The state on Wednesday heard arguments for and against the closure of the labor and delivery unit at Johnson Memorial Hospital, one of three Connecticut hospitals proposing cuts to birthing services.
Executives of the Stafford-based hospital cited low patient volume and difficulty recruiting staff as reasons for their request, echoing arguments presented by leaders at other facilities seeking permission to do the same.
“As a physician, I would like to emphasize that the most important consideration here is patient safety and whether Johnson is able to continue a L&D service in a manner that provides safe and high quality care to patients who come through its doors,” said Robert Roose, Johnson Memorial’s chief administrative officer. “In a low volume environment and correlating inability to retain L&D nursing staff, we cannot provide those services safely.”
And even though the hospital wants to close labor and delivery, it will expand on prenatal and postnatal services available in the community, Roose said.
But Roose also revealed that Johnson Memorial faces sustainability challenges that go beyond the hospital’s labor and delivery unit.
“Is [Johnson Memorial Hospital] considered at risk of closure? Financially?” asked Annaliese Faiella, a planning analyst with the Office of Health Strategy.
“I was not prepared to answer that question today. I’ll be honest,” said Roose with a nervous laugh. “The sustainability of hospitals in the current health care environment is one that is being considered. Right now, there are many hospitals, Johnson Memorial Hospital included, for which financial sustainability is a concern.”
Roose then confirmed that labor and delivery is not the only unit at Johnson facing financial issues.
“Does JMH anticipate closing any other departments?” Faiella followed up.
“I don’t have any comment on that at this time,” Roose responded.
A wave of rural labor and delivery closures
Trinity Health’s proposal to end birthing services at Johnson Memorial is one of three currently under consideration by the state. Hartford HealthCare-owned Windham Hospital and Nuvance Health-owned Sharon Hospital also applied to end labor and delivery services.
If all three hospitals receive approval, only one rural hospital in the state — Day Kimball in Putnam — will offer labor and delivery. And, Johnson Memorial is the only hospital offering labor and delivery services in Tolland County, meaning the county would be left without any maternity units if the state approves the closure.
Activists say that birthing services aren’t being prioritized, even as the state publicly commits to preserving access to reproductive care.
“When they say ‘reproductive health care,’ it’s not just abortion access. It’s also childbirth,” said Brenda Buchbinder, a social worker and member of Windham United to Save Our Healthcare, during a meeting on rural health held in May.
In the cases of both Windham and Sharon Hospitals, community members voiced concerns that the proposed cuts to labor and delivery, as well as other units, are just steps to ultimately closing the hospitals entirely.
The state has not issued a final decision on the applications by either Hartford HealthCare or Nuvance Health.
In July of last year, the state issued a proposed final decision on Windham’s closure, denying Hartford HealthCare’s request. Per the certificate of need process, Hartford HealthCare appealed the decision and OHS gave the system the opportunity for another round of oral arguments.
At the time, an OHS spokesperson said “a final decision shall be rendered within 90 days following the closing of hearing or due date for filing of briefs, if allowed, whichever is later.”
The hearing took place on November 30, 2022, but the state has yet to issue a final decision. OHS did not respond in time for publication to a question about when a final decision would be issued.
The path to Johnson’s labor and delivery closure
In March 2020, Gov. Ned Lamont issued an executive order allowing hospitals to temporarily shut down services to increase capacity for COVID patients.
In response, the following month, Johnson Memorial paused labor and delivery services, before resuming these that July. But it shut them down for good just a few months later.
Roose said the hospital couldn’t adequately staff the unit, despite instituting a “very successful” training program for L&D nurses who then chose to work at other hospitals.
Between 2017 and 2019, an average of 172 babies were delivered at Johnson Memorial, reflecting a 43% decline since 2008, according to Roose’s testimony.
Experts agree that concerns about low volumes and patient safety are valid but say that it has become a common issue hospitals blame for closing labor and delivery units.
“That’s an important consideration, but there are also ways around it. And it’s sometimes used because it’s easier to say than ‘We just can’t make it work financially,’” said Katy B. Kozhimannil, a professor of public health policy at the University of Minnesota.
Kozhimannil’s latest study found that there is in fact a correlation between patient outcomes and birth volumes at rural hospitals, but not at urban ones. However, it also stated that closures are not the solution.
“Closure of low-volume obstetric units is not recommended as a policy strategy in the U.S. based on the current findings,” stated Kozhimannil in the study. “These findings and the available evidence suggest a need for tailored quality improvement resources for rural hospitals, greater investment in rural clinician training, and establishment of referral or transfer networks for rural hospitals to improve obstetric patient safety.”
Elected leaders from the Stafford area testified in opposition to the proposed closure, citing transportation as a major concern.
In testimony, Roose said that patients are choosing to and can continue to deliver at other nearby hospitals, including Saint Francis and Manchester Memorial Hospitals, each located a roughly 30 minute drive from Johnson Memorial.
“Northeast Connecticut is a rural part of the state without much in the way of public transportation and with no direct, easy road connection between the various hospitals cited [by] Johnson Memorial Hospital,” stated Sen. Jeff Gordon, R-Woodstock, in written testimony.
“With all due respect to the proposal, the statement contained within it about the driving distances and times from the towns served by Johnson Memorial Hospital and these other hospitals do not make real world sense,” added Gordon, who has also served as a physician for over thirty years.
Rep. Tammy Nuccio, R-Tolland, also spoke in opposition to the closure, and appealed to OHS to think about the women who would be impacted.
“Just think: if they don’t have transportation, how they’re getting home from the hospital in Hartford to a town — like Union or Stafford or Willington — when those towns don’t even have bus services, they don’t have Uber, they don’t have public transportation. And these are the women that we are going to be putting out,” she said.