The Department of Public Health has just issued its findings regarding the proposed plan by Steward Health Care to close its Level II 13-bed Pediatric Unit at Morton Hospital, a popular service that has existed for more than 50 years and serves an average of 4 – 8 children per day from Taunton and surrounding communities. (The DPH letter text appears at the end of this release). The DPH finds that this unit provides an essential service that is “necessary for preserving access and health status for children in the Morton Hospital service area ”
The DPH based its finding on its review of the issue and the testimony at a public hearing held on May 21, where dozens of provider, 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, including that Morton Hospital:
· “did not consult with members and leaders of the community that it serves to assess the impact of eliminating this service on patients and families in need, and possible alternatives to the elimination of necessary services.
· would, under its plan, force families to travel well out of the community to obtain acute hospital level care for their children, and substantially limit the ability of many families to provide comfort and support to a hospitalized child; and,
· would, through creation of a four-bed observation unit adjacent to its Emergency Department, expose children to potentially dangerous or disturbing conditions.”
The DPH letter calls into question the census data provided by Morton Hospital management to justify the closing and demands that Steward provide detailed records of every patient cared for in the unit for the last three years, while also calling upon Steward to provide a detailed plan as to how they will address the concerns of the community and maintain access to services for these children, which will then be reviewed by DPH.
“We greatly appreciate DPH’s findings that this is an essential service, and that the loss of this service will deprive children throughout the region the care they deserve,” said Joyce Wilkins, RN, chair of the MNA/NNU local bargaining unit at Steward Morton Hospital, which represents the nurses who work on the unit. “Our hope now is that the unit remains open to continue to provide excellent care for children and the state officials do whatever is necessary to ensure that this service remains open for these vulnerable children.”
The Morton Hospital Pediatric Unit provides first rate care to hundreds of children each year who are suffering from a variety of acute medical conditions, undergoing tests or undergoing and recovering from surgical procedures. For example, care provided includes care and observation of children undergoing IV hydration, or infants whose parents have witnessed them either stop breathing or have had a seizure at home. Higher acuity patients include six-week old infants with respiratory illnesses who need oxygen and are breathing too hard and/or too fast to feed, newborns who are having trouble withdrawing from narcotic addiction and children in toxic shock.
The unit is staffed by a team of expert caregivers including registered nurses and licensed practical nurses who together have more than 200 years of experience in pediatric nursing and many of the RNs are board certified in pediatrics.
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Text of Letter from DPH
On May 21, 2013, The Department of Public Health (“Department”) held a public hearing in response to the notification received from you regarding Morton Hospital’s intent to close its inpatient pediatric unit. As a result of its review, including testimony presented at the hearing the Department has made a finding that the pediatric services Morton Hospital has proposed to eliminate are necessary for preserving access and health status in Morton Hospital’s area.
At the hearing held by the Department on May 21, 2013, numerous participants including providers, community members, parents of patients and former patients, and elected officials, expressed concern that the elimination of these services will negatively impact the care provided to patients. Of concern to a number of those who testified was that Morton Hospital:
· did not consult with members and leaders o the community that it serves to assess the impact of eliminating this service on patients and families in need and possible alternatives to the elimination of necessary services;
· would, under its plan, force families to travel well out of the community to obtain acute hospital level care for their children, and substantially limit the ability of many families to provide comfort and support to a hospitalized child; and,
· would, through the creation of a four bed observation unit adjacent to its Emergency Department, expose children to potentially dangerous or disturbing conditions.[1]
Of significant concern to the Department is the wide variance in the census data provided to it by Morton Hospital from that reported by numerous sources both before and during the hearing. In order to address this matter, the Department is requiring that Morton Hospital provide with its plan the daily midnight census of the pediatric unit from January 1, 2010 through April 20, 2013, and clarify for the Department whether this count includes just children admitted to the hospital or both children admitted to the hospital and those held in the hospital for observation. If the daily census data does not include children held for observation, please indicate this and include the corresponding census of children held for observation during the same time period. With this , the department requests that Morton Hospital provide no later than 15 days from the date of this letter, but under separate cover, a listing by name of each patent under the age of 18 who was admitted to the hospital or held by the hospital for observation, along with the date and time the child arrived at the hospital, discharge diagnosis, and the date and time the child left the hospital during calendar year 2012 (from January 1, 2012 through December 31, 2012) and for calendar year 2013 from January 1, 2013 through April 30, 2013. Such list should be provided in electronic format such as an Excel spreadsheet and capable of being sorted by both name, discharge diagnosis, and the dates of admission or arrival and discharge.
In addition, as Morton Hospital has indicated through the publication of newspaper ads in the community that its leadership is concerned about the ability of its nurses on its pediatric unit to remain proficient due to declining patient volume, the Department is requesting that Morton Hospital provide it information detailing what evidence hospital leadership has relied on to arrive at its conclusions; when this evidence was first reviewed and when this conclusion was reached; and what Morton Hospital has done to ensure that staff were adequately trained to provide safe care to patients following this determination.
As a result of the Department’s findings based on testimony presented at its May 21, 2013 hearing, Morton Hospital is required under 105 CMR 130.122(G) 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 elimination of services;
(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 elimination 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 eliminated service; and,
(6) A protocol that describes how patients in Morton Hospital’s service area will access the services at alternative delivery sites.
Please ensure that your response to this letter addresses the concerns listed above, and it specific as to what steps Morton Hospital will take to mitigate the impact of the elimination of these beds and services, and what outpatient services are now provided and whether there will be any changes to those services.
While Morton Hospital originally notified the Department that it planned to eliminate its pediatric services on June 18, 2013, and a hearing was scheduled for Friday, April 19, 2013, the unprecedented closure of the greater Boston area due to the manhunt for “Marathon Bomber #2” forced the rescheduling of the public hearing to May 21, 2013. As a result of the rescheduling of the hearing, the Department anticipates that should Morton Hospital decide to continue with its proposal to eliminate its pediatric services, such closure shall not take place before July 20, 2013, at the earliest, so as to allow the hospital the full 60 days provided for in the Department’s essential services regulations to develop and implement its plans. Also, please provide in you plan details as to exactly when Morton Hospital will stop admitting new pediatric patients, as you letter of March 20, 2013 simply indicates this will occur “[a]s the closure date approaches…”.
Under the provisions of 105 CMR 130.122(H), the plan Morton Hospital submits to the Department will be reviewed to determine if the plan assures access to the essential services in Question following Morton Hospital’s closure of its pediatric services.
t Please note that Plan Approval is required before any alterations to Morton Hospital’s physical plant. In addition, should Morton Hospital proceed with the closure of its Pediatric Service, Morton Hospital must obtain approval from the Department for the delivery of services in the manner in which it proposes.
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