Background on Baystate Noble Nurses and the Community’s Fight for the Future of the Hospital

For more than 120 years, Noble Hospital provided comprehensive care to residents in Westfield, West Springfield, and the surrounding communities of Hampden and Hampshire counties. In 2015, Baystate Health acquired Noble and promised to “provide more care locally,” pledging that, “patients will see enhanced services.”^[i] While Baystate has made promises like these in each of the communities where it operates hospitals, it has rarely kept them:

• Baystate outsourced service after service from Franklin Medical Center in Greenfield, a practice that only slowed once Franklin nurses went on strike in 2012.
• In 2014, Baystate closed Mary Lane Hospital
• In 2019, Baystate closed the ICU at Noble and Wing
• In 2019, Baystate announced plans to close 3 mental health units: The Fowler at Noble, Franklin, and Wing
• In 2019, Baystate announced plans to open a for-profit mental health facility in Holyoke with US HealthVest. Baystate cancelled the deal after investigative journalists revealed HealthVest’s history of providing inadequate and dangerous care
• In 2020, Baystate partnered with Kindred Healthcare, a Kentucky-based company owned by investment firms.

Baystate executives’ willingness to make promises they won’t keep is surpassed only by their greed. Despite being one of the most profitable health systems in Massachusetts and receiving a combined $428.6 million in grants and loans from the federal government since May,  Baystate Health has spent the last nine months devaluing the care Noble Hospital nurses provide, demanding significant takeaways in paid time off, overtime, and health insurance, and has offered less than a 1% raise over the course of a four-year contract to the most highly-skilled, veteran nurses.^[ii] In contrast, as the opioid crisis continues and the COVID-19 pandemic surges, nurses at Baystate Noble have been fighting for safe staffing and competitive wages, and focusing on meeting community healthcare needs. Noble nurses surveyed more than 460 community members, who overwhelmingly support the expansion of inpatient medical/surgical beds, the reopening of the ICU, and keeping the Fowler Wing open.

ICU

Baystate Health finalized the closure of Baystate Noble’s ICU in August, indicating that patients who needed ICU care could easily be transported to the Springfield hospital. But Donna Kelly-Williams, RN, president of the Massachusetts Nurses Association, said, “Many patients rely on the ICU – patients who need the critical care at the moment they need it. Minutes, even seconds, count when a patient requires ICU-level care.” Closing the Noble ICU care is particularly dangerous for patients in the ED and operating rooms, who may arrive at the hospital in critical condition or whose condition suddenly worsens. And eliminating ICU care is tantamount to eliminating equal access to care for Westfield and surrounding communities as critically ill patients will be transported for care and whose family members will face challenges in remaining close during a loved one’s recovery.

Mary Martin, RN, an emergency department nurse, said the lack of ICU beds has an impact on the whole hospital, including the ED: “Can you imagine having eight beds of people just waiting to be admitted where you still have the constant flow of people coming into the [ED] for acute illnesses? That puts the wait times much higher.” Indeed, nurses report that the ICU at Baystate in Springfield is often at capacity, so whether that unit can meet the needs of the additional flow of patients is an unanswered question. 

The surge in COVID-19 infections creates an even greater need for ICU-level care. Among the communities that most heavily rely on Noble Hospital, both Westfield and Southwick had growing incidences of COVID in the last two-week period measured by the state.[iii] Springfield is a “Red Zone” area, with both a higher percentage of people testing positive for COVID and a higher overall COVID case count. These combined factors suggest that COVID patients in the Noble service needing ICU care may wait in the Westfield ED for beds to open in Springfield, the community hardest hit by COVID in Western Massachusetts. Nurses and community members are concerned that, by the time those beds are available, patients will be beyond help.

Fowler

As with the closure of the ICU, Baystate’s plan to close Noble’s Fowler Wing inpatient psychiatric unit would have far-reaching impacts. Fowler provides care to adults, many of whom have comorbidities (e.g., mental illness, addiction, and diabetes) and require inpatient treatment, where healthcare providers can assess their physical and emotional needs, administer medication, and intervene in the case of emergency. Community needs are so significant that mental health disorders accounted for four out of the top ten – or 35% of – discharges at Noble Hospital, according to the most recent publicly available data.^[iv] And Baystate Noble’s 2017-2020 strategic plan, which identified mental health and substance use as its top priorities, noted “an urgent need for improved access to mental health services and increased resources for substance use treatment and prevention.”^[v] The report also outlined some of the challenges facing residents living in the Noble service area^[vi]:

• Hospitalization rates for mental health/substance use disorders were 70-80% higher than the state in Westfield and West Springfield.^[vii]
• “Blacks in Westfield experienced high ER visit rates for mental health disorders, with rates more than three times greater than that of Whites and that of the state.”; “The rate among Latinos in West Springfield was 94% greater than that of Whites.”
• Latinos in Westfield and West Springfield experienced significantly higher hospitalization rates than both whites and the statewide average for mental health and substance use issues.
• Opioid-related hospitalization rates were also higher among Latinos when compared with whites
• Youth are disproportionately impacted by mental health issues, including depression and teen suicide
   

Even with the existing 20 beds in the Fowler Wing, Baystate Noble acknowledges that portions of its service area are “medically underserved,” and residents experience a variety of barriers to prioritizing healthcare needs and accessing care, from a “lack of providers” to housing shortages and food insecurity.^[viii] Travel times from towns like Southwick, Chester, and Granville to the proposed site in Holyoke could be up to forty minutes by car, and the Holyoke site is inaccessible by public transportation; from Westfield State University, it can take two hours and thirteen minutes by bus to get to Holyoke. These travel times are unreasonable for people needing urgent mental health and addiction treatment; Baystate has not proposed a solution. Given the high rates of mental illness and drug addiction, the associated rates of hospitalization and ER visits, and difficulties accessing care, the Fowler Wing is an essential service to Hampden County communities. These services are also essential to Noble’s ongoing survival as a full-service hospital, which Baystate has repeatedly committed to maintaining. 

Closing the Fowler Wing at will place obvious obstacles in front of Westfield are patients and their loved ones who rely on a local unit for their care if they are forced to seek those services in Holyoke. Fewer and fewer people – particularly the low-income, students, and people of color – will get the care they need, as geographic isolation, insufficient public transportation, and costs associated with travel to and from Holyoke prove to be barriers to care. And the effects of reduced access to care are likely to be felt by the larger community.

ProPublica, which reviews ER wait times in all U.S. hospitals, found that, when compared to the state averages, patients at Noble Hospital have a shorter wait time before being seen by a provider, spend less time in the ER before being sent home or admitted to the hospital, and patients who have been admitted are taken to their room more quickly than the Massachusetts average.^[ix] But patients with stroke symptoms wait twice as long as the statewide average for a CT scan. So while the majority of Noble’s existing ER quality measures compare favorably to Massachusetts measures, the presence of an on-site psychiatric unit makes it possible to move patients with mental health and addiction problems out of the ER and into their rooms quickly. If patients are forced to wait hours, days, or even weeks in the Noble ER for a bed in Holyoke, timely and safe care for every patient in the ER will be jeopardized.

So why would Baystate jeopardize this community’s access to healthcare? Greed. Despite the huge profits Baystate Health turns every year, focusing on revenue-generating services and partnering Kindred Healthcare will allow Baystate to be “more selective” about the patients it will treat. This profit-centered approach will deepen disparities in access to care and exacerbate poor outcomes for the most vulnerable populations in the communities surrounding Westfield.

A Noble Hospital for the Future

Baystate’s single-minded attention to profit has will continue to cost the Noble Hospital community so much, as Baystate forces patients families seek care in Springfield, the lack of an ICU drives up ER wait times and leaves acutely ill patients without intensive-level care, and eliminating the Fowler Wing will mean that some of the most vulnerable patients will no longer have an accessible mental health unit to rely on in a crisis. MNA nurses at Noble Hospital, elected leaders, and hundreds of community members now call on Baystate Health to work with them to rebuild a Noble Hospital for future generations that will once again be a full-service facility where nurses and staff can safely care for patients in their own communities and be afforded fair wages and benefits for their work. Baystate can afford to make this happen. Community residents cannot afford to lose more access to care.

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