Calls for Legislative Action to Prevent Future Closings of Needed
Hospitals To Guarantee Life-Saving Care to those in Need
CANTON, Mass. – The recent decision by the Waltham Hospital Board of Trustees to close the 117-year-old community hospital represents a failure of the market-driven health care system in Massachusetts, according the Massachusetts Nurses Association, which represents more than 22,000 registered nurses, including more than 200 working at
Waltham Hospital.
The closure will leave the citizens of Greater Waltham without access to a health care safety net and will surely result in the needless death of many residents because of a lack of access to appropriate life-saving acute care services.
The crisis in Waltham is not an isolated one. The state’s attorney general is reported to be tracking six other hospitals on the verge of closure. In recent weeks, Addison Gilbert Hospital in Gloucester has been the focus of intense debate in that community as its parent
company, Northeast Health Systems of Beverly, is moving towards closing beds and removing vital services from the facility which serves more than 40,000 residents.
In both cases, the state has little power under current law to do anything to protect the vital health care resources provided by these community hospitals. If a hospital is to close, all the Department of Public Health can do is call a hearing and determine if the facility provides an essential service, without the power or authority or funding to do anything about it.
"Let us be very clear, there are not enough acute care services to adequately take care of the citizens of this commonwealth at this time," said Julie Pinkham. "At Waltham, we are now looking at taking away a community hospital from a community of 60,000 residents, with another 100,000 people who work in that city on a daily basis. And replacing a full service acute care hospital with an urgent care clinic, as has been proposed, does not in any way represent a viable alternative to keeping this hospital open. This is a hospital the Department of Public Health deemed as an essential service, yet, still nothing is being done or it appears can be done to protect these vital services for this community. This is unacceptable."
According to Pinkham, what has happened to Waltham Hospital is the inevitable result of a deregulated system where survival is based on unbridled and unfair competition that has nothing to do with providing appropriate care to people who need it.
The current system was created in the later 80’s and early 90’s as the health care industry sought and the legislature agreed to deregulate the system, allowing hospitals to compete openly and without restriction for survival. In the ensuing years, more than 26 hospitals have closed and massive regional networks built around tertiary care teaching hospitals
were created.
Deregulation was instituted under the rationale that competition would result in the closure of unnecessary beds and inefficient hospitals, resulting in significant savings and more efficient delivery of services. The system has failed on all counts according to extensive research of the industry conducted by Alan Sager at the Boston University School of Public Health.
"After studying the causes of hospital closings in 51 U.S. cities, we found that the market doesn’t work. Community hospitals are likelier to close—even though they’re more efficient—in part because they lack sufficient physicians (as was the case with Waltham Hospital). Teaching hospitals and wealthier ones tend to survive," Sager explained.
According to Pinkham, "We have created a system where well funded teaching hospital networks dominate the hospital industry, drawing physicians, admissions and resources away from much needed and less expensive community hospitals. Waltham Hospital is the latest loser in this Darwinistic struggle for survival."
Careful Planning and Legislative Action is Needed
The MNA believes that the unbridled reliance on a deregulated health care system must end and that the legislature and state government must take steps to enact health care policies to stabilize the health care system and the hospital industry in Massachusetts.
First, the legislature must begin the development and implementation of a state health care policy that sets short and long term goals for health reform in Massachusetts. State Sen. Richard Moore, Senate Chair of the Joint Committee on Health Care, has begun this process.
Second, State Rep. James Marzilli (D-Arlington) and State Rep. Emile Goguen (D-Fitchburg) have filed legislation, H. 552 and H. 1088, to regulate Massachusetts hospitals to ensure the survival of needed facilities to meet the health care needs of the state’s residents. The law would:
- identify which hospitals and hospital services are essential to the health of their communities;
- identify hospitals in danger of closing or of changing services in ways that could harm their communities;
- create a receivership law that would empower public officials to petition a court to appoint a receiver to stabilize, conserve and receive each needed but endangered hospital;
- provide technical assistance as needed to support the hospital’s survival; and
- create a dedicated trust fund, whose revenues would be generated by an assessment on acute care hospitals’ total revenue, as well as the ability to access funds from the free care pool or other distresses hospital funds.
Third, given the current budget crisis, and understanding the essential core service that the health care system provides, it is also imperative that the legislature act responsibly to explore avenues of generating revenues to support the maintenance of the state’s health care safety net.
"We cannot meet the health and human services needs under the current strategy of budget cutting as the only option. We need to raise revenue or people will die," Pinkham said.
Finally, the MNA also believes that in addition to the hospital stabilization bill, a much broader and fundamental restructuring of the health care system must take place. The organization is one of a number of health care and consumer organizations calling the passage of legislation to create a single-payer health care system in the state.
"The bottom line is that the current health care system cannot be incrementally ‘fixed’ without injuring patients. This patchwork system is failing and the simple reality is it’s much more cost effective, efficient and fair to have a one-payer pool with one set of rules covering everyone," said Pinkham. "If we don’t proceed with major reform now, we are going to find it much more expensive to have to rebuild this collapsing health care infrastructure."
