Christina McCulloch MBA, BSN, RN, President of Sharon Hospital presents Nuvance Health’s side of the debate about the future of its Labor & Delivery unit
In September, 2021, Nuvance Health announced plans to shut the Labor & Delivery unit at Sharon Hospital. In January, 2022, Nuvance submitted its application to the state of Connecticut. The next step in the regulatory process, which is being governed by Connecticut’s Office of Health Strategy (OHS), is a public hearing to be held on Tuesday, October 18, 2022 starting at 10am via Zoom, with public testimony scheduled to begin at 3pm. The public is encouraged to provide written or oral testimony (details below). After the meeting, OHS will announce its decision.
“Proposing phasing out Labor & Delivery was not an easy decision. Sharon Hospital’s Labor & Delivery unit has served a meaningful role in the lives of so many of our patients and community members. However, we continue to see declining birthrates resulting in low patient volume—less than one birth per day on average over the past 10 years,” said Christina McCulloch MBA, BSN, RN, President of Sharon Hospital.
The hospital’s physicians and physician assistants voted 25-to-1 against the proposed cut. Save Sharon Hospital, a nonprofit community organization, battled to keep the unit open. The group traces its history back to 2018, which marks the last time that Nuvance attempted to close the unit. At that time, the group succeeded in keeping the unit open. “Together, we can do it again,” said the group.
Within the last few years, there’s been quite a bit of debate on the topic. As the adage says, “There are two sides to every story.” McCulloch weighs in on the factors that led to Nuvance’s announcement and the growth-based transformative plan created to ensure Sharon Hospital’s sustainability.
“It’s important to me and our entire leadership team that the community hear from us about what’s going on at our community hospital,” said McCulloch. The former quality director and Chief Nursing Officer has been employed by Sharon Hospital for nearly a decade, and originally hails from the area.
She takes pride in the hospital’s 5-Star Quality Rating from Centers for Medicare & Medicaid Services. “The fact that we were one of just three hospitals in Connecticut to earn the top rating speaks volumes about the skill and compassion of our team,” said McCulloch.
McCulloch cited the American Hospital Association’s September 2022 report, Rural Hospital Closures Threaten Access: Solutions to Preserve Care in Local Communities. It stated that between 2010 and 2021, 136 rural hospitals in America have closed. She said that demographic trends show that births in the Sharon region have also been declining for more than a decade.
“Unfortunately, we had to make difficult decisions to adapt to the current realities of the healthcare industry. Sharon Hospital cannot survive the challenges facing our industry unless we make difficult decisions to adapt to the changing needs of our community. If granted approval to close this service that often goes days at a time without a delivery in a fully-staffed unit, we will be better positioned to maintain and expand the services currently in-demand among our patients and community members and remain a vibrant part of our community for years to come,” added McCulloch.
Transformational Growth Plan
McCulloch spoke about the transformational plan, which is mainly focused on growth. It involves a significant investment in Sharon Hospital’s facility and expanding access to primary and specialty care across the region.
During the planning process, Nuvance received input and worked closely with clinical staff, physicians, and community members as they examined all opportunities available to them.
“Unfortunately, no one was able to develop a solution to make the hospital sustainable without a reduction in underutilized services. This plan, validated by an independent, rural health expert, is predominantly focused on growing our services and expanding access to care,” said McCulloch.
Over the past three years, Nuvance has already invested more than $14.5 million to update imaging equipment, technology, and facilities. This has funded all the new facilities upgrades and equipment, including a new MRI scanner and 3-D Mammography technology.
The hospital also implemented a Telehealth Kiosk in its General Surgery office. It enables those without reliable Wi-Fi at home to use telehealth services to connect with out-of-town specialty clinicians. This service reduces the need for patients to travel outside of the community for care. Via the kiosk, patients can access specialty services, including neurology, oncology, and infectious disease care.
Beyond the new equipment, technology, and facilities, the hospital is actively recruiting new hires. In addition to the two clinicians who joined the team earlier this year, Dr. J. Keith Joseph, a primary care physician and Dr. Bhuiyan, a hospitalist were brought on board. In its effort to remain focused on furthering its commitment to women’s health, Sharon Hospital is seeking a women’s health coordinator, EMS Coordinator, and Medical Director.
America’s maternal health crisis
Labor & Delivery services are a necessary part of women’s healthcare. The White House recently released a Maternal-Health Blueprint to address the nation’s crisis. Its first goal was to increase coverage of high-quality health services.
McCulloch believes that this Blueprint aligns with Sharon’s goals of ensuring comprehensive women’s healthcare across the lifespan. “We expect that as the plan unfolds, it will complement the work our hospital and system are already doing in this area. Examples include addressing social determinants of health, conducting implicit bias training, providing pre- and post-natal care, and expanding access to primary and behavioral health care,” explained McCulloch.
The emergency obstetrics training of Sharon’s Emergency Department staff, in addition to the newly created women’s health coordinator role that will support women in proactive birth planning, will ensure that—if the CON (Certificate of Need) application is approved—Sharon will proactively meet the Blueprint’s goal of improving obstetric readiness for rural and community hospitals without Labor & Delivery units, she continued.
A former patient at Sharon Hospital shared her story about an emergency she experienced during labor. She credited Dr. Howard Mortman, OBGYN for saving the life of both her and her baby. Some people in the community worry about a crisis of this kind—especially with the nearest hospital at least 45 minutes away. They wonder how Sharon’s team can keep patients and their babies safe without a Labor & Delivery unit.
Based on data from similar, neighboring facilities who closed their Labor & Delivery units, McCulloch does not anticipate the proposed closure to result in emergent births at Sharon Hospital.
“However, it is important to know that Emergency Department providers have labor and delivery training as a foundational learning through their residency program when training to become a physician. Throughout the regulatory process to phase out Labor & Delivery, Nuvance Health and hospital leaders have instituted additional clinical trainings to prepare staff to help mothers and babies through emergent situations. The trainings have and will continue into the future and are reinforced through simulated drills,” said McCulloch.
The Emergency Department providers and nursing staff are also completing Neonatal Resuscitation Program (NRP) training that mirrors the training current Obstetrics and Pediatric providers complete. The Emergency Department staff will be fully equipped to stabilize infants prior to traveling to one of the neighboring hospitals, in the event of an emergent birth that requires resuscitation.
It should be noted that resuscitation is only necessary when a newborn is dying—a situation that can potentially be avoided when an obstetrician with a support staff delivers a baby.
Dr. Mortman has been delivering babies at Sharon Hospital for 31 years. He explains that at any moment, the birth of a baby can turn dramatically dangerous such as when there is a sudden drop in the fetal heart rate, maternal hemorrhage, eclamptic seizure, or shoulder dystocia. It is common to have obstetrical and gynecological emergencies, not infrequently when least expected is otherwise normal pregnancies or healthy patients. These situations require highly trained skilled experts to minimize poor outcomes.
“We continue to ensure our teams, in partnership with local EMS personnel, are prepared for any emergency. We continue to meet on a regular basis with the local EMS squads to ensure continuity of communication across all areas as Sharon Hospital adapts changes,” stated McCulloch.
Nonprofit status & small town economics
As rural hospital closures occur, ethical questions arise about hospitals’ responsibilities to their communities. Sharon Hospital is a nonprofit hospital that is part of Nuvance Health’s nonprofit health system. McCulloch explained that to remain operational, nonprofits need enough capital to cover expenses, just like any other business.
“We cannot function unless we make enough revenue to cover the costs associated with the services we provide,” she added. Funds are needed to pay staff salaries and benefits; fund maintenance projects; purchase supplies; and reinvest in facilities and communities to ensure that Sharon can continue to provide high-quality care.
According to the American Hospital Association’s Rural Hospital Closures Threaten Access-Solutions to Preserve Care in Local Communities report, “In 2020, rural hospitals supported one in every 12 rural jobs in the U.S. as well as $220 billion in economic activity in rural communities.”
Since Nuvance Health is one of the largest employers in Litchfield County, many are concerned about the planned closure’s economic impact on this rural community.
“This plan will allow us to remain sustainable in the long-term, helping us remain one of the largest employers in Litchfield County. In fact, we are working hard to recruit new employees as we continue growing our primary and specialty care services,” said McCulloch.
It’s important to mention that Nuvance’s proposed plan also called for consolidating its inpatient units into one Progressive Care Unit (PCU). McCulloch stated that the hospital will continue to provide nearly all the same services in the proposed PCU. “This will primarily be a change in location within our hospital to help our clinical teams operate more efficiently and modernize our facility.”
On the topic of finances, according to Becker’s Hospital Review, Nuvance Health reported a net loss of over $130 million while its President and CEO John M. Murphy, M.D., took home $12.8 million in fringe benefits.
McCulloch explained that at Nuvance Health, an all-volunteer committee of the board of directors sets compensation policy and endorses talent acquisition strategies brought forth by staff. The process is informed by a nationally recognized vendor that provides industry and market analysis, top talent acquisition and retention strategies, and competitive hiring practices.
All compensation plans—including salaries, bonuses, and pension payments—are commensurate with experience and industry pay to ensure that Nuvance Health and its hospitals attract the highest quality staff. This extends to the clinical staff and administrative staff, as well as leadership.
“We adjust salaries on an ongoing basis to ensure every member of our exceptional team is compensated appropriately. In 2021, Nuvance Health issued a one-time pension payment to Dr. Murphy, CEO of Nuvance Health, based on a long-standing, multi-year contractual agreement,” she added.
Throughout the pending debate, Sharon Hospital used various tools to keep the public updated. Among them is a landing page on its website, and a sub-page that is dedicated to community engagement. It includes media coverage and information from the 30-plus community meetings Sharon has held. On November 9, 2021, an opinion piece from the hospital’s Board of Directors ran in The Register Citizen.
“As leaders, it is our responsibility to position Sharon Hospital to remain sustainable and strong into the future to ensure we can continue to meet the evolving needs of our patients and community. I’m incredibly passionate about this hospital, our five-star team, and the patients and community that we serve,” concludes McCulloch.
How to provide testimony
To provide an ORAL TESTIMONY, log into Zoom (visit: www.savesharonhospital.org for the link) on October 18th at 10am to sign up to testify. The public testimony starts at 3pm. To provide a WRITTEN TESTIMONY, email your testimony to OHS at firstname.lastname@example.org by October 17th. Please reference Docket No. 22-32511-CON