DPH Issues Finding Declaring Both the Pediatric and Psychiatric Units at North Adams Regional Hospital are Essential Services that Should Not Be Closed

Calls Upon NARH to Work With the Community to Find an Alternative Plan to Keep These Vital Services Open

NORTH ADAMS, Mass., Nov. 21, 2013 /PRNewswire-USNewswire/ -- The Department of Public Health has just issued its findings regarding the proposed plan by the management of North Adams Regional Hospital (NARH) to close both its 5-bed inpatient pediatric unit and 11-bed inpatient psychiatric unit (known as the Greylock Pavilion), two popular programs serving vulnerable children and those suffering from acute mental illness in Northern Berkshire County (the DPH letter text appears at the end of this release). The DPH finds that both these units provide an essential service that is "necessary for preserving access and health status in the hospital's service area."

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The DPH based its finding on its review of the issue and the testimony at public hearings held on Nov. 1, where dozens of providers, community members, parents of patients, former patients and elected officials opposed the closing and expressed concern that elimination of these services will negatively impact the care provided to patients. The DPH letter cites a number of serious issues related to the proposed closure plan and a concern voiced by nearly every opponent to the closures, stating, "numerous members of the community have commented to the Department that they rely on North Adams Regional Hospital when they need hospital services in winter months when travel to another facility outside the community can be difficult."

In response to the closure plan, the DPH letter includes an appeal to NARH management to reconsider its plan, proposing that "the hospital delay closure of its pediatric and psychiatric service in order to work with the community to assess options other than closure." 

"We greatly appreciate DPH's findings that these are essential services, and that the loss of these services will deprive children and those suffering with mental illness throughout the region the care they deserve," said Susan Revotskie, RN, a psychiatric nurse who works in the Greylock Pavilion, and a member of the Massachusetts Nurses Association/National Nurses United, which represents the nurses at NARH.  "Our hope now is that our administration will heed the DPH's call to work with the community to develop an alternative plan for these services that will keep them open for those in need of care."

The NARH Greylock Pavilion offers a comprehensive inpatient program for adults requiring acute psychiatric care, including patients who are suicidal, homicidal or experiencing a severe mental health crisis.  Right now, there is a critical and growing shortage of behavioral health treatment beds in our state, and closing this unit will result in more patients crowding local emergency departments or going without care altogether.  In proposing to close the unit the hospital's plan is to have psychiatric patients cared for in the emergency department, a setting poorly suited to providing the care these patients require. 

The DPH findings call into question the hospital's plans for treating acutely ill psychiatric patients in the emergency department, posing the question to NARH administration, "How will the hospital ensure that the Behavioral Health Pod to be developed in its Emergency Department will provide a supportive environment to patients being treated and minimize disruption to other patients and staff in the emergency department?"

The NARH pediatric unit provides basic pediatric care in a child-friendly environment from a staff that understands the needs of children.  The loss of this unit, and the hospital's plan, will mean children will be boarded in the hospital's busy emergency department for observation, potentially exposing them to other adult patients and unsafe situations.  Other children will be forced to travel outside their community for care, making it harder for their families to visit and be there with their children when they need them most. 

Again, the DPH took issues with the hospital's plan, asking "How will the hospital ensure that pediatric patients treated in the emergency department and who remain for observation are in an environment suitable for children…and what will be the impact on the hospital's emergency department following treatment in the emergency department?"  Finally, the DPH asks, "How will the hospital ensure that staff providing care to pediatric patients or observing pediatric patients seen in the emergency department are competent in the standards of practice for pediatric patients." 

As the MNA/NNU awaits the hospital's response to the DPH findings and questions regarding the ill-conceived closure plans, the organization will be working with other advocates, community members and policymakers to encourage the NARH administration to heed the DPH's call to work with all stakeholders in the community to find an alternative to the closure of these vital services. 

Text of Letter from DPH

RE:  North Adams Regional Hospital – Essential Services (FMF#2061-055)

On November 1, 2013, the Department of Public Health ("Department") held a public hearing in response to the notification received from North Adams Regional Hospital ("the Hospital"), regarding plans to discontinue the provision of pediatric services and inpatient psychiatric services effective January 2, 2014.

In addition, the Department has reviewed the information that you have provided to our staff regarding the level of service currently provided in your pediatric, inpatient psychiatric and intensive care units, the challenges you face in your efforts to ensure the viability of the Hospital, and your plans to improve the overall quality of health care services in the community. Thank you for sharing this information with us.

It is the understanding of the Department, based on the notice referenced above, information provided to the Department by the Hospital and the presentation of the Hospital at the hearing that:

• While licensed for five pediatric beds, the Hospital currently operates two pediatric beds, which the Hospital has proposed will be closed. Upon closure of its pediatric service, the Hospital will provide what it describes as "episodic care" in its Emergency Department with subsequent observation for up to six hours of pediatric patients who present with an emergent condition, while transferring those who present with a high acuity illness or require an inpatient admission.
• While licensed for twenty inpatient psychiatric beds, the Hospital currently staffs at a level sufficient to operate eleven inpatient psychiatric beds, which the Hospital has proposed will be closed. Subsequent to closure of its inpatient services, the Hospital will provide outpatient psychiatric services described as "intake, referral, therapy, medication management and community supports."

As a result of its review of information provided to the Department by the Hospital, and the testimony of patients, staff and numerous members of the community both at the hearing held on November 1, 2013, and by email directly to the Department, the Department finds that the pediatric services and inpatient psychiatric services the Hospital has proposed to discontinue are necessary for preserving access and health status in the Hospital's service area.

Accordingly, under 105 CMR 130.122(G) the Hospital is required to prepare a plan that details how access to these services will be maintained. The plan must be submitted to the Department within 15 calendar days of this letter and include the following elements:

(1)   Information on utilization of the service prior to proposed reduction;

(2)   Information on the location and service capacity of alternative delivery sites;

(3)   Travel times to alternative service delivery sites;

(4)   An assessment of transportation needs post reduction of services, and a plan for meeting those needs;

(5)   A protocol that details mechanisms to maintain continuity of care for current patients of the reduced service; and,

(6)   A protocol that describes how patients in the Hospital's service area will access the services at alternative delivery sites.

Numerous members of the community have commented to the Department that they rely on North Adams Regional Hospital when they need hospital services, especially in winter months when travel to another facility outside the community can be difficult. In addition to the elements above, the plan submitted by the Hospital must address the following concerns of the Department;

Pediatric Services:

• Can the Hospital delay closure of its inpatient pediatric service in order to work with the community to assess options other than closure?
• How will the Hospital ensure that pediatric patients treated in the Emergency Department, and who remain for observation, are in an environment that is suitable for children?
• What will be the impact on the Hospital's Emergency Department of keeping pediatric patients for observation following treatment in the Emergency Department? Please ensure your response includes your projections on volume, and how this will impact on staffing in the emergency Department.
• How will the Hospital ensure that staff providing care to pediatric patients or observing pediatric patients seen in the Emergency Department are competent in the standards of practice for pediatric patients?
• Will the Hospital perform surgery on pediatric patients, and if so what types of surgery and under what conditions? Who will monitor these patients, where and how will the Hospital ensure that staff providing care to pediatric patients or monitoring patients following surgery are familiar with the standards of care for pediatric patients?
• How will the Hospital mitigate the impact of closing its pediatric service on area ambulance services in light of the travel time from the Hospital to other facilities when transfer for an inpatient admission is necessary to treat a patient?

Psychiatric Services:

• Can the Hospital delay closure of its inpatient psychiatric service in order to work with the community to assess options other than closure?
• How will the Hospital ensure that the Behavioral Health Pod to be developed in its Emergency Department will provide a supportive environment to patients being treated, and minimize disruption to other patients and staff in the Emergency Department?
• How will the Hospital mitigate the impact of closing its inpatient psychiatric service on both patients and families in light of the limited public transportation services available in the community? Please describe what services will be available, when and at what cost for families of patients admitted to other facilities.
• How will the Hospital mitigate the impact of closing its inpatient psychiatric service on area ambulance services in light of the travel time from the Hospital to other facilities when an inpatient admission is necessary to treat a patient?

Under the provision of 105 CMR 130.122(H), the Department will consult with the Department of Mental Health in its review of the portion of the plan the Hospital submits related to the closure of the inpatient psychiatric service to determine if the plan assures access following the Hospital's proposed closure of the services. Following its review, the Department will advise you in writing of any remaining comments or concerns.  The Hospital is required to submit a timely response to any such comments.

Thank you for your continued cooperation in this process. If you have any questions, please contact Sherman Lohnes at 617-753-8160.

SOURCE Massachusetts Nurses Association/National Nurses United

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