AUG. 27, 2024.....The state, Steward Health Care, and the company's lenders and creditors need "to take action to lessen the devastation" that the looming closure of Nashoba Valley Medical Center in Ayer "is having, and will continue have," on people who live in the central Massachusetts region, the expert monitoring patient care at the bankrupt company's hospitals urged in a new report.
Suzanne Koenig, a health care management consultant, urged in a supplemental report filed late Monday in U.S. Bankruptcy Court that the parties involved keep Nashoba Valley's emergency department open for an additional 30 days, or at least provide funding so an ambulance could be stationed outside the closed emergency room for at least a week after it closes this Saturday morning.
"Nashoba is a community fixture that has provided healthcare to residents for over fifty years. It is the sole emergency department (“ED”) within a thirty-minute radius in a community with limited paramedics and emergency medical services (“EMS”) personnel and no public transportation," Koenig, who is also a senior living facility owner, wrote in her report.
She said the closure of Nashoba Valley will turn a five-minute trip to an emergency department into a half-hour drive, effectively taking EMS workers out of service for an additional 45 minutes during the return trip. She said area EMS providers have staffed the area "for short trips for emergency care," counting on access to Nashoba Valley's ER.
"In addition to limiting the availability of EMS personnel, the EDs in other communities are not staffed or equipped to absorb the former Nashoba patients. This toxic combination of delayed EMS response times and overtaxed EDs will lead to dire results for patients needing emergency care," she wrote.
The Executive Office of Health and Human Services did not respond to questions from the News Service related to Koenig's report, whether the state was receptive to her requests, and the state's efforts to ensure people served by the closing hospitals know where else to seek care.
The News Service caught up with Public Health Commissioner Dr. Robbie Goldstein as he left an unrelated event at the State House on Tuesday. He said he has been in frequent contact with Koenig and said the report shows that "she's doing her job, which is to support the communities and make sure that everyone has resources for care." The commissioner said DPH is "really engaged" in similar work.
"I've been talking to the fire chiefs in Nashoba Valley and surrounding towns for weeks now. We're thinking through ways that we can support emergency medical services and pre-hospital care, talking to hospitals in the area -- Emerson Hospital, UMass and Health Alliance. So I think we all have the same goal, which is support pre-hospital care and emergency medical services," he said.
Steward said last month that it did not get any satisfactory bids for Nashoba Valley or Carney Hospital in Dorchester, and announced that the two facilities would close by the end of August. The Ayer hospital is slated to be shut down for good at 7 a.m. on Aug. 31, Koenig said, adding that she "will file a further report regarding the closure upon its conclusion."
Steward is in the process of "transferring or discharging patients at Nashoba," Koenig said. Citing continuity of care concerns, the ombudsman added a footnote to her report to point out the need for Steward "to present a clear plan for (a) transferring, storing and accessing historical patient records and, most importantly, (b) providing assistance to patients to find alternative healthcare providers."
"The Ombudsman is working closely with the Debtors on these matters," Koenig said.
She asked that the parties who have financial and political stakes in the messy Steward saga find a way to keep the ER open for an extra month, or to post an ambulance there after closure so anyone who rushes there expecting care can at least be stabilized and transported elsewhere.
"I am cognizant of the myriad of issues in these cases and the various stakeholders’ desires to maximize their recoveries. Notwithstanding, the Nashoba closure is devastating to the community and the patients who rely on this hospital and the ED. The patient population served by Nashoba played no role in the decisions that ultimately lead to the closure of Nashoba," she said. "While the Ombudsman is hopeful that the Commonwealth arrives at a solution to reopen the hospital in the coming months, the Ombudsman requests that all parties carefully consider the inevitable outcomes of this expedited closure on the most vulnerable of the community and come together to provide for a basic level of interim services while the affected community adjusts to the closure of Nashoba."
EOHHS also did not respond to News Service questions about any conversations around reopening Nashoba Valley after it closes. Koenig said in her report that Sen. Ed Kennedy, who represents nearby Pepperell and Dunstable, mentioned during a public hearing on the Nashoba Valley closure that he was working with others on"plans to fund a reopening of Nashoba with support from the Commonwealth."
"What I've done is I've had a few conversations with Commissioner Goldstein and with some of the administrators at other nearby hospitals to see if there was interest in them taking over the hospital," Kennedy told the News Service on Tuesday. "And for me, I think the major issue is the geography. If you take that community hospital and shut it down, it's a long way to get emergency services out there."
Kennedy said there has been interest among other hospital operators in taking over at least some of Nashoba Valley's services, but said his sense is they want to wait for the facility to close pursuant to the bankruptcy process before potentially being revived. He said the Legislature could have a few opportunities to consider funding related to a Nashoba Valley revival if or when it takes up a stalled economic development bill and a pending supplemental budget.
"If funding was going to be the major roadblock, I think it doesn't need to be," he said.
Koenig was tapped in May to serve as patient care ombudsman for Steward's hospitals in Massachusetts, Ohio, Pennsylvania, and Miami-Dade County in Florida. She is also keeping an eye on the closure of the Carney, but said she was not similarly requesting that the Dorchester hospital's ER remain open for an extra month in part because "there appears to be closer options for these patients to receive alternative healthcare service."
But she did urge that an ambulance be posted up outside Carney's ER for at least a week after closure, too.
"Over the weekend, the Ombudsman was informed that a patient walked into the ED with a gun shot wound needing attention. It is incidents such as this one justifying the cost of having an ambulance stationed at the ED entrances for Carney and Nashoba for at least seven days," she said.
Goldstein said it is important for people, particularly in Dorchester and Ayer, to know that DPH has "been engaged in this work for many weeks, really, many months; that we have been working with all of the local providers, the community health centers, the emergency medical providers; that we are watching and we're carefully engaged in this and on the ground; and we will continue to do so even after the hospitals close."
"We're not going to walk away from this responsibility," the commissioner said.
[Sam Drysdale contributed reporting.]
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08/27/2024
