Thank you for the opportunity to address our concerns for the closing of Labor & Delivery at Windham Community Hospital.My name is John Brady. I am a Registered Nurse who worked in the Backus Hospital ER for 21 years. I now serve as Executive Vice President of AFT Connecticut, a union of 30,000 members in Healthcare, Education and Public Service, including members at the Hartford Healthcare facilities of Windham Community Hospital, Backus Community Hospital, Natchaug Hospital, Windham Public Schools, Windham State Vocational High School, the University of Connecticut, Eastconn Regional School District, and various other state employees who live in the Windham area.
We would like to make several points.
• The decrease in number of births at Windham Community Hospital is a result of actions taken by Hartford Heathcare since it acquired Windham.
• The Windham Community is a rural, poverty-strickencommunity of color with a large population for whom English is a second language.
• Communities of Color suffer from health inequities in part because of a discontinuation of services such as this.
• The Community suffers from a lack of reliable transportation.
• Hartford Healthcare claims a lack of physicians and nurses but has not demonstrated an effort to attract or retain such healthcare professionals.
• Hartford Healthcare has violated the spirit, if not the word, of the Certificate of Need process by going on “diversion” for over one year.
• Hartford Healthcare has an obligation to provide for the needs of the community it is entrusted to care for.
• Hartford Healthcare has the financial resources that allow it to provide these needed services to the community.
To understand the current situation, we need to go back to before the acquisition of Windham Community Hospital by HartfordHealthcare in 2009. Until that time, Windham CommunityHospital was an independent, community hospital with a board composed of citizens of the Windham community. Windham Community Hospital operated on a small positive margin. Since Hartford Healthcare acquired Windham Community Hospital, Windham has suffered a monetary loss every year.
In 2015 Hartford Healthcare eliminated the Intensive Care Unit. HHC avoided the Certificate of Need process by calling this a “decrease in level of services” not an “elimination of services.”Since then, the Connecticut legislature has changed the law so that a “decrease” now requires a CoN determination.
A Hartford Current article at the time offered this:
“Hospital officials offer a different take. Being part of a larger system has helped Windham Hospital survive amid years of financial losses, spokesman Shawn Mawhiney said. The hospital is one of two in the state that has posted negative margins for each fiscal year since 2009. According to Hartford HealthCare, the hospital is projected to lose $8 million this fiscal year, the equivalent of $11,000 per day.
The potential changes — including cuts to the critical care unit and reducing the number of inpatient beds from 87 to 32 — are intended to ensure the hospital adapts to a health care market in which hospitals are projected to have fewer inpatients, Mawhiney said.
"First and foremost, what we're trying to do is keep Windham Hospital's doors open," he said. "The reason we're doing this is to avoid closure. We want Windham Hospital to be there for the community for many years to come, and in order to do that, Windham needs to be transformed into a different kind of health care organization.
What would that look like?
Hartford HealthCare officials have described the Windham of the future as offering "cornerstone" services — like emergency medicine, cardiology, oncology and short-stay inpatient care — while functioning as a "gateway" to the health care system. In some cases, patients would get more complex services at other facilities.
What would be lost?
Hartford HealthCare hasn't released definitive plans or sought state permission for any changes that would require regulatory approval. But a June 23 notice to staff listed significant changes, including:
— reducing beds from 87 to 32
— no longer offering complex inpatient surgery or critical care unit-level care;
— eliminating the sleep lab and clinic and radiology school;
— moving the general surgery and wound care clinic to another part of the health system;
— downsizing and regionalizing community benefit and support services, including nutrition and diabetes services;
— cutting 119 positions, part of 418 being eliminated throughout Hartford HealthCare.
The cuts are part of a broader set of changes to the system that officials attributed to state and federal funding cuts, declining inpatient volume and increased competition.
The prospect of changes to the critical care unit has drawn particular criticism. Some say not having that service as a backup could make doctors hesitant to perform even routine procedures at the hospital.” (1)
Now, Hartford Hospital wants to eliminate Labor & Delivery at Windham Community Hospital. They claim that the number of births have declined and that it is not safe to deliver babies at Windham because of low volume. We believe that the decrease in births is directly related to decisions made in 2015 and that this decrease was manufactured by Hartford Healthcare so that they could claim a need to discontinue services on safety grounds. They claim, according to documents filed in the CoN application process:
“For years, the Hospital has struggled with a declining number of births. A significant number of Windham-area mothers are choosing to have babies at other area hospitals, primarily at Manchester Hospital, Hartford Hospital and The William W. Backus Hospital.”
“The Hospital’s only OB-GYN practice stopped providing services in 2015 due to declining patient volumes and coverage issues. Despite its best effort, the Hospital has not been successful in recruiting additional providers to the area due to low patient volume and the Hospital’s inability to ensure consistent provider coverage.”
In fact, deliveries remained constant until 2015 and then started falling because Hartford Healthcare created conditions in which “difficult deliveries” were pushed to other hospitals.
2011 – 384 births
2012- 393
2013- 374
2014- 376
2015- 205
2016- 137
2017- 98
2018- 108
2019- 99
In 2015, the hospital eliminated the ICU, increased surgery transfers to Hartford Hospital, and failed to come to a continuation contract with the Mansfield OBGYN group. The result was predictable, a decrease in births.
Hartford Healthcare states that “Obstetrics volume at Windham has declined precipitously due to changing demographics, and women increasingly choosing to have their babies at other hospitals.”
However, as Donna Handley said on a virtual town hall meeting “Women go where their physicians instruct them to go.” Donna Handley virtual town hall meeting 8/10/20 16:55 mark
The Windham Community is a rural community with a high degree of poverty, a high degree of people of color, and a high degree of English as a second language, when compared to the rest of eastern Connecticut. The public transportation is lacking or absent and transportation was noted as a prime issue in the last Community Needs Benefit Survey. Women transferred by car of ambulance must travel on 2 lane roads to Norwich, Manchester, or Hartford, a ride that takes nearly 30 minutes in clear weather without any traffic difficulties. Families trying to support such women are on their own to try to find transportation.
The Covid pandemic has illuminated the health disparities of people of color. One of the causes for such disparities are decisions like this one, forcing women of color to travel outside their communities to give birth.
Hartford Healthcare points to a shortage of physicians and nurses but we know of no efforts to recruit or retain these healthcare professionals and nurses were reassigned when Windham stopped deliveries in 2020 and in 2015 they fired 109 employees, many of them nurses.
Hartford Healthcare placed Windham Community Hospital on “diversion” for all Labor & Deliveries in June 2020, over a full year ago. This is a clear attempt to circumvent the Certificate of Need process.
IF the state of Connecticut decides after careful review and examination of all the facts, that it is appropriate for Windham Community Hospital to permanently discontinue Labor & Delivery services, which it has provided since its founding in April of 1933 when 3,700 community members raised $450,000 in the height of the depression to replace St Joseph Hospital which had become too small, then it should be done through the CoN process. Until then, Hartford Healthcare has a responsibility to the community to provide services as per itslicense.
Calling it a “diversion” for more than a year is either an EMTALA violation or a violation of the spirit, and the perhaps the word, of the Certificate of Need process.
Finally, Hartford Healthcare has the financial resources to fulfillits obligation to the residents of the state of Connecticut. Financial resources that are mostly the result of resident paid for programs, such as Medicare, Medicaid, the Affordable Care Act, and its tax exempt status.
As reported this August in Chief Investment Officer, on the $4.1 Billion HHC investment fund:
“While being on the frontlines of the pandemic, the Hatford HealthCare (HHC) investment office managed an annual gain of 33.5%, well ahead of its market benchmark of 26.2%” (2)
We urge the Office of Health Strategy to listen to the thousands of community members who have signed petitions and the city councils of Windham, Mansfield, and Ashford in rejecting this Certificate of Need. Application and order Hartford Hospital to restore Labor & Delivery at Windham. Community Hospital.
John Brady RN
Executive Vice President
AFT Connecticut
(1) Hartford Current- Cuts at Windham Hospital Prompt Worries About Access to Care, August 6, 2015, https://www.courant.com/health/hc-ctm-windham-hospital-cuts-0807-20150806-story.html?outputType=amp
(2) Chief Investment Officer- Exclusive: Hartford HealthCare Posts a Healthly 33.5% Gain Despite Industry Pains, August 4, 2021, https://www.ai-cio.com/news/exclusive-hartford-healthcare-posts-a-healthy-33-5-gain-despite-industry-pains/
