Closing of birthing center prompts reconsideration of law change

Rockville General Hospital sparked local controversy late last year when it closed its birthing center. It also drew attention to a little-noticed change in state law that allows hospitals to eliminate services without first getting state approval–something a Vernon lawmaker now wants reversed.

In the past, hospitals were required to get approval, known as a certificate of need, before they could make changes such as eliminating services, adding beds or purchasing equipment like CT scanners. But under series of changes to the process, passed as part of the budget bill last year, hospitals no longer need approval to terminate inpatient or outpatient services, except those involving mental health or substance abuse.

State Rep. Claire L. Janowski, D-Vernon, who faced criticism during last fall’s campaign over her vote for the budget measure that included the changes, has introduced a bill aimed at once again requiring hospitals to get approval before cutting services. Removing that authority from the state appeared to be an unintended consequence of other changes to the certificate of need process, she said.

“Everyone seems to think that that was not the intent,” Janowski said.

The state Department of Public Health has not yet taken a position on Janowski’s proposal. But department spokesman William Gerrish said allowing hospitals to terminate services without getting approval was “deliberately included in those changes.”

The changes, which were expected to reduce the number of certificate of need applications by 50 percent, came shortly after the Office of Health Care Access, previously an independent agency, was folded into DPH. Supporters said they were intended to make the certificate of need process more responsive to changes in the health care system.

Gerrish said removing the need for hospitals to get approval to eliminate services was done in part to bring Connecticut in line with other states.

“In no other state was that a requirement based on the research that we did,” he said.

Much of last year’s debate on the certificate of need changes centered on other provisions of the proposal. During a public hearing, only one person raised concerns about removing the public’s ability to weigh in on hospital service cuts.

Then word got out that Rockville General’s parent company, Eastern Connecticut Health Network, was closing the hospital’s birthing center, the Birthplace, and eliminating inpatient obstetrical services.

Dennis McConville, ECHN’s senior vice president for planning, marketing and communications, said the change in state law did not affect the decision.

“We would have had no problem with applying for a certificate of need,” he said.

The decision to close the program stemmed in part from a drop in the number of deliveries and difficulty recruiting staff. It came after an obstetrician announced plans to leave the hospital’s medical staff, prompting concerns that the number of births at the hospital would drop to about 200 a year. Doctors typically need to perform a certain amount of procedures regularly to maintain competency, and McConville said such a low birth volume could ultimately make it difficult to maintain quality.

ECHN is also the parent company of Manchester Memorial Hospital, a 10-mile drive from Rockville General, and McConville said closing the Birthplace would not present access problems for patients.

Although a certificate of need hearing process might not change the outcome, Janowski said the public should have a chance to weigh in.

“Having the opportunity to hold a public hearing on any change, especially when it impacts a small hospital, is very important,” she said. “It may not change the decision that ultimately will be made by the Office of Health Care Access. They may decide that it’s legitimate and it’s needed and it’s appropriate, like any decision that they review. But the point is to have that opportunity, that transparency to get the public input.”