts for these residents, the hospital "will identify possible disproportionate effects of the closure of the services on marginalized communities" AFTER THE CLOSURE.

In light of UMass Memorial's plan, community advocates and area legislators will now look to the Healey administration to do whatever is necessary to maintain this vital service to protect North County residents

LEOMINSTER, Mass., Aug. 23, 2023 /PRNewswire/ -- Disingenuous, callous and preposterous are some of the words being voiced by community advocates, impacted residents, policy makers and members of the Massachusetts Nurses Association in reaction to the long-awaited response from UMass Memorial Health to the Department of Public Health's finding that the Birthing Center at Leominster Hospital is an essential service "necessary for preserving access and health status within the hospital's service area."

"We are shocked at the arrogance and disdain for our community, particularly the most vulnerable in our community displayed by UMass Memorial in this response to DPH," said Eladia Romero, a board member with the Spanish American Center, who serves as a co-chair of Community United to Save OUR Birthing Center, a coalition of residents, local officials, caregivers and advocates from throughout Worcester County.  "Their so called "plan" is no plan! In fact, their only plan is force mothers, particularly poor and those of color who are placed most at risk by this closure to rely on nonexistent public transportation or to call 911 for an ambulance so that they can deliver enroute on the side of the road, or in an overcrowded hospital emergency room -- or to die trying.  It is heartless and it is absurd."

Romero points to the lack of detail and truthfulness about access to transportation as a major flaw in UMass's thinking.  "They actually state that travel during peak and non-peak hours to UMass Memorial in Worcester and Henry Heywood Hospital in Gardner are the same as they are from Leominster and Fitchburg.  We know that's not true and if they are willing to lie to DPH and the community about it then they know it's a major issue that will impact our community members." 

Since the closing was announced, nurses working in the unit have reported numerous instances where expectant mothers presented to the hospital just minutes from delivery and had the nurses and staff at the Center not been there, and those patients were forced into an ambulance, there is no way they could have made it to an alternative location.  In fact, local news reported on a case where a mother had her uterus rupture while at the hospital and were it not for the expert care provided by the Birthing Center staff, she and her baby might have died. 

The issue of health equity and access to care for poor and BIPOC residents, who are placed most at risk by the closure, was a major focus of the public hearing and DPH's findings, where they asked the hospital to detail how the system would protect these residents.  UMass's response?  To hire a firm to look into the issue, and after the closure, "to identify disproportionate effects of the closure of the services on marginalized communities."

"So instead of keeping this service to protect these mothers from harm, they are claiming they will take a look after the fact to see all the harm and suffering they caused by closing it. It's disgusting," Romero added.

Another bone of contention for those opposing the closing is the claim that these mothers can easily gain access to care at other hospitals in the region, particularly UMass Memorial in Worcester.  But nurses who work at UMass Memorial in Worcester decry that claim.

"There is no way we can take care of the patients from Leominster and Fitchburg," said Barbara Labuff, RN, a maternity nurse at UMass Memorial in response to the UMass plan.  "We don't have the infrastructure, resources and staff to handle those patients as we are struggling to provide adequate care to those patients we have now.  Closing this service will not only harm the patients of North County, but it will degrade our ability to care for patients here in Worcester. This is a bad and dangerous decision."

Romero and other advocates also take issue with UMass Memorial Health's failure to provide any plan to handle emergencies that present to the hospital.

The nurses at Leominster Hospital are also very concerned about what will happen to laboring patients who will continue to present to the hospital's busy emergency room.  The nurses are even more concerned after meeting with hospital management on Tuesday to discuss those concerns.  Management informed the nurses that there will be no obstetrician on staff at the hospital following closure or maternity trained staff available on site and no plan to handle emergency cesarean sections, that are often required now.  Emergency department staff are not trained to provide that level of care and there is not an adequate plan or realistic ability for them to do so. 

The hospital's offer for pre and postnatal care is entirely based on the current offerings in town with no such care provided at the hospital.  After a similar closing at Morton Hospital in Taunton that community saw obstetrical practices go from four to one in the year following the closure and appointments for women in that community are nearly impossible to get. The hospital informed the nurses that they also plan to end any gynecological services, otherwise known as healthcare for women, as they will have no gynecological medical staff and any emergency procedures done for the patients will have them recover on a medical surgical floor, while the hospital's plan is to transport them to another facility as soon as they are stable. 

Advocates for the Birthing Center have made a strong case that the Birthing Center must be maintained, including labor, delivery, postpartum and nursery care for families living in communities of Northern Worcester County. The UMass response failed to truthfully address any of the evidence provided by advocates that countered blatant misinformation provided by UMass to justify the closing, including:

• Shortage of staff to operate the facility – testimony was provided showing that nurses have documentation of dozens of qualified nurses who sought positions on the unit who were turned away without being interviewed or hired.  Current nurses on staff, through their union, also offered numerous strategies for the cross training of staff to cover holes in the schedule, strategies that the Health Alliance administrators refused to pursue.  And finally, as soon as the closure was announced, UMass found the resources to hire 12 temporary staff to operate the unit through the closing.  In their response letter, UMass patently lied to DPH claiming that they in fact took many of these very steps, when they did not do so.
  
  
• Lack of Obstetrical Coverage – the legislative delegation and the nurses on the unit offered testimony regarding information from local providers who have been willing and continue to offer a plan to provide obstetrical coverage to maintain the unit. Again, the hospital has refused those overtures and instead seeks to shutter the service. Once again, UMass's response to DPH failed to report this information, continuing their false narrative.
  
  
• Declining Birth Rates – The Hospital has also pivoted to declining birth rates as a rationale but the data the legislative delegation has provided confirmed the region's population is growing and young families are growing. Our birth rate competes and exceeds the state's birth rate. Beyond that, challenging the notion that the "market has spoken" and has chosen other hospitals, is disproven by UMass Health Alliance's own data. Leominster Hospital, until this year when the Hospital Administration began implementing the closure, was the largest provider of birthing services for North Central Mass families. And we would argue, any plan that would place 500 – 700 women a year in such peril is on its face, immoral and in direct violation of our oath to do no harm. And Romero points out that the statistics provided by the hospital show births at the hospital to date are ahead of what they were the previous year.

DPH Report on Increase in Maternal Morbidity Underscores Need for Administration to Save Service

The Coalition's position on the closing was further buoyed by the release last week of an alarming report by the Massachusetts Department of Public Health showing a dramatic increase in the rate of serious complications and maternal child deaths from labor and delivery in our state over the last 10 years. DPH researchers found that rates of severe maternal morbidity climbed from 52.3 per 10,000 deliveries in 2011 to 100.4 per 10,000 deliveries in 2020, an average increase of 8.9 percent each year. It also found that women of color continue to face higher rates of complications, with black women consistently experiencing the highest rates. Compared to white non-Hispanic women, black non-Hispanic women experienced 2.3 times higher rates of complications on average during the study period, and Hispanic and Asian/Pacific Islander women experienced rates 1.2 times higher. This is the very population placed most at risk by the proposed closure of the Birthing Center at Leominster Hospital, the only facility serving the two Gateway Cities of Leominster and Fitchburg.

A quote by Governor Maura Healey in the press release about the DPH report clearly articulates the same concerns about the need for access to services like the Birthing Center that will be made at the hearing on Monday, when she stated, "This report shows that there is much more work that we need to do to address racial and gender inequities in health care. It is essential that everyone has access to comprehensive, high-quality and inclusive maternal health care.  We can and must do better for mothers, for kids and for families – and our administration is committed to doing just that."

With the DPH findings in hand and in light the hospital's plan, the Community United to Save Our Birthing Center Coalition and others who oppose the closing will be looking to the Healey administration to honor that commitment by providing whatever support is needed to preserve the Birthing Center to ensure continued access to safe maternity care in Northern Worcester County.   

In fact, on the day the UMass Memorial plan was released, the coalition's call for Governor Healey's intervention was joined by the Worcester NAACP, with sent a letter to Governor Healey and UMass Memorial Health CEO Eric Dickson calling for the service to be maintained to protect the communities of color served by the Center.  The NAACP letter can be found here.

SOURCE Massachusetts Nurses Association