Healey will not stop Leominster maternity unit from closing

WORCESTER — Gov. Maura Healey will not use her executive powers to stop UMass Memorial Health from closing its maternity unit in Leominster.

The unit is set to be permanently shut down at midnight Saturday, and advocates had been calling on the governor to intervene. However, a lawsuit is expected to be filed by the City of Leominster in an effort to block the closure.

Healey on Friday did ask the state Department of Public Health to do a statewide study on maternal health care in Massachusetts, and a second study to assess essential hospital services in North Central Massachusetts.

"Incredibly disappointing” is how state Rep. Natalie Higgins, D-Leominster, described her feelings about Healey not stepping in to stop the shutdown. “I am worried about the health and safety of the community.”

Legal maneuvering

Meanwhile, there is movement on the legal front. Greenberg Traurig, the Boston law firm representing the City of Leominster, was in the process of filing a lawsuit in Worcester Superior Court on Friday afternoon, seeking to temporarily halt closure, said lawyer Robert Ross.

The crux of the request for an injunction is that the state DPH failed to issue a written decision on the unit's closure. That is required, said Ross, based on state administrative procedure law. In that law, agencies are required to write decisions when they're involved in adjudicatory proceedings, said Ross.

The DPH went afoul of the law, said Ross, when it issued only a four-sentence statement to UMass Memorial last Thursday. To Ross' knowledge, the department didn't issue any written rulings beyond what went to UMass.

"The DPH didn't do any of the things required by law," said Ross.

The four-sentence statement, included in an email this week by UMass Memorial President and Chief Executive Officer Dr. Eric Dickson to the health system's medical providers reaffirming Saturday's closure, reads: “DPH remains steadfast in its commitment to safe, high-quality care for all residents of the commonwealth. UMass Memorial HealthAlliance-Clinton Hospital’s September 11 letter clarifies that it does not have sufficient professional staff to continue to operate the unit safely after September 23. It also included details about the transportation services UMass Memorial is offering to patients and about the capacity of other providers to take on the care that will no longer be provided at Leominster. In these circumstances, DPH has determined that it will now focus on monitoring and enforcement related to the implementation of the closure plan.”

Ross said the DPH's proceedings are not closed because the department did not issue a full written decision of closure. As part of its lawsuit, Leominster claims the unit must remain open until the DPH meets the administrative proceeding requirements.

The initial court hearing could start in Worcester in the coming days, said Ross.

UMass Memorial Health and the DPH are defendants in the lawsuit. UMass said in a statement that it will close the unit on Saturday at midnight: "While we do not comment on pending litigation, we will not be able to safely staff the unit after September 23. Based on this, we believe the most clinically appropriate course of action is to close the unit and keep it closed."

The DPH said it followed the law, and is committed to safe care.

"DPH cannot mandate that the center remain open," said its statement. "Rather our focus must be on making sure that birthing people in the Leominster area have a safe and accessible alternative to the care they need and deserve. DPH has followed the law in this matter and remains committed to access to safe, high-quality care.”

Nurses weigh in: 'Deeply disappointed'

Upon hearing the news that Healey won't step in to stop Saturday's closure, the Massachusetts Nurses Association blasted the governor and the state process.

"We are deeply disappointed that the governor and her administration has failed to intervene to protect the most vulnerable mothers and newborns throughout all of Worcester County," said nurses association President Katie Murphy in a prepared statement.

Murphy didn't stop there, stating the nurses association "expected more from this administration." She cited a recent DPH report that shows Massachusetts faces a higher rate of labor and delivery complications, especially in marginalized communities like those served by the Leominster unit.

Murphy also mentioned Healey's recent visit to the Leominster maternity unit and storm-ravaged Leominster. Those visits, said Murphy, gave nurses the impression that the governor sympathized with those who felt the unit must remain open.

In a reference to the four-sentence message the DPH sent to UMass regarding the monitoring and enforcement of the closure plan, Murphy continued to criticize the Healey's administration: "Claiming now that the state will monitor the situation after the closure, to acquiesce to the UMass system which has acted in bad faith throughout this process is akin to saying you will count the bodies on the ground after the plane has crashed – a plane you were warned was unsafe to carry those passengers."

Financial data: Unit losing money quickly

Meanwhile, UMass Memorial released data to the Telegram & Gazette on Friday that paints a picture of a unit that is hemorrhaging money. Last fiscal year the unit had a $3.7 million operating deficit. For the first three months of the current fiscal year, the deficit was more than $800,000.

The hospital did not immediately supply the unit’s financial information annually for the past 10 years, as requested by the T&G.

“The closure of the inpatient maternity unit at HealthAlliance-Clinton Hospital's Leominster campus was based on a clinical decision stemming from persistent challenges with appropriately staffing the unit. It was not financially motivated, nor will it improve our system’s financial performance,” reads a hospital statement.

Approximately 75% of maternity patients in Leominster are insured by Medicaid, said the hospital. Medicaid is the nation’s public health insurance program for low-income people. Medicaid reimbursement rates historically don’t cover the costs of care.

Losses in Leominster will be absorbed by UMass Memorial Medical Center in Worcester, where many of the maternity patients in Leominster are expected to go for care and delivery, according to UMass.

“UMass Memorial Health will still be financially impacted by existing reimbursement shortfalls; the impact will just be absorbed by a different hospital within our system,” said the UMass statement.

Details of two studies ordered by Healey

They will focus on ensuring Massachusetts residents, especially those in rural and underserved communities, have access to high-quality health care. The emphasis will be on inpatient, prenatal and postpartum maternal care.

Health and Human Services Secretary Kate Walsh, Undersecretary for Health Dr. Kiame Mahaniah and DPH Commissioner Robbie Goldstein were told by Healey to complete the studies by Nov. 15.

One will review prenatal, postpartum and birthing services across Massachusetts. Health equity will be a focus along with the availability of quality services in rural and other underserved communities. Officials are expected to produce a set of recommendations for ensuring that high-quality services are reasonably available to all Massachusetts communities.

The second study will review access to all essential health services in the Northern Worcester County area and develop a plan to support or improve access where needed. This will include:

● A review of hospital services, community-based care and social supports.

● Consultation and collaboration with providers and community leaders to ensure that access to critical services is protected following the closure of the Leominster inpatient maternity unit.

UMass Memorial: Leominster closure is 'heartbreaking'

“Heartbreaking” is how Dickson described the impending closure in a Thursday email to the health system’s medical providers. But the decision had to be made, said Dickson, because the unit doesn’t have adequate staff to protect the health of patients.

“Closing a service that has been a part of the fabric of the community isn’t easy — in fact, it’s heartbreaking,” said Dickson’s email. “All of us as caregivers must focus first and foremost on the health and well-being of our patients.

Dickson continued: “Keeping a birthing center open without adequate obstetrical coverage is not in the best interest of our patients and is something we are not willing to do, regardless of the political pressure and damaging headlines. Sometimes the right thing to do — and I know this is the right decision for our patients — is the harder thing to do.”

DPH: No legal authority to stop closure

The state DPH has no legal authority to stop UMass, or any hospital system, from closing an “essential” service.

The agency asked UMass to postpone closure after it determined the health system's plan was inadequate because it failed to provide alternatives for patients to access quality health care after the unit closed. Once an adequate plan was developed and implemented, the unit could close, said the Department of Public Health.

UMass Memorial: Two reasons for closure

UMass cited falling birth numbers along with a staff shortage as the primary reasons for shutting the unit down.

In filings with the state, UMass data showed births dropped from 762 in fiscal 2017 to 511 in fiscal 2022. Opponents argue the current number is at least 600 annually and would be higher if UMass didn’t funnel patients to UMass Memorial Medical Center.

They also claim efforts by doctors and nurses to boost staff numbers were thwarted by UMass officials.

In a public hearing, UMass leadership said the decision to close the unit was not about finances, but opponents disagree. They claim many of the unit’s patients are low-income and MassHealth reimbursements don’t cover the costs of care. To consolidate costs, UMass funnels patients to Worcester, said opponents.

'Everything possible' done to boost unit

In his email this week to providers, Dickson said “everything possible” was tried to rejuvenate the unit over the past five years, but closure was the only option to protect the health of patients.

The law firm representing UMass Memorial told the state DPH that the lack of a sufficient number of OB/GYNs in the unit was the “primary reason why we must make the closure recommendation.”

At least five obstetricians/gynecologists are needed to meet on-call, 24/7 services that the unit demands, according to the law firm. Currently, there are two OB/GYNs on staff, and temporary staff to fill the gap isn’t consistently available, the law firm said.

In its determination that the UMass plan is inadequate, the DPH cited transportation access and impacts on local ambulance service as the two biggest weaknesses in the plan.

In his email Thursday to providers, Dickson said the hospital’s plan fully adheres to the DPH regulatory review process.

“We are confident that our plan effectively prioritizes the health and safety of birthing people and newborns throughout the North Central region by offering 24/7/365 curb-to-curb transportation access for patients and their loved ones, ensuring safety and equity when the Medical Center receives these additional births, and to help support the most vulnerable in this region, dedicating more than $600,000 to support prenatal and postpartum care.” 

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

This article originally appeared on Telegram & Gazette: Leominster maternity ward closing: Healey won't intervene to stop it