In September, 2021 Nuvance Health announced plans to shutter the Labor and Delivery Unit at Sharon Hospital – a 78-bed general hospital in Connecticut’s Litchfield County. At the time, Nuvance announced that it would also make cuts to the Surgical Department and Intensive Care Unit. The reason: reduced patient demand and staffing challenges, which were further exasperated by the COVID-19 pandemic.
More than 12,000 people are employed by Nuvance Health’s network, which includes seven hospitals, of which Sharon ranks highest in patient satisfaction and safety ratings. According to Becker’s Hospital Review, in 2019, the non-profit system’s projected annual revenues amounted to $2.4 billion. Sharon Hospital’s physicians and RNs voted 25-to-1 against Nuvance’s proposed cuts to Sharon Hospital.
As a rural hospital, Sharon Hospital took pride in delivering “personalized, community healthcare” to just under 15,000 people residing in Region 1 of Connecticut as of 2021, not including patients who crossed the border from New York and Massachusetts.
According to the US Government Accountability Office, more than 100 rural hospitals closed between 2013 and 2020. When these hospitals shutter, those who reside in the community must travel, on average, about 20 miles further for vital services. When it comes to obtaining treatment for alcohol or drug abuse, that distance typically increases to about 40 miles.
A difference of life and death?
When rural hospitals close or limit their services, another key issue is that people must travel greater distances to receive emergency care in the wake of an accident, heart attack, or other critical situation. It’s important to note that the leading cause of death in Connecticut is heart disease according to the Centers for Disease Control and Prevention (CDC). This is a reason for concern.
Researchers at University of Kentucky and IZA Institute of Labor Economics (initiated by Deutsche Post Foundation) measured the effects of access to emergency care after a closure. Its findings revealed that urban patients in zip codes where a hospital closes have a small change in transportation time, but rural patients average an estimated 15.7 additional minutes. According to Dr. Mortman, an OB/GYN at Sharon Hospital, this additional time could mean the difference between life and death.
Connecticut State Representative Maria Horn has addressed the potential closure of Sharon’s Labor and Delivery services. She pointed out that these services are a necessary part of women’s healthcare and closely related to Sharon’s ability to attract and retain young families.
It is important to note that the US has a disturbingly high rate of infant mortality, according to the CDC. To clarify, infant mortality is a death that occurs before the baby’s first birthday. This statistic is an important marker of the overall health of a society. In 2019, the infant mortality rate in the US was 5.6 deaths per 1,000 live births. In Connecticut, that rate was 4.2 infant deaths per 1,000 live births.
Unfortunately, the US also has a high maternal mortality rate. The World Health Organization defines maternal mortality as “the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and the site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes.”
According to the CDC, in 2020, 861 women were identified as having died of maternal causes in the US compared with 754 in 2019. The maternal mortality rate for 2020 was 23.8 deaths per 100,000 live births compared with a rate of 20.1 in 2019. The fact that the rate is rising marks another cause for concern, and further cements how vital it is to have a hospital with services such as Labor and Delivery within a relatively short driving distance for patients.
Beyond the impact on health, there’s the toll hospital closures and/or limiting services take on their communities. Specifically, closures can have detrimental effects on rural communities. According to The Effect of Rural Hospital Closures on Community Economic Health, National Library of Medicine, National Institutes of Health, the closure of a sole hospital in the community reduces per-capita income by $703 or 4% and increases the unemployment rate by 1.6%. Closures in communities with alternative sources of hospital care had no long-term economic impact, although income decreased for two years following the closure.
Many community members are directly employed by local hospitals such as Sharon. Hospitals are often considered vital to local economies since they bring outside dollars into the communities via third-party payors, provide jobs, stimulate local purchasing, and help attract industry, young families, and retirees.
Obligation and ethics
As rural hospital closures and/or limited services become more common, many patients are left without sources of care, raising ethical questions about hospitals’ and clinicians’ responsibilities during and after closures. In many cases, hospitals have been the economic hubs of their communities and we can only hope that they seriously consider the short- and long-term consequences that their decisions will have on community life.
An article entitled, What Should Be the Scope of a Health Network’s Obligation to Respond After a Hospital Closure? by George M. Holmes, PhD and Sharita R. Thomas, MPP, and published in the AMA Journal of Ethics, has shed a light on this issue. As stated in the article, “the last few years have seen an increase in the rate of rural hospital closures; from 2010 through 2013, there were 7.5 rural hospital closures per year, compared to nearly 13 per year from 2014 through 2018.”
According to Holmes and Thomas’ findings, “the causes of rural hospital closure are varied […] but can be roughly categorized into four broad groups:
1. Demographics: low volume due to declining or aging population or decreases in women of childbearing age
2. Economics: lower insurance coverage or lower household income, which reduces ability to pay
3. Technology and market trends: consolidation, decreasing use of inpatient services, staffing requirements
4. Policy changes: projected decreases in Medicare physician payment rates by 2025, although improved financial performance of hospitals in states that expanded Medicaid and Affordable Care Act provisions that shifted the financial costs of providing care from consumers to the federal government could reduce the likelihood of hospital closure.”
Health care organizations faced with the decision of whether to close a rural hospital and/or limit its services should consider the potential emotional, economic, practical, and political impacts of closure for the community and for itself.
Dana Domenick had a baby at Sharon Hospital earlier this year and shared, “I understand why a privatized hospital would shut down some of its services such as if the maternity ward is being underutilized. I truly get it, but I also hate it. To me it seems that Nuvance is trying to make money rather than service the public.” She continued by elaborating: “My entire experience at Sharon Hospital was incredible! I felt so taken care of and I think hospitals should strive to be like Sharon Hospital. Instead of closing the maternity ward, Nuvance should be trying to bring people to the hospital to have babies, and for them to have their own amazing experience like I had.”
What is the Save Sharon Hospital group, why was it formed, and what is its goal?
Save Sharon Hospital (SSH) was originally formed during the summer of 2018 when Sharon Hospital announced its plans to close Maternity services in less than a month. According to the group’s website, “We were outraged by the decision to remove this vital service from our community and upset by the lack of communication from Sharon Hospital. Our hard work paid off, and Sharon Hospital announced that it would keep Labor and Delivery open indefinitely!”
As the group’s website explains, later that year, HealthQuest (the NY-based company that previously owned Sharon Hospital) and Western Connecticut Health Network (WCHN), applied to the Connecticut Office of Health Strategy (OHS) to merge their two organizations. OHS made the decision that HealthQuest and WCHN could merge (eventually becoming Nuvance Health), and took the public testimony provided by SSH and other community members to heart – OHS required that Sharon Hospital maintain all services including Maternity for the next five years as part of its Certificate of Need (CON) process as a caveat for the merger.
Fast forward to September 2021, and once again Nuvance announced plans to close Maternity, this time in 8-12 months. However, according to the SSH group’s website, OHS has yet to approve the closure, and Nuvance’s five-year commitment is not up until April 1, 2024. “Rather than closing down our vital services, Nuvance should be using the remaining time in its five-year commitment to find sustainable solutions to maintain our hospital as a full-service operation,” the group’s representative stated.
They continued to explain: “Since Nuvance’s September 2021 announcement, we have formed a non-profit 501(c)(3) organization, and hired an experienced healthcare attorney from one of Connecticut’s major law firms. Our lawyer has helped plan our legal strategy and communications with OHS, and is responding to the legal filings in connection with the ongoing CON process.”
In response to the letters from SSH and the medical community, on February 3, 2022, OHS opened an official investigation into Nuvance’s compliance at Sharon Hospital with the initial agreement made in April 2019, citing: “Information received from the community and Hospital suggests that key discrepancies persist concerning the Hospital’s compliance…” and that OHS “shall have the power to administer oaths and take testimony related to the matter of the investigation.”
Nuvance on revenue loss
Sharon Hospital’s owner, Nuvance Health, claims that since Nuvance bought the facility in 2017, Sharon Hospital has lost about $40 million. It therefore plans to close the hospital’s maternity ward and convert the intensive care unit (ICU) into a “progressive care unit.”
Nuvance claims it plans to phase out Labor and Delivery because Sharon Hospital has seen fewer than 200 annual deliveries for the past four years – an average rate of fewer than one delivery per day. It claims that some days pass with no births at all, but a fully staffed unit is still in place. It states that an underused unit cannot be maintained while ensuring that Sharon Hospital can continue serving its patients and community in the long-term. It also states that the Sharon Hospital Emergency Room physicians are trained to deliver babies.
As for Nuvance’s plans to convert the ICU into a progressive care unit, according to CT Insider, hospital officials say the change to the ICU wouldn’t reduce services. This plan intends to maintain the same level of service without losing revenue.
According to a March 2022 article in CT Examiner, Nuvance came in with a .46% profit margin. Nuvance Health’s president and CEO John Murphy, MD, took home $12.8 million in fringe benefits, the News-Times reported October 21.
Save Sharon Hospital’s stance
SSH countered those points stating that although Nuvance has cited low annual birth numbers and high operational costs for the reasons behind the cuts, SSH claims that Nuvance hasn’t been transparent about the numbers. SSH also says that important data has not been shared with the public, including what the total number of births per year would need to be for Nuvance to break even financially, and what the total reduction in operating expenses and/or increase in revenues would need to be for Nuvance to break even. They also point out that according to the documents filed by Nuvance to OHS, not only has the annual number of births averaged above 200 at Sharon Hospital for the past four years, but the decline in birth rates at Sharon Hospital can be largely attributed to the lack of promotion of the birthing suites, along with the repeated announcements of imminent closure. As for the proposed replacement of the ICU with a progressive care unit, the medical professionals in their group claim that a progressive care unit cannot provide the same level of care found in an intensive care unit, and the loss of an ICU would definitely be felt by the community. SSH feels that the proposed changes would take necessary services away from residents. Additionally, both the members and supporters of SSH as well as numerous physicians like Dr. Howard Mortman, emphatically explain that limiting or eliminating services such as Labor and Delivery can be the difference between life and death for those in need of said services.
“I care about my patients like they are my family. And what is about to happen if Nuvance gets its way will threaten the lives- and the quality of my patients’ lives. The proposed closures and/or limitation of services is going to cause lifelong morbidity and overall bad outcomes,” explained Dr. Mortman.
Although Nuvance claims that its Sharon Hospital Emergency Room physicians are trained to deliver babies, SSH counters that by stating that despite how highly trained the Emergency Room physicians are, their experience delivering babies is unlikely to be matched by a certified obstetrician who has completed a five-year residency in obstetrics and gynecology and who is trained in obstetrical emergencies.
Nuvance on growth and ability to meet the evolving needs of the community
Nuvance says its plan focuses on growth and envisions a sustainable, vibrant future for the hospital. It claims that the strategic direction is the result of years-long planning by Sharon Hospital and Nuvance Health to analyze how the community seeks care and chart a sustainable path forward in meeting long-term needs.
It says that the plan includes expanding primary and ambulatory care to improve patient outcomes and reduce the need for hospital stays; investing in behavioral health to fill a gap in the region to better meet the needs of the growing 65+ population and expand services to adolescents and adults with intellectual and developmental disabilities. It plans to convene workgroups to evaluate opportunities for consolidation, and phasing out underused service lines that are available at other Nuvance Health facilities, which includes developing an operational plan to evaluate the days and hours of operating room availability to improve the efficiency of the currently practiced surgical schedule.
Save Sharon Hospital’s stance
To counter, the SSH group says that Nuvance’s plans don’t take into account the population growth that has occurred during the pandemic. School enrollment in Region 1 grew by almost 2.5% from pre-pandemic figures in the 2018-19 school year compared with the 2020-21 school year, a possible indication of the relocation of many families to this area as a result of COVID-19. Nuvance’s plans also don’t take into account the need for people within the community to have safe, local access to healthcare. For example, pregnant women would be required to travel 45-60 minutes to another hospital to deliver their babies, which may be too long during an emergency situation, and could be dangerous during inclement weather.
Regarding the plans to evaluate operating room hours, according to SSH any cut to hours would lead to times when people needing emergent surgeries would need to be transferred to another hospital for these surgeries – again, which could mean the difference between life and death. Sharon Hospital states that if the Labor and Delivery unit closes, it will no longer be required to pay anesthesiologists to be on call for births after normal operating room hours or to pay surgeons to assist with emergency C-sections. This also means that there will be no surgeons or anesthesiologists for all other emergency surgeries outside of normal operating hours.
The rallying cry
The community, along with the SSH group, has put forth the rallying cry against Nuvance’s repeated attempts to shutter the doors of Labor and Delivery and limit other services. Some patients and community members have gone so far as to claim that Nuvance is “waging a war on women and women’s healthcare” by attempting to shut down and limit these services.
Amy Scheim of Millerton, NY, gave birth to her first child in 2021 at Sharon Hospital and she emphatically explained that, “I can’t say enough positive things about my experience, about Dr. Mortman and the entire Sharon Hospital staff. During my stay at Sharon Hospital, my needs and concerns were being heard and respected, which I can’t say is the case at most other hospitals.” When it came to the possible closure of the maternity ward, Scheim continued, “I am completely outraged that Nuvance is trying to close Labor and Delivery. Sharon Hospital and their birthing suites really stand out in terms of the level of care and support being offered, well beyond the day that you go home. Nuvance has an opportunity to stand out and support pregnant women and families, but instead they’re going to abandon them and walk away. They will be abandoning a large part of our population and will ultimately be putting them at higher risk because they now have to travel so much further, not to mention if they have possible complications. The closure is an abandonment instead of an investment in our community, and Nuvance will be leaving our families high and dry.”
The community has shown up to have their voices heard in numerous ways such as by contacting local and state politicians, by signing letters and petitions, and by attending a number of rallies hosted by the SSH group. SSH is planning for community events in the near future, leading to the upcoming public hearing on whether or not Nuvance will gain permission from the state to close labor and delivery at Sharon Hospital. (The date for the public hearing has yet to be scheduled by the state). These events will be announced in the local media and on the SSH website.
As you can deduce from the information, facts, and opinions shared above, this is not a simple matter and there are a lot of variables involved. At the end of the day, we can only hope that when decisions are made that the sole focus will be on what is best for the welfare and health of the people that reside in the community.
To learn more about Sharon Hospital please visit www.nuvancehealth.org/
To learn more about the Save Sharon Hospital group, please visit www.savesharonhospital.org.