AG Tong discusses WCMH maternity closure

 Connecticut Attorney General William Tong was in Willimantic this week to meet with residents concerned with the closing of Labor & Delivery at Windham Hospital, led by Windham United to Save or Services, a community group dedicated to this purpose, and to do a radio program with State Representative Susan Johnson.

Here is an article from The Chronicle written by Michelle Warren

Tong discusses WCMH maternity closure

MICHELLE WARREN

Chronicle Staff Writer

WILLIMANTIC — A week after Hartford HealthCare was fined by the state for prematurely closing the maternity unit at Windham Community Memorial Hospital, Attorney General William Tong was in town this week, discussing the challenging regulatory process involving hospitals.

“The law and the regulatory infrastructure around all of this — I’ll be charitable — is very complicated,” Tong said while joining emergency responders, town officials, state legislators and other community members during lunch at Garibaldi’s Mexican Food in Willimantic.

The event was held before Tong appeared on WILI’s show “Let’s Talk About It” with state Rep. Susan Johnson, D-Willimantic.

On Wednesday, Tong spoke about the problem of large corporations “monopolizing,” including health care corporations.

“There are concentrations of market power in so many industries right now,” he said.

Given the power of the large companies, Tong emphasized the importance of the community members bringing their concerns about the closure of the Windham Hospital maternity unit to Hartford HealthCare’s attention.

“It’s really important that you elevate your voices,” he said, noting other people are “pushing in the opposite direction.”

Hartford HealthCare applied through the state Office of Health Strategy (OHS) for a certificate of need application to terminate the maternity unit services on Sept. 3, 2020.

The CON application shows the last birth occurred at the hospital in June 2020.

In its CON application, Hartford HealthCare cites the low birth rate and trouble recruiting staff as reasons for the closure.

On Feb. 8, the state Office of HealthCare Strategy announced it was fining Hartford HealthCare at least $151,000, or $1,000 a day, for closing the maternity unit before receiving approval from the state to terminate the service.

Under state statutes, Hartford HealthCare is required to apply for and obtain a certificate of need before terminating a service like the birthing unit, which OHS states Hartford HealthCare did not do.

However, OHS reduced its fine to $65,000.

In a letter Tuesday, Office of Health Strategy Deputy Director/Chief of Staff Kimberly Martone sent a letter to Hartford HealthCare Director of Strategic Planning Barbara Durdy notifying Hartford HealthCare that it would be fined $1,000 a day, from July 1, 2020, to when they “properly filed” for the CON application on Sept. 3, 2020, resulting in 65 days in violation and a $65,000 penalty.

She wrote that consistent with state statutes, Hartford HealthCare has the right to request a hearing related to its penalty.

“We remain committed to working with OHS to bring our application to a decision in a timely manner,” Hartford HealthCare Director of Media Relations Tina Varona said in an email Wednesday.

“We disagree with any penalty and are evaluating our legal options.”

She declined to comment further on the matter, including whether Hartford HealthCare planned to request a hearing.

OHS could not be reached for comment.

Many expressed concerns about the closure of the maternity unit during a CON hearing held by OHS on Nov. 10, 2021, some of whom attended the event Wednesday.

One of the main concerns raised is the time it would take for women going into labor to get to a hospital with a birthing unit, with some now traveling to The William W. Backus Hospital in Norwich or Manchester Hospital instead of Windham Hospital.

Brenda Buchbinder, a member of the Windham United to Save Our HealthCare coalition, which has been vocal about its opposition to the closure of the maternity unit, said there are people in the area who don’t speak English and others who don’t have vehicles.

She said pulling the “plug” on the unit in the middle of a pandemic is “absolutely heartless.” “There is no bottom line that justifies it,” Buchbinder said.

Johnson thanked Tong for his work on the Windham Hospital issue.

“We have to regulate it to the best of our ability,” she said.

The first step, Johnson said, was setting up a process through the Office of Health Strategy.

Speaking about potential dangers on the roads heading to the hospital, Willimantic Fire Department Chief Marc Scrivener spoke about an accident involving an American Ambulance that got into a head-on accident March 25, 2021, on Route 32 in Franklin.

During that accident, 49-year-old Dawn Brett, a Willimantic resident, was killed and the ambulance driver and front-seat passenger were hospitalized with minor injuries.

Scrivener said when Willimantic has to send an ambulance to Backus for a medical transport, including a woman going into labor, it takes away staff that would respond to Willimantic calls.

He said two Willimantic EMTs respond to each ambulance call, noting the Willimantic Fire Department has “minimal staffing” as it is.

“That’s a downstream effect that you might not think of,” Scrivener said.

Tong said often, private institutions that operate like for-profit institutions make decisions “based on dollars and cents” and justify those decisions with spreadsheets and reports.

However, he said, the impact service changes will make on the community should also be considered.

Tong said in “really extreme circumstances,” the situation can “cost lives.”

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Hartford Healthcare fined

 If a Connecticut hospital wants to end a service, it must seek state approval prior to doings so. That is the law. Hartford HealthCare broke that law and the State is fining them $1000/day. 

The purpose of the law is to protect CT patients and families. The idea is that it should be the people of CT who decide if a hospital can close Labor & Delivery, or any service, not the CEOs of a hospital corporation, because hospitals exist for the good of the community, not the financial gains of a few at the top. 

This process, called the Certificate of Need, (CoN) exists to protect CT residents. Hartford Healthcare ignored this procedure when they ended Labor & Delivery at Windham Hospital. As a result of the CoN hearing last November, it was revealed that HHC decided in late 2019 to end L&D. The last baby was delivered at Windham in June of 2020. HHC did not file for permission (a CoN) until the fall of 2020, a clear violation of the law. 

No doubt HHC will appeal and $1000/day (now at $151,000) is pocket change to HHC, especially because it doesn’t come out of the CEO’s pocket, but it is an important step in the state of CT holding hospital corporations accountable to the law. 

This does not settle the bigger question of whether HHC will need to re-establish L&D at Windham. That decision is still forthcoming from the state, who still seeks additional follow up information post the November hearing. 

AFT Connecticut has been proud to be a part of a community coalition, Windham United to Save our Healthcare, that has worked hard to hold HHC accountable. I thank the many community members and organizations for not giving up on the people of eastern CT, especially the Wonen, babies, and families directly affected. I also want to thank the leadership and members of AFT CT and AFT, especially Jan Hochadel and Randi Weingarten for supporting this effort every step of the way. 

A copy of the order from the state is at https://www.hopeunions.org/sites/default/files/article_pdf_files/2022-02/other-civil_penalty_notice.pdf

AFT Nurses & Health Professionals Hope Unions Connecticut AFL-CIO

My Christmas wish for Healthcare Professionals

 Merry Christmas and a big thank you to all my healthcare friends. Your strength and dedication over the past 2 years has been remarkable. I know you are often at the end of your ropes. Many have decided to retire, move away from the bedside, go to travel agencies, because we all reach our limits. 

I get it.

I work every week or two as a volunteer vaccinator but I know I couldn’t handle the grind of 16 hour shifts, often mandated at the last minute, usually with insufficient staffing. All made worse by healthcare corporations that often put profit over patients and staff.

You’ve been called heroes at the same time you are yelled at and physically attacked. 

I get that some people have concerns about vaccinations. I urge them to discuss those concerns with their doctor or other trusted healthcare professional or their clergy. 

I do not get those who refuse vacination, masking, or testing just because it is “their right.” 

“Their right” in contributing to Healthcare Professionals burnout.

I don’t dispute that it is their right to not vaccinate, not wear a mask, refuse to get tested.

What I’m saying is that those actions bring consequences, including the consequence of adding to Healthcare Worker burnout.

Every “right” comes with a corresponding “responsibility.”

Tomorrow we celebrate the birth of Jesus. 

Some of us believe he was God, who decided to be born a man. His life was an example of how to live in service of others, something Healthcare Professionals exemplify. He chose to be born poor, homeless, to an unwed mother and a step father. He hung out with fishermen, tax collectors and prostitutes. He taught love and acceptance.

He would have loved todays nurses and other healthcare professionals. 

He would have done all he could to help them.

Merry Christmas my friends and thank you. 

Windham Labor & Delivery

 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/

Save Labor & Delivery at Windham Hospital

 Some 18 months ago Hartford Healthcare discontinued Labor & Delivery services at Windham Hospital, forcing pregnant mothers to drive the 30 or more minutes to Backus Hospital in Norwich, along a windy, 2 lane route 32, and making it difficult for family members to be a part of one of the most important events in a family’s life. Compounding the problem is the fact that the Windham area has a higher percentage of lower income people who lack reliable transportation and a higher percentage of mothers of color, who historically have poorer maternal outcomes.

That would have been the sad end to the story except for one important fact. Connecticut has a Certificate of Need process that must be followed whenever a healthcare corporation wishes to increase or decrease services. That process will culminate this Wednesday with a Certificate of Need (CoN) hearing, and the community is pushing back. Our hope is that the state steps in and reverses this decision.

The discontinuation of Labor & Maternity and other visual services is something that is playing out across this country. The fact is that it is expensive to run a Labor & Maternity unit, an Intensive Care Unit, and other units in hospitals. As healthcare corporations have gained control of more and more hospitals in a region, there is an economic advantage to consolidate some of these services into hub hospitals and to use the other hospitals in the system as intake, or feeder hospitals, sending most patients to the main hospital. In the Hartford Hospital system, Backus Hospital in the east and Hartford Hospital in the center of the state have become those hubs. While this may make economic sense, the bigger question is whether it is in the best interest of the patients and families. 

There is also a larger, fundamental question. What responsibility does a hospital, having been granted a license by the state to provide services to the residents of the state, have to those residents? Especially considering the many tax advantages these hospitals have been granted and the fact that their income comes from taxpayers in the form of Medicare and Medicaid payments or insurance premiums. Shouldn’t state residents have a say in what core services these hospitals have to offer? Connecticut residents believe so, that is why we have a CoN process (which shockingly is not available in all states)

A community group has been formed to push back against this closing, Windham United to Save Our Healthcare, you can find them on FB @Windham United to Save our Healthcare. Many organizations have joined this coalition, including AFT Connecticut, CT Citizens Action Group (CCAG), Hartford Organization of Professional Employees (HOPE), Generations Family Healthcare, NARAL, Northeast CT Grassroots Group, Planned Parenthood, Quiet Conor Shouts, The Neighbor Fund, Universal Healthcare Foundation, Volta Boricua, We the People Windham and the NAACP. The Town Councils of Windham, Mansfield, Eastford, and Coventry have passed resolutions supporting a  return of L&D services. Several state representatives and senators have expressed support. Most importantly, hundreds of area residents are asking for L&D services to be restored. 

It is time for Hartford Healthcare to do the right thing. It is time for them to fulfill their obligation to the community, to provided needed services. 

If you want to testify at the hearing, you can submit written testimony and/or testify verbally. You do not have to be an expert, we will have experts. More important are your personal stories, told from the heart. Many will be gathering Wednesday at the Windham Town Hall to watch the hearing, which will be on zoom. There will be an opportunity to testify from there but you can also watch and/or testify from home if that is more convenient. The information is below. 

Zoom information for next week's Certificate of Need Hearing. All are welcome to join us at the Windham Town Hall, however you can log on from home using this information. It can also be found here: https://www.hopeunions.org/sites/default/files/wcmh_maternity_srvs_con_hearing_flyer.pdf

If you’d like to join us at the Windham Town Hall to watch or testify. On November 10, 2021 the state health department’s Office of Health Care Access will hold a hearing over Zoom to decide if Hartford HealthCare can permanently shut down the Windham Hospital maternity unit. This virtualCertificate of Need hearing is the community’s chance to weigh-in. The WindhamUnited to Save our Healthcare Coalition will be gathering at the Bellington Auditorium on the top floor of the Windham Town Hall to view the hearing and provide a space for community members to testify.

Testimony for Hartford HealthCare begins at 10am. Public testimony begins at 3pm. 

To submit written testimony or to sign up to offer a 3 minute Zoom testimony please email: savewindhammaternity@gmail.com