2023-06-20 00:00:00 - Joint Committee on Health Care Financing
2023-06-20 00:00:00 - Joint Committee on Health Care Financing
SHOW NON-ESSENTIAL DIALOGUE
SPEAKER1 - A second to take your seats. Okay. In spite of the fact that it is dark in here, we will not be passing off the Los Angeles, and
SPEAKER2 - everybody Stay awake. My god is in the dark. Target.
SPEAKER1 - Okay.
Okay. I will ask all the members of the committee and those individuals participating remotely on the team's application. Please mute your microphones unless you are speaking or until
until you are recognized by the
care. Just a minute. I'm gonna try and use this. It is just say. It's not
we're on remotely. Also, if you're not speaking, if you wouldn't mind unless you're coming up next. Also turning your video off will probably have a better chance. of keeping the communications of flowing. So thank you. My name is Cindy Friedman, and I'm the senate chair. of the joint committee on health care financing. With this today, we have the following senate members of the joint committee. Vice Chair Cronin.
And is there anyone else on okay. And the Our my cochair chair lawn is is stuck at home, so he's he's with us remotely. but I will also introduce the house members of the joint committee who are here rep Diggs Rep Kane, rep mortuary, rep Sabodosa.
Okay. Yep. Great. Thank you. Okay. So we will be hearing testimony on 18 matters pertaining to health resource oversight and market dynamics. We will be taking legislators out of turn as is the tradition of the committee. A legislators who register who have registered will be called on first, and if there's any legislator that would like to testify, we'll recognize you as well after. when all the legislators have been heard, we'll turn to the individuals who preregistered to testify. After all preregistered individuals have been called to test time153 permitting, the chairs155 will call any individuals who did not preregister, but signed up at the door to testify just so everybody knows because these are of a hybrid, these
rooms are booked continuously. So somebody will be coming up after us most likely. And so that's why we're asking you all to
sign up And also we may have to move it along faster if we're starting to run out of time. It's not personal. It's just what we have to do so that all these hearings can happen high in a hybrid fashion. If you haven't registered, please fill out the signing form of out in the hallway, I believe, is is where you can get it. and return it to the committee staff. They are also seated outside and they can take it for you. Okay. So I just wanna go over some guidelines. We are conducting this hearing in person. And as I said, remotely using the Microsoft Teams platform, Individuals who registered to testify at the hearing will be afforded 3 minutes to226 speak, and that's because we have so many people who wanna testify. Please note that the chairs at their discretion can allow that to be can further the time limits237 10 set the time limits greater or less again depending on where we are in in the process of hearing247 the testimony. When individuals have concluded their testimony, please, if you're remote mute your microphone, and turn off your video.
I'd ask the committee members to hold off on with question until the per people person have testified.
And if you're participating remotely267 on teams, As I said, please remain muted with your camera up till you are called by the chair.
For those watching on live stream, any individual organization may submit written280 testimony and supplemental information282 on any bills on the DACA to the committee via email, the instructions to do so are available on the hearing notice on the live stream page. Also, I ask you not to read your written testimony. We promise you that we read all the testimony that comes into us So303 this is an opportunity for you to come305 up and say some words specifically about something. But your formal testimony will be will be read. I promise. I also want to recognize rep Barrows and rep Laurel. and I see Senator Sierra as well. Okay, so I am now gonna start with the list. We're gonna get328 everybody that Thanks. Okay. Great. So the first the332 first person we'll hear from is Senator Keenan334 here.
No. Okay. Representative, Sally Curran?
SPEAKER3 - No. I can hear you, but it's real.
SPEAKER1 - No. Okay. We have a panel, an in person panel. Senator Cronin, rep Higgins, reps lot Nick, rep Ferguson, rep Kushmirick, and rep Kilkoy.
Good morning, everyone.
SPEAKER4 - thank you, Kate, for
SPEAKER1 - And good morning to rep Barber. He's just like this, but might be leaving.
REP HIGGINS - HB 1175 - SB 736 - Good morning, Chair Friedman, and Chair lawn, and honorable committee members. My name is Natalie Higgins, I'm State Representative in the 4th Worcester district representing the gateway city of Lemon stir. Unfortunately, I'm here testifying in a very timely moment that we're taking up 1175 because we're facing the closure of an essential service in our community hospital, our birthing center, which includes our labor and delivery unit and our postpartum unit and I wish I wasn't here. I've been in the legislature for seven years, and this is the second time we've seen the closure of essential services in Lemon stir Hospital. About six years ago, it was our inpatient pediatric unit and our cardiac and pulmonary rehab. We're coming to you unified as a delegation because we need to save these services in gateway cities like Lemon stir and Pittsburgh and the surrounding more rural towns in North Central Mass. The next closest option for labor and delivery is Gardner about 30 minutes away. Worcester, more than 30 minutes away and Concord more than 45 minutes away, and we represent gateway cities. These are communities without access to robust public445 transit, just getting between the twin447 cities can be incredibly hard. So we're coming to the committee to take a hard look at this legislation and figure out how can we add more T to the essential services process to give DPH and this Commonwealth more tools to make sure that we're not losing these critical essential surfaces from our most at need populations. So I'm really grateful to be joined with this delegation, we speak together often, but never with the ferociousness that we're coming at you today. So thank you for the time.
SEN CRONIN - HB 1175 - SB 736 - Madam Chair, honorable members the committee, our delegation does not live in a fantasy world, and we know our health care system in Massachusetts is under incredible fiscal strain,486 and that mitigating workforce shortages is the preeminent challenge for providers. We are fully aware that gateway cities like ours with high publish to private payer mixes put especially high strain on our providers. But our communities are not dying, they are growing, and they are thriving. Our legislature has walked a walk over the past two years when it comes to providing resources to our community's healthcare providers to stabilize and to maintain the delivery of essential services. In November 2022, UMass Memorial received $27,000,000 from the legislature, its subsidiary health alliance received more than $6,000,000. That's in addition to $20,000,000 in 1115 safety net funds in 2022, and 38,000,000 in ARPA funds all to stabilize and maintain the delivery of essential services in economically distressed communities.
UMass Memorial attributed their decision to close our birthing unit to declining birth rates544 in the region and workforce shortages. First, workforce challenges, what workforce challenges could not be551 overcome with an $80,000,000 shot to the arm over the555 past two years? I don't think the men and women who are joining us today who work in the unit could provide a good answer to that, and we haven't received one either. Second, UMass Memorial has claimed that there is567 a declining birth rate in the region, we have not been provided with data to support that. In fact, CHIA data shows more births in 2021 than in 2019 in the North Central Service area, and the latest census data shows that our community is growing. What is true is that fewer mothers from our region are giving birth at Lemon stir Hospital. What we don't understand is whether that is due to administrative sabotage, but we haven't been given a good reason to believe otherwise.
Considering the support taxpayers have provided UMass Memorial, is it too much for them to come to the table in good faith and tell us what they need to keep the doors open for expectant mothers in our community. Considering the billions in support taxpayers provide in our health care system, shouldn't the state have a voice in what services stay open and where? The current system allows DPH no real voice and no real mechanism to make sure our health care system works for every corner of our state. So I'm grateful to Senator Cyr for filing this Bill and leading this conversation but I would offer to the633 committee that we need to go further than this Bill goes. And that HHS and637 the Department of Public Health, the state entities that license our healthcare system, that subsidize it with billions of dollars, need not just a stronger voice, but regulatory teeth to protect and maintain essential services in every corner of the commonwealth. Thank you.
REP KUSHMEREK - HB 1175 - SB 736 - Morning, Madam Chair, Mr. Chairman, honorable members of the committee. The communities I represent of Fitchburg and Lunenburg know the ravages of hospital consolidation far too well. 20 years ago, Fitchburg had its own hospital campus known as Burbank Hospital, for nearly a century, that hospital service Fitchburg and the surrounding communities. When the proposal came before the community to consolidate Fitchburg's hospital, into Lemon stir's Hospital, the guarantee and the promise made by the hospital and then again by UMass when they acquired Lemon stir Hospital, was to ensure further access to care and treatment, more services and better services as well as to make it more accessible broadly to our entire region. Since that time, we've seen repeated hospital service and essential service consolidation and closure, not just from Fitchburg, but the same services that they promised that would become more robust when they left Pittsburgh to be consolidated in the Lemon stir have since closed and been consolidated from Lemon stir into Worcester. What that means for a community, particularly one as diverse as Fitchburg, one of the most diverse communities in all of Worcester County, is that repeatedly, what I've heard in the past two weeks alone are from single mothers, often, many of whom whose primary language is Spanish with real fear and concern about how do they access prenatal care?
It's already an incredible and herculean effort to get to Lemon stir every other week for the routine checkups and the critical checkups that we know are so important to delivering healthy outcomes through the term of the pregnancy. Increasingly, parents are concerned and skeptical that there will be an ability for them to get to Lemon stir Hospital every two weeks for nine months. So the answer that many say, unfortunately, I'll have to miss those important check ups, and hopefully, we'll get the next one. Those are unsustainable options for our region, and we know that those will be damaging options not only for community, but for the entire Commonwealth and adjourned will each be paying for those problems for decades to come. Thank you, Madam Chair, thank you committee members.
REP ZLOTNIK - HB 1175 - SB 736 - Thank you to the members of the committee. John Zlotnik, a Representative from Gardner. The point I808 want to make in regards to this Bill, and I810 think the important takeaway is that this increases the notification time from six814 months to a year. Why that's so important, I think, in addressing this problem and having been through this process before, six months gives us very little time to do anything, whether that's bring more state resources to bear to try and address the issues that are resulting in the potential closure, organize, make counter arguments, gather data or prepare for837 other outcomes, that is the most important thing I think we841 can do with this Bill as it buys us more time. to do all of the things that we're doing right now on a very truncated timetable, and that's why this Bill is so important. Because, again, anyone who's been through this knows how critical that time is in terms of addressing these issues and trying to save these services in our community. So thank you for your time and your consideration of this Bill.
REP FERGUSON - HB 1175 - SB 736 - Thank you. Kim Ferguson, 1st Worcester District, Holden, Princeton, and Westminster. I will be brief, I'm the closer right here. We just want to, again, thank you for listening to our story today. We're here again to articulate the dire need to get legislation such as this passed. My folks in my small towns are greatly impacted by this in terms of just their travel time and the fear of what if something happens?891 How am I going to get, you know, to the hospital, etcetera, in a timely fashion? Quite frankly, being told that you could take a cab to Worcester is not an option, and that is one of the options being given to them right now. So again, articulating the dire need for this villain. Thank you all for coming today. SHOW NON-ESSENTIAL DIALOGUE
Just
to have a very
SPEAKER10 - stick to plant.
SPEAKER11 - He was at the
SPEAKER6 - moment and closed.
SPEAKER12 - Well, I
SPEAKER13 - won't take up too much time.
REP KILCOYNE - HB 1175 - SB 736 - As I'm sure my colleagues already eloquently stated some of our reasons for being here today, namely access to health care in North Central Massachusetts. So my district includes six towns sandwiched right between the city of Worcester and Lemon stir and Fitchburg. So all of these communities vary in in density and in population, many of them are rural, some948 less so. We are fortunate to have Clinton Hospital that serves952 the town of Clinton and some of those surrounding954 communities that ensure many in my region have957 access to health care. However, over the last961 several decades, in my lifetime anyway, we've seen a steady closure and elimination or consolidation of services. We understand the complexities of our health care system here that necessitate some of these decisions at times but what we have seen play out in our communities, in my communities, is that increasingly, year after year after year, we have less accesses to services and care that previous generations did.
Now with the example of what you've heard about today that's going on in Lemon stir Hospital, which is part of the UMass helpline system, of which Clinton Hospital is also a part of, is the loss of maternity ward. Almost 36 years ago, my parents moved to the town of Sterling, which is in North Central Massachusetts, and when my mother became pregnant later that year in 1987, she had options that ranged from going to the city of Worcester, to go into the city of Lemon stir to serve the care that they had there and other areas in North Central. One thing that has struck me as devastating with this decision and why I think this Bill would be necessary to preserve the care that we have is, I'm 35 years old now, I also live in North Central Massachusetts and despite all the talk of progress we have made in women's health or women's rights, I will have less access and less choices than my mother did 35 years ago when I want to start a family. My hope is that we can make sure that when we talk about health care, when we talk about services that we keep an eye towards making sure that the families and residents that live in our communities don't go backwards in accessing the care they need. SHOW NON-ESSENTIAL DIALOGUE
So with that, I will seed it to my colleague, person, and thank you
SPEAKER14 - so much for your time.
SPEAKER15 - We're
SPEAKER14 - done. Yeah. We're done. Sorry. Oh,
SPEAKER8 - yeah. Yeah. Cool.
SPEAKER1 - You got some questions.
SEN FRIEDMAN - So just a1087 couple of clarifications and then I'll turn1089 it to you. So they're closing all prenatal care, so if you want, where will women get prenatal care now if they close Lemon stir?
SHOW NON-ESSENTIAL DIALOGUE
Yeah. Yeah.
SPEAKER9 - It's Right.
KUSHMEREK - Well they have fewer beds, they've assured that that the fund will be made as deferred. It's obvious already that the practice will follow where the admission can be, and that will be closer. SHOW NON-ESSENTIAL DIALOGUE
I would think so. Okay. And
What is it that if you
FRIEDMAN - If we could call UMass right now and say we want you to do something today besides not close it, what would it be?
HIGGINS - So I think that they can keep the unit open if they wanted to keep the unit open. They come to us, it's not a financial decision, it is a staffing challenge. That is a solvable problem. I know it's a challenge across the Commonwealth, but we have plenty of nurses here who are going to counter the stories that have come out of UMass administration. There are changes that they could have made to address the staffing challenges. They were having trouble filling four positions and told us that they could not find traveler nurses, after they announced the closure, they hired 12 traveling nurses to cover those nursing shifts. Like, they've manufactured this crisis because they don't want to sustain labor and delivery in Lemon stir. We think that's unconscionable because too many of our families can't afford to do so. In case and point, Rep Zlotnik represents Gardner, a community half the size of Lemon stir, never mind growing in Fitchburg, which makes us four times the size, they're keeping their1194 labor and delivery unit. They have figured out1196 how to do that with half the births that1198 Lemon stir and Fitchburg sent to1200 Lemon stir Hospital and or surrounding communities.
KILCOYNE - I'm sure this has been addressed, so I apologize if it has but we also should point out that we've limited access to public transit in our region as well. So one of the responses we got in terms of families, especially in Fitchburg and Lemon stir, but my regions included in this as well that there could they could take a bus to Worcester but there's only one, I believe.
HIGGINS - There's one bus that get to and from Worcester from Lemon stir a day. My father-in-law has tried to take that bus, it's incredibly challenging, it's not going to work for our families. So, we're continuing to hear from our EMS providers who are really worried, these are families that don't have access to transportation that are going to rely on ambulance services to get to a hospital that much further away, putting a strain on our entire system.
FRIEDMAN - And what is your closest community health center?
HIGGINS - Lemon stir and Fitchburg, we have a community health center. SHOW NON-ESSENTIAL DIALOGUE
in Lemon stir and Fitchburg. Okay.
CRONIN - Madam Chair, I'd like to just answer your previous question just briefly. I think what the delegation is asking for is for them to come to the table in good faith and tell us what they need in terms of resources, in terms of buying, in terms of regulatory changes, to keep this essential service open in our region. That collaboration didn't happen before we were informed that this meeting was going to be closed and so that's the ask from our delegation. SHOW NON-ESSENTIAL DIALOGUE
k.
Yep.
Sure. That's infuriating. You are the delegation for that area, and nobody reached out to you to actually Say, hey. Look. We're having problems here. It just got sprung on you.
Just the Xbox.
That is unconscionable that they did that. Yeah. I'm Belila.
Yeah.
REP MURATORE - Our delegation went from Plymouth, and our delegation speaks with our CEO and vice president clinical services on a quarterly basis and we get the updates of what's happening, what needs to happen, and you're absolutely right, travelers would answer their form, they don't want to pay for the travelers, obviously. One question I do have though is, again, I'm from Plymouth, so I don't know the distance. So how far is Lemon stir from Worcester? Because I agree with, Madam Chair that people are going to follow. SHOW NON-ESSENTIAL DIALOGUE
They're gonna follow. How far is it from now?
Without traffic. Yeah. unbelievable.
SPEAKER6 - k. It's hard to say. It's 5 minutes, you know, without1369 traffic, you know. Oh, sorry about that.
SPEAKER8 - Yeah. Westminster even more. Yeah. I'm up to 45 -- Mhmm.
SPEAKER1 - -- 4045
Thank you.
Cheers. Yeah.
SPEAKER15 - Yeah. For the home. Good morning, home. You look towards spoken you in a kind of a reverse need.
REP MURRAY - When new services are offered by various in the sundry healthcare providers, through a pretty robust determination of need to see whether or not we need it, right? I don't know whether you would get a good answer or you would get a bad answer but it's kind of just a a reverse of what somebody had to do at one time in order to provide those services. So just throwing it out there. SHOW NON-ESSENTIAL DIALOGUE
all our meetings. So Luedenburg, a a towel is doubled in size every decade reconsecutive decades. It's 1 of the fastest growing municipalities.
KUSHMEREK - You can find our Commonwealth, Lemon stir and Fitchburg to the gateway communities are not only growing in the about 5%, and Pittsburgh, about 9% in Lemon stir, but the demographic analysis shows that we expect those population trends to taken. You've asked to supply this own data just last night at about 9 o'clock to demonstrate that burst from North Central Massachusetts have actually increased over the past three years, over the past decade as well. It's just that they are manufacturing efforts outside of Lemon stir Hospital. They've been directing folks to other hospitals other than they're all1472 over the past six years.
CRONIN - And so to be very clear what the implications of that are, means people with choices are going1478 to have choices. People who are more active and are going to have more access to transportation and be able to get to what service1484 we think there. The people who are going1486 to be left with no choices are the people who we need to fight the hardest. The people who are single mothers who are living in poverty or who face barriers, in terms of transportation, in1499 terms of language to access all these essential services that to be taken from our1505 community. So that's why the stakes1507 are so high and I think, you know, we have an opportunity as a1511 delegation here, but also as a safe to send a message that business as usual1515 needs to change, especially when you're talking about taking internal1519 health care of not one, but two gateway cities. SHOW NON-ESSENTIAL DIALOGUE
are gonna sail.
SPEAKER1 - representatives.
REP SABADOSA - Thank you. Senator, actually, my question sort of builds off what you just said, and I want to express my sympathies in my tenure in office I've seen three nursing home closures, one maternal health closure, and two behavioral health closures in my region, so I understand what you're experiencing now. But the question I wanted to ask and because you're legislators and you probably have this experience is if I got a call tomorrow telling me I needed to find a new doctor, I'm not sure I could find one. There are no new doctors accepting patients in my region, so I don't know what I would do, and I wonder if you could share with us any of the stories you might have heard from patients who might1565 have challenges in the middle of a pregnancy1567 finding a new doctor.
HIGGINS - This is happening. For those pregnant families who are faced with the decision if they bring out the error they were going to get birth and what they're going to do, in the interim if there's an emergency, like, those are just impossible choice this. When our inpatient pediatric unit closed, I testified that the Department of Public1590 Health Essential Services said because of these, our families are going to become more DCF involved, and parents are potentially going to lose custody of their children for accessing just basic care. We just worked with1604 a family for three years, she finally got her kiddos back, her four kiddos because all she did was bring her kid into Lemon stir Hospital for a burn that they were not prepared to handle, they shipped her and her kids to Worcester and then sent her home and said, don't worry, mom, we've got this kid up. Go home, get a good night sleep, make sure your two other kids get to bed, DCF pulled their kids the next morning. The stakes here are higher, right? Like, we fought for three years to get that family reunited and were successful. If someone gives birth on the side of the road, and there is an emergency, if someone's in the emergency room and they are not prepared because they cannot move that patient, if they don't have the equipment, we are going to lose lives. In Massachusetts, one is too many, right? We're Massachusetts, we can figure out these problems and if we don't stem the tide here, I don't know what we're doing.
REP KANE - Thank you, Madam Chair. You may not have been given this information yet but is there existing capacity in the Worcester location for handling higher labor and birth delivery? I guess the other question is, what is the private public payer mix at the unit they're closing? Is there any reason if it's higher on the public payer side, are they saying that's one of the reasons that they're closing it, or is it a mixture?
HIGGINS - So, Rep Kane, they're not using that as a rationale. I will say we just heard a story from some of our incredible nurses where there was a 31 week birth and like, thankfully delivered successfully and swept away to Worcester. There wasn't a bed for the mom to meet that baby in Worcester, so the baby went to the NICU and the mom stayed at Lemon stir Hospital and really concerned about the capacity and what that does to a family when they're recovering. I'm going to defer to Rep1726 Zlotnik who can talk about the state of Gardner, but we have twice as many births at Lemon stir than Gardner sees1732 and Gardener's committed to keeping their labor and delivery unit. I think that these problems are solvable.
ZLOTNIK - I think the question of capacity is tricky because everybody's facing these same challenges, right? You know, obviously, like Natalie just said, Gardner's committed, Haywood's committed to keeping their unit open. I think they've some incredibly creative solutions to some of the problems that everyone is facing but the concern is that there is a bit of a domino effect with some of these closures or any of the ramifications with anything that happens in the health care system across our region because everybody's taxed, right? Everybody's short staffed, everyone's having trouble recruiting, everyone's on a tight budget. You know, so it's not like there's sort of a magical surplus of resources somewhere that all these patients can go to. So I think we're all realistically skeptical of that being smooth, which I'll just tie it again to, that's why at the baseline, these types of things takes more than six months to iron out. You know, whether it's notifying people of making sure that, whatever landing site they're going to is gonna be ready for them, it takes more time than the current system allows. SHOW NON-ESSENTIAL DIALOGUE
Any other question? So
SPEAKER21 - So repeat myself.
SPEAKER1 - Oh, Senator Cyr?
SPEAKER22 - Can I ask the virtual question? I I I feel like, you know, thank you.
SEN CYR - Thank you, Chair Friedman. You know, I feel like you all just offered testimony that conveyed in1826 real time exactly why we need Senate Bill 736 and House Bill 1175. I think it reflects and I think your testimony was more compelling than anything, you know, I could have given. Although, you know, we've seen this very same scenario sort of play out with maternal health, right? So, you know, we had Morton Hospital closed their services, patients were redirected to be at Plymouth hospital, to South Coast Toby in Wareham, then1861 Toby closed, patients were redirected to St. Luke's in New Bedford and Falmouth. Then Falmouth closed and patients were redirected to Hyannis via the Plymouth in New Bedford. Right? And the remaining hospitals we have in the region are completely overwhelmed with a sudden influx of patients. I would sort of ask, you know, what is to keep these hospitals from saying in a couple years or a couple months, you know, we're not out to close Gardner.
I certainly buy the workforce piece, I don't buy the cost piece. Fair health just completed and the parent's cost hospital for in 50 states. Massachusetts has one of the highest charges and paid rate and yet we're seeing these closures. So, I would ask you folks,1905 what is there to keep to actually have a rational process by which we assess essential services in Massachusetts? We could talk about this in the context of behavioral health too, look at what's happening in Western Mass despite significant support and financial support from the state to bolster these facilities, we're continuing to see closures. So, you know, looks are current, I mean, I obviously filed the Bill, so I have some opinions on it but there's a current process at DPH, which I remember being involved1938 in when I was a mid level bureaucrat of that agency. It is effectively a talk and company show and if the hospitals just endure, I guess, the public shaming of that process, they can do what they'd like.
You know, I think in a health care ecosystem where we just continue to see further consolidation, this lack of accountability is really detrimental, particularly for communities like yours and communities like mine, right? Those of us who are geographically isolated. I live an hour from1969 the closest emergency department and also the closest maternal health, not that1973 I'm necessarily seeking that right now at this time, right? You know, this is a real issue, particularly for those of us in the hinterlands as we continue to see this consolidation of this consolidated health care system. So I wonder if you all could talk a little bit, is there any commitments? I'm sure you've received commitments right from these folks being like, we won't close Gardner but have you received anything else? Do you have anything else that's sort of stronger than some sort of verbal commitment to continue the services you know, in the region or what other services are next? I mean, I remember Jen Flanagan working on these issues in your neck of the woods, you know, probably a decade ago, so seems to be a pattern here in North Worcester County, it's a pattern in Southeast of Massachusetts. You know, just curious what other steps of accountability have you received too?
KILCOYNE - Thank you. First of all, thank you so much for your advocacy on this issue. Obviously, given your work on this Bill is one of the reasons we're here today. But I think that you speak to a lot of the reasons why we're sitting here, what's happening in Lemon stir Hospital, obviously, is kind of a crisis right now, but we see what the future could hold. This is not the first time we've been down this road. You mentioned Senator Flanagan's work a few years ago, I was behind the scenes on that as well regarding in that case, I know there's other2057 closures happening as well that I think Rep2059 Kushmerek can speak to. But Clinton Hospital closed several what was deemed nonessential services in about 2018 and so we had to basically raise enough noise to forge DPH to sort of hear some of the public testimony. I think one thing that we fear is once these facilities start falling. In my district, once Clinton hospital, if these closures continue, there will be no hospital and people in my region will have nothing but two urban areas to go to. I think being able to factor in some of the public health impacts of this, the true community impacts of this and factor into the decision making is huge. Again, we appreciate your words today and your advocacy on this Bill.
CYR - Well, if I may, right? With these closures, right, you all will be just more and more like Cape Cod, right? So I represent a community furthest from a hospital, from the emergency department anywhere in the Commonwealth. That's province down Turro, Wellfleet, and East Ham. You know, look, you make certain sacrifices when you live at lands' end, and I understand in our very small rural towns while we probably couldn't support sort of a full fledged hospital in Providence town or Turro or something. You know, year round, we have some good support from our community health centers but we're the outlier, right? You know, we should not be adding more communities that are further and further, right, 45 minutes an hour plus away from these services. So I really worry that you folks are going more in the direction of where we are on the Cape. You know, we should be the exception, we should be an outlier, not increasingly, I think, for hill towns and for2157 hinterlands or parts in the South or in the West or the part of the state increasingly left with very limited health options, you all shouldn't be going in the direction for where we are here on the outer Cape.
KILCOYNE - And Senator, you probably understand this as well that putting directions into Google Maps or Map Quests are not really indicative of the actual travel burdens that many families face. Whether you're coming from one end of the city to the other and don't have access to a regular bus route or, in my case, you could literally be in the deep dark woods of Northern Sterling or Lancaster with no street lights and, you know, God knows what kind of animals walking across if you have an emergency in the middle of a night in the middle of the night. So I think there's a lot of factors that are simplified oftentimes in these decision making. I think we've seen a little bit of that2205 in the explanations that we've been given for some of these closures and I agree with everything you said that we have to make sure that we're not adding an increasing lack of access in more communities than we have right now and I think that's fear and why we're here today.
FRIEDMAN - Well, so thank you. I want to answer Senator Cyr's question, behavioral health, maternal health, and primary care are closing because they don't make any money and that's why they're closing and we need to just acknowledge that and have honest conversations about where we want to put our healthcare dollars. We know that the DON process is not working right now, it was put together,2257 you know, I think the last time 13 years ago, the world has changed, we need to fix it.2263 I think Chair Lawn and I totally agree on that, and we're really focusing on doing something around that, which would include these kinds closures. I am deeply concerned that that is not going to happen in the time frame that this Bill would come to fruition, so I will commit us to reaching out to Doctor Dixon and see if we can facilitate a real conversation about your favor. This is just another way that we treat women and so we need a whole lot more thought. SHOW NON-ESSENTIAL DIALOGUE
So that
Sherylon and I think is listening, but I think he would absolutely agree with me that this is something that we may or may not be able to lend our voices to, but we will certainly try.
SPEAKER8 - Thank you. Okay. Thank you.
SPEAKER1 - Oh, I wanna welcome rep, Natasha. I think she's on online. Okay. So now we are
Oh, representative current is here or is testify? There you2350 are.
REP KERANS - SB 736 - HB 1175 - Morning, Chair Friedman and esteemed colleagues on the committee. Thank you very much for the opportunity to be heard on legislation relative to the closing of hospital essential services, what you are talking about. You all are far more familiar with the intricacies of this problem and this legislation. I just did want to take a second to share an example of a closure that has impacted many lives in the area I represent. By the way, I'm Sally Kerans, I represent Danvers, West Peabody, Middleton, Topsfield, Wenham. The nearest hospital is Beverly Hospital but we have no shortage of hospitals, and luckily, our essential services for the most part are intact. However, against the backdrop of closures elsewhere, out of hospital midwifery care has been proven to reduce maternal deaths, decrease reliance on C-sections, and increase breastfeeding rates, all very good things. But despite the hard work of many advocates, some who are here, the North Shore Birth Center Beverly closed in December of 2022.
Now, the birth center was feet away and under the auspices of Beverly Hospital. Given the current laws governing situations like these, DPH had no authority to override the closure decision and countless mothers were left scrambling, some in the middle of their pregnancies to figure out alternatives. It is not an isolated incident and based on a report from the MNA, there have been five such closures of maternal health services, as you all know, across the state from 2009 to 2022. We must do better, this Bill would prevent instances like the closure the Beverly Hospital Birth Center by extending the official notice period to DPH in advance of a closure or discontinuation of health services. I will say during this process, we were very frustrated, and I respect2501 Beverly Hospital, I had a C-section at Beverly Hospital, it went fine, I'm okay. But we were very distressed at the response to our inquiries to Beverly Hospital to ask, can't you find a way? Can you find a way to keep this going? Could you identify another provider?
Now to their credit, they have put up, you know, $1,500,000 to find alternatives, someone has to find them. I think that this legislation would help by giving some tools, it would prohibit the hospital from eligibility for expansion, Beverly Hospital is looking at such plans for a period of three years from the date the service is discontinued if DPH deems it essential and require the AG to sign off on any closures. So with that, I just wanted to share again, my perspective, feeling very grateful that women in my area don't have to drive an hour but if your water breaks, you're going to drive an hour. So I'm very grateful that we're not in that situation, but also hopeful that this legislation could prevent the further erosion of what we all know are essential services. Thank you. SHOW NON-ESSENTIAL DIALOGUE
Thank you.
SPEAKER12 - Coming back next door to a 1 where they have no AC. of all the AC in this 1. Anyway, thank you very much. Any question?
SPEAKER1 - Thank you very much.
SPEAKER15 - Thank you.
SPEAKER11 - Bye
SPEAKER1 - bye. The next of
a rep Capano Capano.
REP CAPANO - SB 736 - HB 1175 - Thank you, Madam Chair, members of the committee. I'll be brief, I don't want to repeat everything that was just said. I2623 agree with my colleagues2625 and I'm here to support Senate 736 and House Bill 1175, an act relative to the closing of hospital essential services because I'd like to prevent what's going on in Lemon stir right now. A quick story about what happened in Lynn, I've been around for a long time. I was on the State Council of Lynn for a long time before I came here2653 to the State House, I remember when there were two hospitals in Lynn, since that time, 30 years later, we have zero hospitals, and we have 20,000 people more than we had before, so I think that there needs to be more accountability. The determination of deed, like was mentioned earlier, really, the hospitals can make it sound like nobody is even using the hospital, they can play with numbers, and that's what they did, they can deny service, take services out, make it look like nobody's using the hospital and in the end, just do whatever they want to do as they did in Lynn and I'm talking to decent sized hospitals, so2702 I'd2702 like to prevent that.
Right now, people in Lynn have to go to Salem Hospital, where the emergency room is just like a lot of emergency rooms that you hear about now. It's just overwhelmed where people are waiting for hours and sometimes days and if they can't get to Salem Hospital, they have to go to Mass General in Boston, it's just totally unacceptable. I have stories, nightmares, actually, which probably some of my colleagues here have too of people waiting in the hallway for a room because there is no rooms. So they've created this and actually complaining about it now. There are examples of where hospitals and other places want to expand in places where they have just closed community hospitals. Lynn is a poor city, we need access to health care. It's much easier probably to start there and then move their way along but this consolidation of the hospitals here, the elimination of services, all going to the bigger hospitals and I don't know, you know, how they are going to survive the nursing shortages that people talk about.
My wife has been a nurse for 40 years, and people are leaving because they can't stand working in the hospital anymore. When she started, what she tells me is when people came in, they would treated as patients, now they're treated as customers and nurses just can't take the stress of working anymore. So what is obvious to everybody else is the fewer hospitals there are, and the more patients that have to go to those fewer hospitals, the more stressed the workforce is going to be. I have information from the MNA that tells me there are more nurses now than there were pre Covid, but people are leaving the industry. So I don't want to digress too much, I'm in strong support of this Bill, and I urge you for a favorable recommendation out of committee. Thank you. SHOW NON-ESSENTIAL DIALOGUE
Thank you.
RIP Daugherty.
She's not mine.
Bye.
SHOW NON-ESSENTIAL DIALOGUE
Bye. Thank you very much for thank very much for providing me with this opportunity. I was a very
Hold on. 1 second. Sure. Start to speak with You're not coming through. Talk to say hi.
Hi.
2873 You2873 hear? Can you all hear? Don't laugh. No.2875 We can't we're having a little trouble2877 hearing you. Alright.
I'm going to do is to step out2881 and change
That's better. That's2883 better. Yes.
Alright. So you're just yell out if I stop hearing me.
REP DOHERTY - HB 1175 - SB 736 - So thank you very much for the opportunity to testify in support of H 1175 which you have just heard from my colleagues from Central Massachusetts. The story here in the Southeast regarding closures is basically the same sad2907 tale that is being experienced all over the Commonwealth. I represent the 3rd Bristol district, Taunton and Eastern Taunton being a gateway city. Here, since the takeover by Stewart of Morton Hospital, the community has seen the loss of a pediatric unit in 2013, the loss2928 of the maternity unit in 2017 and now the plan closure2932 of the detox unit, which has been proffered by the hospital up the line to DPH for2939 approval. The lack of pediatric2941 and maternal health service has been devastating to the members of my community. The elimination of these services has not meant that families in2949 the greater Taunton area don't need this care, rather, it has meant that the families are forced like others as you have described in great detail, force them to travel further for services or even go without care. Presently, the Stewart proposal to relocate the more cap facility to Dorchester will have a similar effect on those from our community who seek access to substance use disorder treatment.
This Bill will create a process for the closure of hospital essential services which would include a number of checks and balances. The one year notice that you heard about before closing or discontinuing essential health service, it also requires hospitals to seek approval from the Department of Public Health before so doing and provide evidence of community input. But I will say that when maternity and pediatrics closed and when this proposal to close the detox unit, community input has been given loudly and strongly, and it seems to be to no avail. Stewart is a private corporation that holds sway over our health and well-being here in the Southeast. This legislation requires hospitals to submit plans to DPH for assuring continuing patient access to care following closure especially if the closure will significantly reduce ready access to these essential services. Further, the Bill seeks to ensure continued operation of essential services during health emergencies such as we saw during the pandemic and it will ensure that hospitals will be unable to close any beds or units or facilities for the duration of the emergencies.
So you can see that this is multi faceted, taken together, the several components of this legislation recognizes the challenges that have been experienced in the Commonwealth not just here in the Southeast, but as you have heard, all over the Commonwealth with respect to access to essential healthcare services and seeks to provide a robust process, working with stakeholders3080 at the local and state level to prevent similar problems from continuing to happen again and again and again in the future. So I thank you for your time, I'm very interested in listening to my colleague's testify to this legislation and I urge this committee to support our effort to support our communities by giving 1175 a favorable recommendation. Thank you very much. SHOW NON-ESSENTIAL DIALOGUE
SPEAKER1 - Thank you. Questions?
None. Senator Pacheco.
Senator Kennedy.3118
SEN KENNEDY - HB 1175 - SB 736 - Good morning, Madam Chair, Chair lawn, and members of the committee. I will submit written testimony and but did want to take the opportunity to add on and to stand with my colleagues both of North Central Mass3139 delegation as well as my other colleagues who've jumped in just to offer similar experiences that we've had in the Worcester area with recent and sudden closures both at Community Health Link, which is a subsidiary of UMass Memorial which recently announced closure of their detox and transitional services as well as with one of our health centers here in the community. The point that I'd like to offer and to add into the conversation that has occurred so far and the important nature of this legislation is that in both instances, while the community and members of the delegation were notified at the 11th hour, as part3182 of the notification we were made aware that the concerns whether it be with3186 staffing, with service provision, with utilization were well known to the hospitals well in advance.
As was noted before, what should be a conversation that members of the delegation, members of the union representation, members of the community should be a part of well in advance to help address some of those challenges, unfortunately, those conversations did not occur. Not only was the delegation asked to respond, again, at the 11th hour in both of those instances, the community was left dealing with not only3222 as we talk about workforce challenges, those members of our community, the workforce, which I know you'll hear from, who were left without3228 a job within 24 hours notice in at least one instance, as well as trying to find ways to support members of our community as we are all seeing in addition to a workforce crisis and increase in need for emergency services, including things like mental health and substance misuse treatment. So the important factor to this Bill to me is not only the additional time that it would require for3259 hospitals to notify the Department of3261 Public Health, but also the requirement that the hospitals are notifying their local delegations, local city and state officials.
Again, members of the unions represented at the hospital, and members of our community so that not only as was mentioned previously, we have the opportunity to help intervene, but that we also can work with the hospital and work with our community to make sure that we are providing an alternative to those services within our community and not to belabor the point, but to add to and uplift the point made by my colleagues that need to make sure that those services are available and accessible within our communities so that our most vulnerable, in particular, residents are able to access them in timely manner. So I will submit more formal testimony, but I just wanted to add that point, again, to me, the importance of this legislation. So I do ask the committee to vote favorably for Senate 736 and House 1175, an act relative to the closing of hospital essential services. Thank you so much. SHOW NON-ESSENTIAL DIALOGUE
sir comments. Are there any other thank you, Senator, for testifying. Are there any other elected officials that I did not see or are online?3339 No? Okay, great. Well thank you very much.3343 We're now gonna hear from Barbara Bain.
BARBARA FAIN - THE BETSY LEHMAN CENTER FOR PATIENT SAFETY - HB 1165 - SB 728 - Good morning, Chair Lawn, Chair Friedman and members of the committee. My name is Barbara Fain, I'm the executive director of the Betsy Lehman Center for Patient Safety and I am pleased to be here today to testify in support of House Bill 1165, and it's Senate companion, Senate 728. These Bills would make minor, but important changes to the leading centers enabling statute and help us advance a pretty critical mission, which is to reduce what remains persistently high incidents and cost of preventable medical harm in the state. I will be submitting written testimony, so just want to give you some highlights, but just some context before I get into what the technical amendments are. As I think some of you know, before the pandemic started, we released research that we were able to identify almost 62,000 individual cases of preventable medical errors in a single year in Massachusetts, and the costs associated with those firm events totaled just over 1% of total health care spending in the state that year.
So these are really significant issues that we're addressing, and, unfortunately, those figures are pretty conservative because of the methodology we use and because of the limited access to data that we currently have. As some of you also know, in just a couple of months ago, we in partnership with the Massachusetts health care safety and quality consortium that the Betsy women center has been leading, we released a road map to health care safety for the state, and that's a broad, long term strategic plan to really3472 make significant progress on these issues. We're excited about the road map, it is really a sort of a classic Massachusetts first in the nation attempt to implement a coordinated phase set of action3488 steps to overcome the barriers that have been standing in the way of real progress on safety improvement. Some of these action steps will require legislative action, and we'll be looking to you for help on that in the future. But the Bills before today seek only modest technical amendments to our enabling statute, so really what we need to carry out are our mandate. So part of our mandate, I mentioned data, is that we gather and analyze data from multiple sources and regularly publish information about health care safety risks and trends across the state. But currently, we're only able to access, like, the tiniest sliver of the relevant data that we need that's collected by various state agencies boards and commissions.
So one of the technical first simply is to clarify the authority of other state entities to enter into appropriate data sharing agreements with the Betsy Lehman Center. I'm also excited to report that with the support of the Healey administration, we are about to convene a new interagency task force focused on harmonizing and optimizing this multitude of safety data collection systems and so your favorable action on this amendment will be especially timely and impactful. The Bills also would create a permanent trust account for the Betsy Lehman Center so3582 that we can seek and receive3584 and retain funding from the federal government and private foundations. The executive office of administration finance has established a temporary3593 trust for the center, but it's going to expire in 2025, and they've already told us that they will not renew the trust without express legislative authorization. So I just want to close with two points about the Bill. It doesn't add any costs, and they don't fundamentally alter the Center's Authority and these Bills have also been reported favorably by this committee in multiple past sessions and so it would be really great3624 to get it over the finish line in this session. So just thank you again for the opportunity to speak on these Bills, and we appreciate your support and refer to working with you in the future. Thank you. SHOW NON-ESSENTIAL DIALOGUE
Any questions or comments?
Thanks so much.
Emily, too long.
3648 see3648 normally.
Okay. Marie
Ritocco.
Katie Murphy.
SPEAKER27 - I'm here. Sorry. Sorry about that. I'm working from home too and I was trying to pay attention. Excuse me. Can I start?
SPEAKER1 - Yes, please.
SPEAKER27 - Okay.
MARIE RITACCO - MASSACHUSETTS NURSES ASSOCIATION - SB 790 - HB 1179 - Thank you, and it's very nice to be here. I am Marie Ritacco, the vice president of the Massachusetts Nurses Association. I have been a nurse for almost 40 years and for the majority of those years, I worked at St. Vincent Hospital in Worcester. I3693 was one of more than 700 nurses3695 that joined a nearly 10 month strike against Dallas based Tenant3701 Healthcare, a multibillion dollar for profit corporation that is the poster child for the Bill that I am here to testify about today, Senate Bill 790, and House Bill 1179, the hospital profit transparency and fairness act which would require hospitals to be transparent about their financial holdings and claw back excessive profits and funds spent on exorbitant CEO compensation to ensure that taxpayer dollars are instead dedicated to3736 safe patient care and essential health services. As I said, my employer, Tenant Healthcare, is a perfect example of being one of the nation's largest most profitable hospital corporations. St. Vincent Hospital is among the most profitable of all of Tenants, acute care hospitals.
According to the most recent3758 financial report, Saint Vincent Hospital,3760 has a profit margin of 14%, which is four times the state average for hospitals and a whopping 67% of its revenue is derived from taxpayer money in the form of Medicare and Medicaid payments. In 2020, CEO Ron Rittenmeyer bragged to shareholders of its plan to use furloughs and staffing benefit cuts and more than $2,800,000,000 in CARES Act funding to maximize our cash position. Tenant proceeded to cut staff during the pandemic and went on to post profits during the pandemic of $414,000,000. Tenant's stock value also nearly tripled as tenants executives sued Covid relief funds to boost the company's bottom line. As a nurse who worked at St. Vincent throughout the pandemic, I can tell you those profits were made on the backs of nurses and other staff, and at the expense of safe patient care. Hospitals and large healthcare corporations are putting profits before patients, while patients and communities are being put at risk.
You'll hear today about how hospitals are putting profits before patients by closing essential health services across the state.3835 To hold these hospitals and healthcare corporations accountable, this proposed legislation would do the following; require a facility that accepts a certain percentage of taxpayer money and has an annual operating margin in excess of 8% to pay civil penalties equal to the amount of profit that exceeds 8%. It would require a hospital that receives taxpayer money and compensates its CEO more than 100 times his annual compensation of the lowest full time employee to pay a fine equal to the amount over that cap. It would require every hospital that receives taxpayer money to disclose all financial assets, including asset held in offshore accounts. Finally, these Bills create a new Medicaid reimbursement enhancement fund where in the aforementioned civil penalties are deposited and used to improve Medicaid reimbursement to eligible hospitals. This could help to maintain essential health services in communities across the state. Today, we have a healthcare system of haves and have nots, where the health care corporations are the winners, and too many patients and communities are the losers. Our hospitals no matter who owns them are a public trust in our safety net and this initiative is designed to3913 give some long overdue control back to the taxpayers and help protect that safety net. Thank you very much for your time. SHOW NON-ESSENTIAL DIALOGUE
Thank you. Are there any questions
No. Thank you. Katie Murphy now.
KATIE MURPHY - MASSACHUSETTS NURSES ASSOCIATION - HB 1175 - SB 736 - Good morning. Thank you very much, Chair Friedman, Chair Lawn, respected members of the committee. My name is Katie Murphy, I'm an ICU nurse at the Brigham and Women's Hospital and President of the Massachusetts Nurses Association representing over 25,000 nurses in healthcare professionals, and it is on their behalf I offer this testimony in support of Senate 736 and House 1175. The loss of essential services in communities in the Commonwealth is in a crisis. For years, we've seen high and healthcare corporations eliminating essential health services. These closures happen over the objection of the communities and in most cases, despite the determination of the Department of Public Health. This has left pockets of the state without access to essential health services. Our current essential health service closure process is broken, decisions about these closures are made in boardrooms against the best interests of patients and their communities who suffer without local clinically appropriate care. The legislature has worked over the past two decades to expand insurance coverage but health care is only as good as someone's access to it.
This Bill would make improvements to the current process by one, requiring one year's4015 advanced notice of a closure and others have addressed that issue, requiring any hospital proposing closures or discontinuation of health services to provide evidence of actively having sought and received community input. Prohibiting a hospital expansion for a period of three years from the date of service is discontinued if the DPH deems it as necessary for preserving access to health services. Too often, we see hospitals closing less profitable services, behavioral health and maternity in favor of opening more financially lucrative centers. Requiring the AG to sign off on any closures the DPH deems necessary to maintain health and health service, and prohibit essential services closures during a public health emergency. While this Bill doesn't solve every problem around the closure of essential services, it does take meaningful steps to improve the process and I urge you to issue a favorable report of this Bill and we will submit4081 additional comments in writing. Thank you. SHOW NON-ESSENTIAL DIALOGUE
Thank you. Any questions?
Thank you so much.
Amy Gagnon and Tara Corey.
AMY GAGNON - LEMON STIR HOSPITAL - SB 736 - HB 1175 - My name is Amy Gagnon, I've been a registered nurse at the birthing center at Lemon stir Hospital for more than 12 years. Like so many of you here today, I am outraged by the plan to close yet another essential service. In the last decade, we have seen the loss of no less than 10 maternity units in the state of Massachusetts, each of which was evaluated by the DPH and subsequently deemed essential to preserving the health of the community and still allowed to close. This closure if allowed to go through will have a devastating impact on the families of my community, particularly economically disadvantaged residents who lack the ability to travel long distances to receive care in Worcester. It could mean mothers will be delivering in our already busier emergency room which does not have the appropriate staff, skills, or resources to provide the care these mothers and babies need. Many mothers could end up delivering on their way to Worcester or in the back of an ambulance if we can get one. I have had multiple nights where I try and call BLS or ALS transport and I'm told no one is available for four hours or for eight hours or even until the morning.
A mother in active labor or experiencing an upstorical emergency cannot wait till the morning. I have taken care of countless mothers who have delivered within minutes of being on our unit. One particular patient was a 19 year old mother who came in ready to deliver her first baby prematurely at 24 weeks pregnant, she was supposed to deliver at UMass Worcester because she was considered high risk, but she never would have made it to Worcester. Her baby was born within 15 minutes of her being on the unit, apneic and not breathing and needing positive pressure ventilation then needing to be intubated. I did CPR on this baby for several minutes assisted with umbilical line access in giving epinephrine. The baby was stabilized after several minutes, had our unit not been here, the outcome would have been devastating. Right now, there is little that can delay or stop a closure and as a result, we have seen hospital executives across the Commonwealth of Massachusetts cut all types of services including maternity services. That is why I am here to support House Bill 1175 and Senate Bill 736. The current essential service process is broken and we need your help to fix it.
In 2018, I was there to witness the closing of the pediatric unit and saw firsthand how the DPH declared the pediatric unit necessary to maintain access to pediatric care in the community, but had no authority to enforce its ruling. UMass made a promise to DPH to make a pediatric observation area in the ER and to provide transportation to patients to Worcester at the time of closure. This never happened, and there were no repercussions. DPH needs more control over hospitals in their closing of essential services. I am here because we need this legislation and the improvements that it provides. I want to thank you for hearing our concerns today and I urge you to give a favorable report to this Bill, so we, the people of the4289 Commonwealth, and not the corporations, have access to control those services4293 deemed essential to the public health. Thank you.
TARA COREY - LEMON STIR HOSPITAL - SB 736 - HB 1175 - My name is Tara Corey, and I am also a proud nurse at Lemon stir Hospital. I started my career in a big city hospital and quickly realized the value that small community hospitals give to our patients. I'm here to speak in support of House Bill 1175 and Senate Bill 736, an act relative to the closing of essential services. Both my husband and I4320 were born at Lemon stir Hospital, and it is4322 where I gave birth to both of our children. Lemon stir Hospital is quite literally where my life and my family began, I consider it an honor and a privilege to work with our community members during the most profound moments of their lives, helping new parents bring their miracle babies into this world and watching those babies take their first breaths is truly one of the greatest joys of my life. But all of that is about to change if UMass proceeds with closing our birthing center. When I first learned about the closing, my first reaction after the initial shock was there must be something we can do, but we've learned there really isn't.
The current process for closing essential health services is basically in the control of hospital executives many whom have no medical background and in this specific circumstance have not been there to witness the miracle or the potential dangers of childbirth. We have the support of community, frontline staff at the hospital, and our local and state elected officials, but none of that matters. I've even learned that it doesn't matter if the state's DPH determines it's necessary for the health of our community, and that is why we must perform this process. Community should not4389 be left in the lurch with just four months notice of a closure, expecting mothers should not be left to come up with a new birth plan halfway through their pregnancy. Hospitals should have to engage meaningfully with communities ahead of any closure announcements and have some accountability if they close in opposition to a DPH ruling. The current process makes it far too easy for them to just take away services from any community even when it affects the most vulnerable of populations.
I fear for those who will be left behind if our birthing center closes, the mothers who won't make it to a hospital and will deliver on the side of the road in their vehicles with4424 no medical personnel present, the mothers who will deliver enroute during the 30 minute drive in an ambulance on a non sterile gurney and the mothers delivering in a crowded and busy emergency room with overloaded staff who do not specialize in childbirth and neonatal care. All mothers should have a safe place, physically, medically, and emotionally to deliver their babies, and babies should come into4446 this world under the care of trained personnel in an environment catered to them.4450 Mothers and babies should be able to be cared for at our birthing center. I am saddened and4455 alarmed that our employer wants to strip our community of this absolutely central service and the impact this will have on our patients. I am here today asking for your help, help for our patients, our community, and to help us change the course of health care so that this truly alarming circumstance will never again occur in the state of Massachusetts. Thank you.
FRIEDMAN - A quick follow-up question; How many maternity centers have closed? SHOW NON-ESSENTIAL DIALOGUE
You you mentioned that
COREY - In Massachusetts, there's at least 10 that have closed over the last second week. SHOW NON-ESSENTIAL DIALOGUE
Last second. Okay.
That's it.
SPEAKER1 - Great. Thanks.
Mhmm. Any other questions?
SPEAKER19 - Thank you for your testimony. I
SABADOSA - You talked about the difference delivering in an emergency room and delivering in a birth center and I wondered if you could just clarify why an emergency room would not be the appropriate place?
GAGNON - Delivery bed in the emergency room, there's no neonatal resuscitation equipment there, when you're delivering a baby and the baby needs resuscitation at birth, we need five people available for that resuscitation. You need a respiratory therapist, you need a PD hospitalist, you need a nurse ring nurse one, a nurse ring nurse two and a reporter. So all of these people will be getting laid off if the unit closes except for the respiratory therapist, so there'll be nobody there to intubate a baby. If you have a micro preemie, you cannot maintain ventilation unless that baby is intubated, there's no device capable4558 of doing that. The4560 people that are transporting these mothers back and forth with BLS, ALS, none of them are trained, they don't have equipment on the ambulances to resuscitate these babies.
COREY - I think there is quite a few times in our careers that we've had to go to emergency C-sections, our unit has one there readily available. We're looking at now if there's an obstetrical emergency in the emergency room, have to go to the main OR, which is usually pretty filled up with different surgeries, and they're not catered to infant resuscitation as she was saying. So it's just the whole environment is not going to support any emergencies, let alone significant ones.
FRIEDMAN - Thank you. Have you seen4613 a real decline in the number of people coming to the hospital?
GAGNON - So we have and we believe that it's being orchestrated by the hospital, about six years ago, we were doing over a thousand deliveries a year, and then it quickly went down to 500 deliveries year, and when we investigated it, we found out all these patients were Medicare, Medicaid patients. We used to service a large population among patients that literally disappeared overnight and when we looked into it, these patients were told they now had to go to Worcester and deliver their babies. So we think that's when this sort of all started.
COREY - Although we've seen a decline, they also did change the staffing model, so we don't have as many staff as we did six years ago. So they did make that change in support of the declining birth rate, but we still are busy, I mean we had just last week and there was eight babies born, which is significant for a community Hospital. So, yes, we've seen a decline in the overall numbers, but it doesn't take away from the fact that we're a busy unit serving our community.
GAGNON - This morning, we had a mother come in and deliver within 45 minutes of being on the unit, she never would have made it to Worcester. SHOW NON-ESSENTIAL DIALOGUE
Wow. 45 minutes.
Yeah. It's lonely.
What
FRIEDMAN - So you saw decline, it was very cliff like, one day?
GAGNON - Yes. It's4705 like the whole population of just all that basins.4707
FRIEDMAN - And they were told that they had to go, Medicare and Medicaid had to go to Worcester. Do you know why?
COREY - It was certain providers, so outside of the UMass system, different providers were referring their patients to deliver at St. Vincent or other hospitals that were not part of our system. So it was orchestrated, and it's not people that are coming to the practices that we still see regularly, this is people that see their different family practices throughout the Lemon stir area that are being directed to go to Worcester.
FRIEDMAN - And their doctors are not affiliated with the?
GAGNON - Right. They're delivering under reliant services, which they do have an office in Lemon stir, but they deliver all their patients at CMBs.
FRIEDMAN - Is reliant for profit?
GAGNON - I believe it is.
SHOW NON-ESSENTIAL DIALOGUE
SPEAKER6 - So
SHOW NON-ESSENTIAL DIALOGUE
SPEAKER9 - It's St. G's. Sorry. Yeah. St. G's. Okay. 1st
SPEAKER1 - Okay. So it is. It's part of tenant? Yes.
Okay. Great.
SPEAKER9 - Yep.
SPEAKER1 - Thank you. Yeah.
SPEAKER9 - Thank you.
SPEAKER1 - We appreciate your help. Oh, so I'm sorry. Yep.
SPEAKER15 - any sense of what the
CRONIN - It sounds like people are doing some steering, right, around reimbursement levels. And so is Lemon stir reimbursement rate the same for normal delivery as is Worcester? You know, I know, if you hear anything or? SHOW NON-ESSENTIAL DIALOGUE
service or Medicare, Medicare, medication, financial.
SPEAKER29 - Oh, then, NICU.
SPEAKER9 - Yeah.
GAGNON - So we're seeing nationwide all across the United States, these small hospitals trying to funnel patients to large tertiary care centers, because the cost of the delivery from soup to nuts is around $6000 for a pregnant patient, whereas if I came in having Blue Cross and Blue Shield, it would be as high as $25,000. So we're seeing a lot of these hospitals funnel the patients to the large tertiary care centers to keep them all under one roof that's already busting at the seams because they're generating4843 a lot of money from the NICU. So the high cost that they're getting from the NICU is offset by the low cost4849 that they're getting from the delivering.
MURATORE - Under our Mass health, Medicare, Medicaid, not we, the4859 state4859 of Massachusetts is not paying enough, right? Because we don't have this problem and then if they are steering to go to the big hospitals to let them take the whack and keep them out, you know, if you're gonna lose, you know, 30% every time you treat somebody, and you can move them, that's probably what's going on. So we're just not reimbursing at the proper level to keep it open and then you see the disproportionate drop in number of deliveries and it just goes on and on.
FRIEDMAN - Just for the record, Reliant is owned by UnitedHealth. So that gives you an idea of what this is.
SHOW NON-ESSENTIAL DIALOGUE
it United? Yes.
SPEAKER15 - Yeah.
SPEAKER4 - So thank you too. It's good to see you both again. Thank you.
CRONIN - Thank you so much for your testimony here today. I think we have a clearer picture that when we learned of the closure notice, we were told that birth rates in the region4916 were declining, we haven't been provided with data that has supported that claim. Births at Lemon stir Hospital are declining, but in 2021, there were more than 1900 births in New Mass Memorial Health Alliance's service region that is more than there were in 2019. What Health Alliance is also telling us and I4936 think there is more work that the delegation and people on this panel need to do to understand why patients are being directed one way or another way and we have a system that is working like anything but a system. What Health Alliance has told us and what Doctor Dixon has told us is that they cannot deliver care to people in our community in your unit safely. I'm interested how you respond to that. As a follow-up, I'm interested, what resources do you need that you don't have right now to deliver safe care to expect in mothers in our area?
COREY - That's a great question because one of our big things that I wish we had done marketing over the past six years was we have a pediatric hospitalist in house 24/7, other community hospitals in the area do not. That is a huge thing for me as a mother when I was giving birth to my children to know that there is a doctor specialized for those babies to be there no matter what time of night and that is something I think that shows we can give safe care. I think we do give really great safe care, we have very trained personnel on, we have surgical techs, we have our nurses in LND scrub into the OR for C-sections themselves, we have respiratory therapists covering our unit at all times. We do safety huddles every shift at the beginning of the shift and talk about the team who's on, the patients on the floor, and who has what role. We have a5030 very safe structure in place, I'm5032 not sure where this unsafe staffing model is coming from. I do know they have not been hiring as far as nursing, regular staff, they've been using travelers over the past few years, but we know for a fact there was 40 plus applicants for the positions that they were not hiring over the past few years. So I'm not sure why they're saying that, we provide safe care, and we're committed to continuing that.
FRIEDMAN - I mean, would your record show whether your care was safe?
COREY - Absolutely.
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that.
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I mean, you did.
FRIEDMAN - I would think you would just look at what your record is over the last six years or whatever. SHOW NON-ESSENTIAL DIALOGUE
and you would was born there. I don't know if my trip had already lived there.
SPEAKER1 - Well well, we're sure that but there's always a 1 offs. That's a Perfectly.
MURATORE - Question, have there been less, like, how many nurses and doctors do you have when when a baby's born, is there, like, five or six people?
COREY - We have others with the mom, the labor and delivery nurse, a nurse for the baby, the nursery nurse at all times, plus the obstetrician, if we are expecting any sort of issue at all, we have those three plus we have the respiratory therapist in the room, another nursery nurse, and the pediatrician in the room. So that's five or six people. We are small compared to the big hospital which I know I've heard the bigger hospitals don't have that type of individualized care, don't have that many people available and I think that shows that we can deliver the safe care that we need to deliver. SHOW NON-ESSENTIAL DIALOGUE
Thank you.
SPEAKER1 - Mhmm. Any other questions or comments? Well, thank you very much for coming in for test fine.
SPEAKER29 - Thank you very much for calling us.
SPEAKER1 - Senator Moore, your your bill has been well represented on a
SPEAKER24 - As we
SPEAKER18 - can know, thank you.
SPEAKER1 - Yes. Very yes.
SEN MOORE - SB 789 - SB 790 - Good morning, Chair Freedman and Chair Lawn and members of the committee. Thank you for taking me out of order. So I'm here first to testify on Senate 790. I'm here for two Bills; Senate 789, and act5178 relative to hospital price transparency, and also Senate 790, an act relative to the hospital profit and fairness. First S 790, aims to curb expenses related that are not directly related to our systems of care, yet increasingly contribute to the soaring cost of our health care system. One such cost is the inflated salaries paid to CEOs that rarely reflect the quality of care, patient outcomes, or community benefits. This legislation would require hospitals receiving public money to disclose financial assets and assess fees on publicly funded hospitals that compensate executives up to a hundred times more than other employees, a hundred times more.
These fees will fund a Medicaid reimbursement enhancement fund which will increase Medicaid reimbursements to eligible hospitals. Most acute care facilities in Massachusetts, whether they are for profit or not for profit, receive over half of their revenues from the taxpayer. By limiting salaries, we can begin to claw back excessive profits and ensure taxpayer dollars are dedicated exclusively to patient care and necessary services. The second Bill, Senate 789, is a new file this year, that I hope can set a path towards significant cost savings across the Commonwealth and in their future. This Bill builds on recent advancements in Colorado and in Virginia5265 to establish a5267 baseline of transparency around the cost of goods and services provided by a hospital. These specific requirements are twofold; first, hospitals must make available via their website a machine readable file that contains a list of all standard charges for items and services provided by the hospital. Secondly, that upon request of a patient scheduled to receive an elective procedure, test the service, the hospital must furnish the said patient with an estimate of the payment three days in advance.
We have all heard the terrifying stories about constituents who have faced massive medical debt often due to lack of knowledge about the costs associated with their health care. This Bill would5316 end the uncertainty and allow the Attorney General enforce transparency provisions of the Bill. This enforcement action mirrors the path taken by Virginia when they passed similar language in recent years, however, there remains more aggressive ways to pursue bad actors. For instance, Colorado included a private right of action against hospitals that fail to meet basic transparency standards, which have already helped lower the cost for both individual patients and group plans, like those used by union workers. I hope the committee will see the value of these reforms, both in how they can create cost savings and how they can5355 improve patient care. I respectfully ask that both the Bills be reported favorably so that they may advance through the legislative process. I am free to answer any questions.
FRIEDMAN - That Bill which we will definitely take a look at in 7.89 is the price that's being offered to the patient, the cost of the hospital or the cost of your insurance?
MOORE - It should be the cost to the hospital. SHOW NON-ESSENTIAL DIALOGUE
Okay.
SPEAKER32 - But it isn't it isn't ultimately
SPEAKER1 - the cost to you because --
SPEAKER18 - because you're you're paying it.
SPEAKER1 - Gotcha. Great. Thanks. Any other questions? Great. Thank you so much.
SPEAKER18 - Thank you very much.
SPEAKER1 - k. We're now going to hear from Irene Hernandez, Eladia Romero and Terry Toronto, and it is on the 70 11 sorry. Page 1175 central service closing.
ALLADIA ROMERO - CONCERNED CITIZEN - HB 1175 - SB 736 - Good morning. Thank you for listening to us this morning. My name is Alladia Romero, and I am a resident of Lemon stir. I'm also was considered a community advocate and a leader and I've been so for about 22 years. So I'm here in support of HB 1175 and SB 736, an act relative to the closing of hospital essential services. I want to share my personal story just so that you understand why I'm so passionate about trying to save labor and delivery in Lemon stir. So on February 18th 2014, I was about 31 and a half weeks pregnant. I contacted my OBGYN to tell them I was experiencing discomfort and contractions. I was told by my doctor that I was dehydrated over the phone, and I needed to just drink more water. On February 19th at about 3:00 AM, I was driven to the ER in Lemon stir, I was told that I was in labor, and I was told that there was no time to get me to Worcester.
I had my son via emergency C-section in Lemon stir. When he was born,5497 he was immediately intubated, and we were both transported to different ambulances. I'm here to say that if the ER was5506 not open in labor and delivery, I could have very well have not been here today, neither would my son, it is a vital service in our community. Not only closing of the labor and delivery would this be an extreme hardship for women like me who are experiencing emergency situations, the transportation piece, getting back5528 and forth. In order for my family to visit me, I had a 12 year old daughter, my5532 elderly mother had to drive back and forth every day to the NICU in Worcester. So if families are delivering in Worcester, they're going to have to be transported back and forth. For my mother, not only was it a hardship in general, but it was also a financial hardship for her as well. I imagine that will be the same for many of our community members. I just want to speak to the community piece, the closing of labor and delivery.
So I work very closely with the Latino community along with other communities of color in North Central Mass, I have been asking community members if they're aware that labor and delivery is closing on September 22nd and their response is, no, and how is this even possible? I have seen no information from the hospital disseminated in Spanish, in Portuguese, Haitian Creole, or any other language in our community. Our community was not given an opportunity to provide input, to be able to express how this would cause hardship to us at any point in time. We were simply told this was happening on September 22nd, 2023, and essentially people had to start planning for where they were going to be giving birth. Lastly, when speaking with the minority community members, they state hospitals get to do what they want and they don't care about us. This has to change, hospital must be stopped from closing5618 essential services when it will cause great hardship to our community. As representative Higgins mentioned, one life lost is too5627 many. Thank you.
IRENE HERNANDEZ - ACTIVE LIFE HEALTH CARE - HB 1175 - SB 736 - Hello, and good morning, Madam Chair, Chairman Lawn, committee members. My name is Irene Hernandez, and I am also a bipoc Tineo Leader in North Central Massachusetts. I'm here asking for all of you to be in favor of the House Bill 1175 and Senate Bill 736. I have a daughter, almost had one, who had a placenta rapture in 2017, she was rushed to the hospital, Lemon stir hospital, and she was hemorrhaging, there was no time for her to be transported anywhere else, she had to go into the ER and they had to do, like, saving measures for her and my grandson. Had my daughter been transported somewhere else, she would not be here today, and my grandson would not as well. I am a director of an adult day health center in Fitchburg Massachusetts, it's on the line of Lemon stir and Fitchburg. Lemon stir Hospital is the only access they have to equity and health. I know that when we think about the House Bill, we ask that you be in favor of it and change these things because, you know, at the end of the day,5709 it's going to come down to this, who gets to live?
And who decides who gets to live? Is it the heart attack victim? Is it the person in the car accidents, a multicar accident over here, or is it my daughter who had a placenta abruption and needed three kinds of blood to save her life? So we get to committee, I ask you to please consider in shifting because we get to live, we all get to live, and we all get to have equity in our communities. We get to have a hospital and not a maternity desert, and this is what they're creating. In no way, shape, or form as a community leader, I sit on over 30 commission boards councils at the local state and national level for equity, for health equity because we're dying. Bipoc people are dying. In North Central Massachusetts, Latinos have the highest infant mortality rate, secondly, is the Ghanaian population and then other bipoc members. So I ask you, and I urge you to support us because it's going to come down to who gets to live. Thank you so much.
FRIEDMAN - Thank you. I have a question. If this had closed when your daughter was needing an emergency, would the emergency room not have served her because it was a labor and delivery issue as opposed to a heart attack person who they5800 would do emergency services on?
HERNANDEZ - Yes. So they would they have had access to adequately be able to save my daughter's life or my grandson's life. SHOW NON-ESSENTIAL DIALOGUE
Okay.
Thank you.
SPEAKER1 - Thank you. Any other questions?
SPEAKER18 - No.
SPEAKER1 - Thanks so much. k. Thank you.
Do they have both poles?
You're also here to testify on act relative to closures. Right?
SPEAKER33 - Yes. Good. And
UNIDENTIFIED SPEAKER - HB 1175 - SB 736 - Good morning, Chair Lawn, Chair Friedman and members of committee. Thank you for this opportunity to speak in support of H 1175 and S 736. I am a lifelong resident of Massachusetts, Central Massachusetts born and raised, I have for four decades worked in public health. I am currently a Bloomberg scholar in public health, and in my classes when we teach healthcare and nonprofit leadership, the stories that you've heard, my professors at Hopkins say, that is what's wrong with healthcare, and that's why Americans have some of the worst healthcare outcomes in the5900 world. So this is an example of how healthcare should not work. I've heard references to reimbursement rates and what I want to make very clear is that I run a nonprofit before, I understand that when you run a nonprofit, you get very special treatment, you are tax exempt, and for that privilege, you are expected to balance the books.
Some things bring in money, some things you lose money on but as a non profit executive, you're expected to figure that out. What I would suggest is that if Doctor Dixon, the executive director of UMass Hospital System, is going to come to the State of Massachusetts and say, thank you for those millions of dollars, unfortunately, we do have to close these essential services, I hope you ask him when you talk with him how he can give himself $2,600,000 per year. This is tax payer supported nonprofit hospital, this is not about nonprofit versus for profit, this is taxpayer supported healthcare system that is not only failing us, and in particular, failing poor communities, gateway cities, Black and Brown people, but they are also raising the salary of their executive director year after year after year. He received a pay raise during Covid when things were really, really tough, and we were all trying to figure out how to keep things afloat? SHOW NON-ESSENTIAL DIALOGUE
He received he a pay raisThat time went really fast. I had so much more I wanted to say to you, but I'm I'm here if you have questions.
SPEAKER1 - And please submit written testimony to us.
SPEAKER34 - We're
SPEAKER33 - Absolutely well. Thank you so much. Okay. Thank you. Thank you.
SPEAKER1 - Peter McConnell?
PETER MCCONAUGHEY - CONCERNED CITIZEN - HB 1175 - SB 736 - Good morning. My name is Peter McConaughey, a family physician who worked in Fitchburg for 38 years. During that time, we delivered babies at Burbank Hospital whose LND unit had the lowest c section rate in the Commonwealth for two of the last three years, it was open6081 while6081 maintaining outstanding perinatal quality outcomes. After Burbank And6087 Lemon stir Hospitals merged, the first clinical service they closed was Obstetrics which functionally meant that they had to close the nursery and the pediatric unit. Having closed this excellent unit and this essential service, it was only a matter of time until the business people who ran the organization acted to end all inpatient and emergency services at Burbank. Despite reassurances to the community that essential services would not be cut, today, there is no inpatient service at the Burbank Campus and there are no inpatient services from Lemon stir all the6142 way to Peterborough, New Hampshire.
The emergency room closed, urgent care closed, and it all started with closing LND. The impact on our community has been profound. It is not just a matter of convenience where our community goes for its her medical care, It affects the threshold of the seeking care. It affects the waiting time in the emergency room. The availability of medical and surgical inpatient beds and access to inpatient psychiatry and substance use treatment, it affects the recruitment of physicians and nurses to the area. I am not aware of a single doctor who has opened the practice or moved her family to Fitchburg or Ashby since that closure. Now in an area with no beds for addressing the opioid overdose crisis, and no psychiatric unit, Health Alliance announces it's intent to close labor and delivery with only, I believe, four months' notice.
That's less than that people in the middle of their pregnancy are going to be trying to figure out where they're going to go to safely to have their babies. I mean, that's inhumane at best, that is a broken promise by any measure. The planners at Health Alliance and UMass have been talking behind doors for at least two years, that's my guess. They don't do things like this on 4 months notice, they knew years ago that they were going to do this. So they've been talking about a financial decision that will affect communities and pregnant families immediately and forever after, and they choose to give only four months notice. Why would they plot this all out and then springing on the community, if not to avoid people's loud and vociferous objection. House Bill 1175 will impose a more reasonable notification process when a major local corporation wants to pull a surprise move that will affect the quality of life and access to care. I stand in solidarity with Representative Higgins of Lemon stir, Representative Kushmerek of Fitchburg, Representative Kilcoyne of Clinton and Berlin and Representatives, Donahue and Keith, and Lebouef of Worcester, all of whom are co sponsoring 1175. I request that you pass 1175 out of committee with a positive recommendation. Thank you. SHOW NON-ESSENTIAL DIALOGUE
Donato.
Are you here to testify?
Thank you.
It's quick.
REP DONATO - HB 1185 - Thank you for the opportunity to testify on this Bill, 1185. In summary, the Bill basically would allow both HPC and the Attorney General to make sure that providers do not do the wrong thing with regard to any of the persons that they're working with, working on or any health care aspect of this particular Bill. So that's a summary of it and I appreciate the fact that you took me out of of turn and I hope that the committee looks at this and report6404 SHOW NON-ESSENTIAL DIALOGUE
it out favorably.
Thank you, senator.
SPEAKER1 - 85
SPEAKER2 - break?
SPEAKER4 - Yes.
6408 SPEAKER16408 -6408 I6408 have an 85 break. Thank you. Any questions for the rep? No. Thank you, Senator. Thank you.
Okay. This6419 is a remote panel. It is Mary Havelacek Coronaccia
6425 and6425 Eileen Ryan.
Mary, do you wanna start?
SPEAKER35 - Sure.
MARY HAVLICEK CORNACCHIA - TUFTS MEDICAL CENTER - HB 1175 - SB 736 - Thank you very much for this opportunity. My name is Mary Havlicek Cornacchia, I'm a nurse at Tufts6438 Medical Center for over 35 years now. One of over 1400 nurses providing direct patient care at Tufts. I'm here to testify in support of House Bill 1175 and Senate Bill 736, an act relative to the closure of hospital essential services. On January 20th 2022, the staff at Tufts Medical Center were informed that the Tufts Children Hospital which had operated in some capacity or other since 1894 would be closing. This announcement sent shock waves through our hospital community and the Greater Boston community. Despite community outcry and opposition from the dock and nurses who staff the Children's Hospital, it was closed at the end of June 2022. By late summer, a nationwide SRB outbreak had hit Boston area hospitals hard, we started seeing headlines like those on your screen about not enough pediatric beds for these sick babies.
Children had to be sent out of state to receive care just three months after Tufts closed their pediatric beds. I can assure you that whatever you read in the newspapers, the situation inside the hospitals was much worse, our patients and our children deserve better. The process for reviewing the closure or discontinuation of essential health services in this state is severely flawed. By the time a6519 planned closure is announced, it is basically too late to stop it, that was our experience. We know that this was something the hospital did not pull out of thin air, but instead was something many months in the making, which is why we are asking to extend the notice period for closure to one calendar year. This will give communities more time to respond and patients more time to make plans without disrupting ongoing treatment. It is one year post our closure and our floating families are still struggling to find resources.
We are asking that hospitals be required to engage with more effective communities and constituencies ahead of any closure and that hospitals be required to maintain the affected service for the entirety of the notice period. We are asking if a hospital closes or eliminates a service in opposition to a DPH ruling, that the hospital be prohibited from opening new services until the discontinued service has been restored. The closure of pediatric beds at Tufts was done in opposition to DPH findings, it was against the wishes of the nurses and doctors who worked there, and it was to the detriment of the patients who relied on that care. We can and must do better. I implore a favorable report on H 1175 and S 736. Thank you. SHOW NON-ESSENTIAL DIALOGUE
Thank you. Eileen, Ryan.
EILEEN RYAN - ANNA JAQUES HOSPITAL - HB 1175 - SB 736 - Good morning. My name is Eileen Ryan, I have been a nurse for over 20 years, the past eight at Anna Jaques Hospital in Newbury Port. I am here to speak in support of S 736 H 1175, an act relative to the closing of hospital essential services. In 2021, Anna Jaques hospital closed its pediatric unit, leaving my community and my hospital without access to these vital services. I have lived in Newburyport, and I have used Anna Jaques hospital as my family's hospital for 30 years. The majority of hospital visits have been for my children. I know both as a nurse and a parent how important it is to have these services provided locally, closing the pediatric unit sharply reduces those services. Pediatric care is a crucial pillar of a community hospital, but we were told that the services were not profitable enough for our nonprofit hospital. Anna Jaques mission statement is to provide the highest quality medical care and improve the health of our community in alliance with our medical staff.
Children are one of the most vulnerable populations, therefore, shouldn't the purpose of a hospital be to care for them? Is it unreasonable to demand that a hospital live up to its own mission statement? The purpose of a pediatric unit is not to make money for the hospital, that is what orthopedic surgery and other high reimbursement services are for. The purpose of a community hospital is to serve the need of the whole community. We have essentially said to our community, we are no longer able to care for your children, that means children in crisis are sent elsewhere because we lack the ability to properly care for them. A colleague of mine6734 recently brought her one year old granddaughter6736 to Anna Jaques emergency room in respiratory distress. Before the closure of the pediatric unit, we would have admitted the child for observation while providing supportive care.
While in the emergency department, the child's condition continued to deteriorate and was taken by6755 ambulance to a hospital over 30 miles away. The child was admitted to their pediatric unit for 48 hours and made a full recovery but that's just one example, I cannot tell you how awful it is to tell a parent who comes to your hospital for help that there is nothing else you can do for them, and they must make a trek to yet another hospital to access appropriate care. It is shameful that we allow this to happen, and it is shameful that the current laws and regulatory process do not protect these patients. In the meantime, Anna Jaques Hospital has unveiled a brand new multimillion dollar entrance way, a community hospital has a responsibility to the community it serves, but we are not holding them to that responsibility. Senate Bill 736 and House Bill 1175 would take steps to make meaningful reforms to the current process that currently leaves hospitals completely in charge of the essential health service closure process. Thank you. SHOW NON-ESSENTIAL DIALOGUE
Thank you. Any questions or comments, Brooke, pink?
SPEAKER20 - Thank you. I
KANE - I just have a comment. I have a daughter who is now turning 20 but has battled two chronic diseases most of her life and was a patient at Tufts for many, many years and I think when we're looking at the hospital closure process, you know, the answer from Tufts was, will we need more adult6845 beds? Which was probably true but they also didn't need less pediatric beds. So we have to find a way in which when we're looking at these closures, to understand what the true impact is. Tufts also, I think, did an excellent job treating chronic diseases, we were there every four weeks at a minimum. My daughter was inpatient three times for weeks on at the time, we were told, well you can go to children's, children's is a wonderful hospital, but I found as a parent that the care for a child with chronic diseases, which required many, many visits over many times, was better delivered at the setting at Tufts than it was for6891 another child of mine who had to be seen at children's.
The other part I would add is that the it was a much more diverse who was seen at Tufts Medical Center, and I think we all probably should have realized when Tufts changed their name to Tufts Children's Hospital, which as a marketing major, I couldn't understand why you would change your name to that when we already had a Children's Hospital and leave a name with such esteemed recognition of floating, that that was coming to the point. I was there the day it was announced, and6920 there was not a person in that building outside6922 of leadership who knew it was coming. So I think, again, it's a disservice to the people who work there, it's a disservice to the people who count on care for there to continue with closures the way that they happen now and the6936 lack of planning. So I thank you6938 for being nurses there and I think everyone's comments today really point to the fact that the system isn't working and while there may be opportunities where hospitals need to do something different, we need6951 to think more about what's the trade6953 off when they're looking to add something on or expand something with what's being closed. So thank you. SHOW NON-ESSENTIAL DIALOGUE
Thank you.
SPEAKER1 - Thank you. Any other comments? Thank you very much. So the next Everyone else who is gonna be testifying is testifying on h1175ands736
so you can give your name and go right into your testimony because that's what your we know that that's the bill that you're that you're here to talk about. The next remote panel is
Janet De Maureenville and Kate Cashman.
JANET DEMARANVILLE - BETH ISRAEL DEACONESS - HB 1175 - SB 736 - Good morning. My name is Janet Demaranville, thank you for allowing me to testify. I'm attorney nurse at BID Plymouth, I used to work at Morton Hospital in Taunton until they closed their maternity unit in 2018. My experience as a nurse in a maternity unit that was closed over the objections of my nurse colleagues, the local community and the Department of Public Health, and my7023 experience as a nurse at a hospital handling the influx of patients from other recent maternity closers, my reasons for being here. Others have gone through what the Bills would do as far as affecting closure, so I'm not going to outline all of that. In October 2017, the maternity unit at Morton Hospital was temporarily closed. But as time went by, the unit stopped admitting patients, and we were told that it would close permanently. But it wasn't like women start coming to the hospital, they showed up at the emergency room for care and we're told, we're going to give you a voucher to send you to Good Sam Hospital, which is 17 miles away.
They were given an Uber voucher or told to take a cab, which is not appropriate. I mean, they made it to the hospital, they thought they're in the free and clear, now they've got to go somewhere else. The nearest hospital, like I said, was 17 miles away. For many of our women who walked or took public transportation to the hospital for care, this might have well been a hundred miles. We've all heard the stories of police delivering babies in the back of the car and on the side of the road, and it's such a feel good story, well, it's not so great when7099 the baby has complications or the mother has complications and there's no7103 one to take care of them on the side of the highway. I now work in a maternity unit where we are handling overflow patients from the closure of the maternity units at7113 Toby and Falmouth hospitals. This compromises the care of those patients who normally deliver at BID Plymouth because though our patient load has increased, our staffing and other resources have not.
We are short staffed a lot of the time, we run out of rooms a lot of times, we have to change our nurse's lounge into a patient room sometimes when we get overflow, and none of that is appropriate. Community hospitals should serve the whole community, not just members of the community whose services command the higher reimbursement rates. When Stewart took over Morton Hospital, their motto was community health care close to home, well, that has no longer been the case as their moving services and closing services, and people have to travel out of their own communities to get the care they need. I7166 ask you to take the steps to address this problem including issuing a favorable report on this legislation. Thank you. SHOW NON-ESSENTIAL DIALOGUE
Thank you, Kate.
SPEAKER28 - Hi.
KATE CASHMAN - ST. ELIZABET MEDICAL CENTER - HB 1175 - SB 736 - Good morning. My name is Kate Cashman, and I'm a labor and delivery nurse at St. Elizabeth Medical Center. I've worked there for over 20 years, I've been a nurse for over 30. I'm also a member of the Massachusetts Nurses Associations, congress on nursing practice. In 2021, we published a whitepaper on how access to maternal health services is central to social and racial justice. A copy of this paper is going to be provided to all the committee members. I'm here7208 today in support of House Bill 1175 and Senate Bill 736 because this act relative to the closing of hospital essential services. The repeated closure of7220 maternity units across state is a woman's health issue and a racial justice issue. The white paper which is called maternal services are central to racial and social justice, it chronicles the maternity closes that have taken place over the past decades and what that means for the health and well-being for each woman that are affected in these communities. Our state has seen several hospitals eliminate maternity services, specifically over the past few years, including the current efforts which we're hearing about today. Each of these closures results in women having to travel further to receive prenatal care, deliver their babies, and receive postpartum care.
In several cases, these closures have happened one after another, essentially creating what we call maternal desert. So that each subsequent closure means a woman must travel even further to receive just basic maternity care. In examining these maternity closures, the M&A found that they are more likely to disproportionately affect low income communities and communities of color leading to an increase in the already alarming health care disparities. Minorities, people of color, indigenous people, and individuals in vulnerable communities have greater difficulty accessing basic needed healthcare services. Many of these women with families are simply not able to travel these significant distances and because of this extra burden, they miss very necessary pre and postnatal appointments which could affect their health outcomes. You know, we talk about postpartum depression, one in every seven women suffer from postpartum depression. If they have to travel all these miles to be assessed for postpartum depression, the father suffer from postpartum depression as well, we're just not taking care of our communities.
There are so many out, we could they could also be assessed for preeclampsia well after they've delivered the baby. Other key takeaways from our paper that approximately 700 women die each year in the United States from pregnancy related complications, and approximately three in five of those pregnancy related deaths are preventable. Non Hispanic black women are three times more likely times to die from pregnancy related causes than a non Hispanic white woman. As you have heard from so many people today, so eloquently and so passionately, these essential services our closure process is broken and does not serve the interest of our patients. The improvements in this Bill would mitigate some of the control that these hospitals currently exercise over the process, and it would give much more advance notice of the closures, it would provide and require additional community engagement and then a follow-up to make sure that these7411 commitments are fulfilled. But, ultimately, there would need to be a sign off by the Attorney General. I ask for a favorable report on this legislation, and I thank you for your time. SHOW NON-ESSENTIAL DIALOGUE
Thank you. Any questions or comments? Thank you very much. The next panel is Diane Roberto and Suzanne Love.
SPEAKER21 - Good morning. Good afternoon.
SPEAKER1 - Hello.
SPEAKER21 - Hi.
DIANE ROBERTO - SOMERVILLE HOSPITAL - HB 1175 - SB 736 - My name is Diane Roberto, I'm a resident of Woburn. I've been a registered nurse for 45 years. I have spent over 40 of those years in critical care working in the emergency department at Somerville Hospital. I now work in the urgent care that replaced the emergency department. I appreciate this opportunity to testify in support of House Bill 1175, Senate Bill 736. This legislation would make several changes to improve the existing essential services closure process. One change would be to prohibit the closure of any essential health service during a public health emergency. In the spring and summer of 2020, a pandemic had swept the globe and the fear was we would not have enough resources or beds to care for the influx of patients. Emergency departments were very much on the front lines of the pandemic. We didn't yet have a vaccine seen and case numbers were climbing so you can imagine my shock and anger when Cambridge Health Alliance announced that they plan to move ahead with closing the emergency department at Somerville Hospital as had first been announced in 2019.
Closing the emergency department in city of over 80,000 people, the most densely populated city in all of New England during an outbreak of a highly contagious respiratory virus seemed counterintuitive at best and reckless at worst. We were already handling some overflow patients from the 2018 closure with the Emergency Department at Lars Memorial in Medford and now we were told our emergency7535 department was still closing and would7537 reopen as an urgent care. The closure of our emergency department went forward as planned, unfortunately, this did not and has not stop patients from coming who do not know we are no longer an emergency department and who do not understand that there is a big difference between the care provided in an emergency department and the care provided in an urgent care. Immediately after7558 the closure we were still getting patients with severe Covid symptoms who needed things7562 we could no longer provide.
There were no longer respiratory therapy on-site or the ability to intubate in cases of severe respiratory distress. The best we could do is try to stabilize and transfer via 911. As a critical care nurse, it's extremely frustrating to know what patients need, but also know I can no longer provide it because my emergency department has been replaced with an urgent care. 911 is called on a regular basis because cases present that we can no longer handle at our facility. For example, we recently had a cardiac arrest in the lobby, we could provide CPI and ventilation but no longer have the drugs needed or the ability to provide an advanced AOA. Luckily, we spotted a child with a dangerously low oxygen saturation who was barely responsive in the waiting room, we were also alerted to a person seizing it registration. all things we would have7611 easily addressed when we were in emergency department.
The loss of these services to the community is profound, there is now7617 no access to emergency care in Arlington, Somerville, Medford, Belmont, and several other surrounding communities. The decision to close the Somerville Hospital emergency department was not made with the best interest of the community in mind and our current process has ceded control of those decisions to7633 the hospital and healthcare entities which do not put the public's health as their top priority. Our current process is broken. H 1175 and S 736 make meaningful changes that will benefit the public. I ask you issue a favorable report on these Bills. Thank you.
SUZANNE LOVE - BAY STATE FRANKLIN MEDICAL CENTER - HB 1175 - SB 736 - Hello. My name is Suzanne Love, and I am a nurse in the Emergency Department at Bay State Franklin Medical Center, we are in Greenfield in Western Massachusetts. My support for this legislation is informed by my own experience in my hospital and in my community. As an ED nurse, I'm front row seat to the behavioral health crisis in our state even as my own employer, Bay State, has moved to shutter behavioral health units in Western Massachusetts. These units are currently part of the healthcare safety net in my community and if they do close, the impact will be devastating. Grateful Bay State recently said it would keep open the mental health unit at our hospital after years of community advocacy, but patients in it on Westfield and Polymer are not as fortunate. Keeping care local is critical. Patients should have access to mental health care close to home. I also believe that mental health care should be provided to patients regardless of their insurance status which is their ability to pay, ability to find transportation or medical needs.
Since people come to the ER, and they have a medical condition, but they're also suffering from a mental health condition, and they benefit from having both units in one building. Western Mass has seen devastating losses in behavioral healthcare. During the Covid-19 pandemic, Providence Hospital in the Holyoke closed, the only youth and adolescent inpatient behavioral health beds in Western Mass. They did so over the strenuous objections of the local community and also despite a ruling from the DPH for recommending services be preserved, this closure was in the midst of a crisis of children desperately needing care during the pandemic, holding in the ED due to lack of available mental health7779 beds, these kids can be there for days7781 or weeks. Providence Hospital went ahead with the closure of these units with very little advance notice to the community, and there was nothing the state could do to stop them under the existing laws and the regulations.
These patients must travel over 90 miles to reach comparable services, so that's kids and adolescents and their families who can't get local care, and there's often not public transportation,7807 we're in rural Western Mass and so we don't have public transit for these people, some of whom don't have cars, don't have their own vehicles. So this behavioral health crisis is not new, we've seen years' worth of news stories and reports on the crisis of ED boarding, which, by the way, takes away beds that maybe needed by someone with a medical emergency needs because there's a mental health patient taking up that bed when really those mental health patients would better benefit from being in a mental health facility where they could be better cared for. So the Mass College of Emergency Physicians released data showing that patients boarding for an average of 53 hours per person longer up to 59 hours for kids, the total number of hours these patients have boarded in the EDC was highest total ever reported.
Health policy commission found that 39% of kids and 28% of adults who came to the ER with a mental health issue between March and September, so not a very long time period of 2020 ended up boarding, staying overnight or many nights waiting for a bed. This is happening at the same time Providence Hospital closed their child and adolescent unit, and they said there wasn't a need, there's clearly a need for these beds. The current essential services closure process does not serve the public, it does7891 not serve your constituents, if you have experienced closure in your community, you already know this. If you haven't, I'm sorry to tell you, you may find it in the near future. So please give a favorable report to these two Bills, and thank you for your time and attention. SHOW NON-ESSENTIAL DIALOGUE
Thank you.
Okay. Alan Sager.
SPEAKER16 - Underable chairs and members.
ALAN SAGER - CONCERNED CITIZEN - HB 1175 - SB 736 - Good morning. My name's Alan Sager, I teach at Boston University School of Public Health and I only speak for myself today. Three points; accountability, anarchy, and a plastic insurance card is only a start. In health care under the subject of accountability, no one is accountable in health care for identifying the hospitals or emergency rooms needed to protect the health of a public. Not maternity, not psych, not rehab, or other services. Only one state has a list of needed hospitals and services, it's not Massachusetts. When President Kennedy was elected, Massachusetts had a 141 hospitals for 5,000,000 people. We now have7975 about 60 hospitals for7977 7,000,000 people. More patients are being served in costly big teaching hospitals. Second, anarchy. In health care, nobody is accountable for anything that happens outside the building where they work, not for assuring the right services or the right capacity in the right places.
Why not? First, because we don't have a functioning competitive free market, and second, because government action in health care has rarely been competent. Anarchy is the result and anarchy is why our country spends double the rich democracy per person average on health care while giving much less care to fewer people and we die younger. Massachusetts spends $130,000,000,000 on health care this year but many people go without needed care even though, third, a plastic insurance card is only a start. Healthcare is only as good as a person's actual access. Care givers have to be available to redeem the insurance card and translate it into actual care. Today, when a hospital seeks to close essential services or close entirely, the existing process as countless people have told us already today, the existing process is meaningless.
I saw this firsthand as a trustee of the former Waltham Hospital, we were running out of money, a DPH hearing concluded, this was the first hearing under the current rules, concluded that all our services were essential, we closed. DPH's involvement meant nothing or zero. This Bill takes a baby step toward changing that, please adopt it, please recommend adoption. Going beyond baby steps where we all start with baby steps, but going beyond that, our state needs a comprehensive list of all deleted hospital care, hospital services, in which locations, how much is required. Second, all the hospitals need a budget to finance that care, otherwise, you're pushing on a string. Thank you very much.
FRIEDMAN - Thank you. And in fact, we did pass a statute that is requiring HPC to do that assessment of all our health care services, so you'll be happy to know that.
SAGER - I am happy to know that. and that's why it's so important that the next step is to provide the money to pay for those services through a budget. SHOW NON-ESSENTIAL DIALOGUE
Next 1 is Emily Regan.
EMILY REGAN - CONCERNED CITIZEN - HB 1175 - SB 736 - Good afternoon, and thank you for the opportunity to testify. My name is Emily Regan, I'm a Swampscott resident and mother of three. Over the past year, I have had a front row seat to the essential service closure process as an impacted community member. When I was six months postpartum, I got a letter in the mail notifying me that the North Shore birth Center would close in 120 days. Dozens of patients well into their second trimester received the same letter and were forced to seek providers elsewhere in the middle of their pregnancies. Since then, I have led the work of the community coalition opposing the closure and demanding accountability of the birth center's parent, Beth Israel Lahey Health. In December of 2022, Beth Israel completed the closure of the last remaining birth center in Eastern Massachusetts, leaving our state with just one birth center in Northampton out of 400 birth centers nationally. The essential service closure is broken, and Massachusetts mothers and families are suffering as a result.
Hospitals and health systems are exploiting the current process in the name of profitability with total disregard for the statutory requirement of DPH. I'll provide the most relevant examples from our experience with Beth Israel Lahey that illustrate the need for this legislation. Throughout the closure process, Beth Israel Lahey Health provided numerous pieces of inaccurate and misleading information to DPH. Our coalition alerted the department to these inaccuracies and provided the evidence for accurate information, but the hospital was never required to revise their submission. 13 months later, we still do not even know how many patients were being served by the birth center. Without this basic information, how could the hospital possibly ensure access as required? Beth Israel has completed two essential service closures in as many years. In 2021, it was inpatient pediatrics in Newbury Port and in 2022, birth center care in Beverly.
Both closures were noticed to DPH in May, setting up a September closure and a July public hearing to undoubtedly dampen public engagement and complete nearly all of the required steps between Memorial Day and Labor Day. It seems that UMass Memorial has taken note of this tactic. Despite not having completed the closure process, the birth center stopped providing care to patients. At 38 weeks pregnant, one patient received a call on a Thursday afternoon and was told that she must have a new provider by the following Monday despite the birth center being open. Establish patients were told they could not be seen for a postpartum of WellCare. The only time our coalition got traction was through the involvement of the Attorney General's office, which had the rare ability to intervene because the birth center's closure was8334 also a violation of the merger agreement in place. The Attorney General's office must have the ability to protect Massachusetts residents when so called nonprofit hospitals eliminate access to care.
Finally, at the completion of the closure process, Beth Israel Lahey committed to8352 progress updates, to share with the community, our elected officials and DPH on how their mitigation plan was assuring access. The first update was due to8362 DPH on June 1st, I have requested it from DPH8366 twice now, but have not received a response, I can only assume that the update was never submitted. Under the current process, no one is alerted disclosures until it's too late to identify solutions. The birth center had been sabotaged and slated for closure well before our community and elected officials became aware of it. We need the legislature to take action because our healthcare institutions have proven they will not do anything that isn't making them money, regardless of what's in the interest of public health. Thank you for the time, and I urge the committee to report favorably on this Bill. SHOW NON-ESSENTIAL DIALOGUE
Thank you very much. Senator Pacheco.
SPEAKER37 - Yes, madam, shear. Can8411 you hear me?
SPEAKER1 - Yes, we can.
SEN PACHECO - HB 1175 - SB 736 - Well, thank you very much to you and all the members of the committee. I wanted to make sure I was publicly reported on this, we just went through several closures across the state in major changes in our health care system that is taking place and I must tell you that I've come to the conclusion that the whole process is a charade. Plain and simple, is a charade. I am urging the committee to report the Bill out favorably so that we can have a vote on this issue on the House and Senate floor to make sure that we say essential, that's what it means. We have testimony, the public comes out, they testify, and then public health comes out and says yes, the service is essential and then a few weeks later, the service is the closed. It's outrageous, we as a legislature, just should not stand for this. So I would urge again that 736, and there's a House Bill as well. I don't have it in front of me, I'll be sending into the committee a letter and a copy of a letter I've sent to public health.
I'm hoping that with new leadership in public health under the Healey Driscoll Administration that this issue will be given the seriousness that it deserves. There are too many changes taking place, in particular, in the Southeast region of the state where we now have a major hospital in our region that closed down because of an emergency situation that they were involved in maternity services eliminated, there are site beds eliminated. I mean, there's all kinds of stuff that's going on, we just can't sit by and have hearings where everybody comes out, including public health, and states that it's an essential service, and we keep allowing them to close. But we should either change the words in the law or something else, we should at least be honest with the general public out there. Right now, again, as I said, you know, this is really a sham that's8580 going on, it's just a charade. So I would urge the committee to move forward on this, and I thank you for taking me out8588 of turn to testify on this extremely important Bill. Thank you. I'll be glad to answer any questions you may have. SHOW NON-ESSENTIAL DIALOGUE
Thank you, senator. The frustration is noted by everyone. Appreciate you testifying.
Thank you.
Great. The next person is Julie Curtis.
Yes. Hello. Could you hear me?
Yes.
Yes. Thank you.
JULIE CURTIS - CONCERNED CITIZEN - HB 1175 - SB 736 - My name is Julie Curtis, and I live in Danvers and I'm proud to serve on the Democratic State Committee. I'm here today as a concerned citizen to support House Bill 1175 and Senate Bill 736. What I would like to address today is that the state's process regarding closure of essential health services. Specifically, how even when the state's department of public health holds a public hearing and have to consider all8661 evidence that a service slated for closure is necessary to maintain access and health status in a given committee that the closure8673 can go ahead anyway with no way to stop it. Hospitals for the most part, private entities that serve the public but they are very different from other businesses that offer services because they are part of a social contract. We granted majority of hospitals in the state nonprofit status, alleviating the burden of taxes and foregoing much needed revenue.
Hospitals received significant portions of their funding through Medicare and Medicaid or through direct allocation for a specific purpose. But in return, we, the public expect that these hospitals will provide the basic and essential8726 health services as needed. Right now, in my opinion, that balance seems to be shifting. If hospitals can shutter emergency department unit, behavioral health units, pediatric units, maternity units, and full scale hospital leaving regions of the state without any easy access to these services. That is why the reforms put forward in House 1175 and Senate 736 are necessary. I'm asking that you issue a favorable report on House Bill 1175 and Senate 736, and thank you for listening to me. SHOW NON-ESSENTIAL DIALOGUE
Thank you very much for testifying. Any questions or comments?
Migdalia Villas.
Okay. That wraps up the those who have testified or have the that the who have preregistered
I will ask for anybody who signed up today that we do not have your name that is here to testify.
Seeing nobody? Okay. So there's no no 1 else that's registered but I wanna remind you that we will continue to accept written testimony on the bills on today's dockets. So please if you have more and stay or you wanna add anything or you haven't put in your testimony that we are still accepting that. So I will now entertain a motion to close the hearing. A moment. Some of their second.
SPEAKER9 - Yes.
SPEAKER20 - Bye.
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