Nurse says she was asked to train Leominster ER staff to prepare for closing maternity ward

LEOMINSTER - Amy Gagnon can’t believe UMass Memorial Health plans to close the hospital system’s maternity unit in Leominster.

Gagnon has worked there as a nurse for the past 12 years and feels that hundreds of families who rely on the unit will suffer when it's expected to shut down Sept. 22.

“I was shocked that UMass is even considering closing it,” said Gagnon. “It serves a population in Leominster and Fitchburg that is over 200,000. It provides essential labor and delivery services that the community deserves to have.”

On May 26, UMass Memorial filed a required notice of intent to discontinue service with the state Department of Public Health.  UMass Memorial cited falling birth numbers and a staff shortage as reasons for the closure. Four days after the filing with the Department of Public Health, on May 30, Gagnon said she was asked to give emergency room staff training in the Neonatal Resuscitation Program in order to fill the service cap caused by the impending closure.

Neonatal resuscitation is an advanced level of care specific to problem pregnancies when a newborn isn’t breathing and requires resuscitation. Gagnon said she was first asked to do the training by the emergency department's nurse educator of professional development and Gagnon provided a screenshot of an email from the educator that reads, "I am reaching out to you regarding NRP classes. We are looking to get the emergency department certified in NRP. Could you make some time to talk with me about NRP and how we can move forward with this process."

The second request came from Gagnon’s direct supervisor. A screenshot of the text reads, "Amy-would you consider teaching NRP for the ED? I know it's tough to think about, but they do truly need your expertise and knowledge."

UMass Memorial disputes Gagnon's account. In a prepared statement, the health care system said resuscitation training occurred in its emergency rooms long before the decision was made to close the Leominster maternity unit.

"Neonatal Resuscitation Program training is standard practice for emergency departments, and something we have done with our emergency department staff since well before announcing our planned closure of inpatient maternity services. It is important that we hold these trainings to ensure our clinicians at HealthAlliance-Clinton Hospital’s Leominster ED continue to be well equipped to provide high-quality care when these emergency cases arise."

'So many things can go wrong'

Gagnon believes she can give emergency staff an understanding of neonatal resuscitation before Sept. 22, but worries that without constant follow-up training and supervision, the staff won’t retain what it learned.

Adequate training and supervision won't happen, said Gagnon, because the maternity staff that can do it will lose their jobs when the unit closes.

“So many things can go wrong when you deliver a baby...The emergency room is not trained to take care of these things,” said Gagnon.

Gagnon stressed that an experienced team is needed to safely handle newborn resuscitation including an obstetrician, pediatrician, labor nurse, two delivery nurses and respiratory therapist. That lineup currently works in the maternity unit and all will be out of work Sept. 22, according to Gagnon, except for the respiratory therapist, who floats among hospital departments.

UMass Memorial must have a plan

Gagnon explained she was asked to train the emergency department because UMass Memorial must have a plan in place to show the state the Department of Public Health that it has emergency deliveries covered when the maternity unit closes.

As it now stands, Gagnon is scheduled to give two training classes and she will fulfill that commitment. But she won’t give additional classes because she firmly believes the emergency room won’t be in a position to do the job when the maternity unit closes.

“It’s like asking a labor and delivery nurse to treat a patient having a heart attack. It’s a totally different scope of practice," she said.

Fewer births, staff shortage met with skepticism

Gagnon disputes UMass Memorial’s claim that birth numbers are down in the Leominster unit. In a filing with the state, UMass Memorial noted 762 deliveries in 2017, compared to 511 in 2022.

As Gagnon sees it, birth numbers aren’t falling in the Leominster/Fitchburg area. There are at least 600 yearly, she said, and would be much higher if not for UMass Memorial funneling many of the unit’s patients to maternity services in Worcester.

The reason is economics.

Many of the Leominster unit’s patients are low income, according to Gagnon, and their insurance is covered by MassHealth, the state’s Medicaid insurance program. Low MassHealth reimbursements to the hospital coupled with the expense of running a maternity unit 24/7 mean many patients are directed to Worcester, where maternity expenses can be consolidated.

As for staff shortages, Gagnon said she has tried to help alleviate the problem, but hit roadblocks from hospital leadership.

For more than two years Gagnon said she tried to “cross train” staff in other departments, so they have the skills to assist in the maternity unit when needed. However, Gagnon was told she can only do the training during day shifts. That’s a problem because with two young children at home, Gagnon can only work the night shift, when she would like to train staff.

Doctors have also inquired about jobs in the unit, only to be told nothing is available or there is a hiring freeze in place, according to Gagnon.

Meanwhile, four local obstetricians were set to provide fill-in services at the unit when needed. The agreement between UMass Memorial leadership and the doctors was in place before the closure was announced, but it's moot since the unit is expected to close. UMass Memorial claimed the agreement didn’t meet the overall shortage of staff.

What should the outcome be?

When asked this question, Gagnon said she wants state lawmakers to pass a pending bill that gives the state the Department of Public Health more leverage over hospitals that want to shutter services. Currently, the Department of Public Health can determine that a service is essential to the community that a hospital serves, but it has no legal power to stop a hospital from cutting the service.

Gagnon would also like to see more money pumped into MassHealth so medical reimbursements aren’t so woeful for a hospital’s balance sheet. If that happens, she believes more community hospitals can keep their maternity services going.

Tuition reimbursement for young doctors coming out of medical schools is another idea Gagnon supports. If that existed, doctors could agree to work several years in a community hospital in exchange for having the balance of their education loan drawn down or paid off.

Will get another job

Gagnon expects to be laid off when the maternity unit shuts down Sept. 22, bringing her 12-year run to a close. However, Gagnon isn't worried about her finances because she’s confident she’ll get another job.

But it's the families in Leominster, Fitchburg and the surrounding communities whom Gagnon is concerned about.

“I fear for the patients in the community. I don't care about my job. I’ll get another one. I’m worried about the population we serve," she said.

Contact Henry Schwan at henry.schwan@telegram.com. Follow him on Twitter: @henrytelegram.

This article originally appeared on Telegram & Gazette: UMass Memorial Health nurse raps closing of Leominster maternity unit