I read reporter Cris Villalonga-Vivoni’s well-researched article, “CT Hospital industry calls for overhaul of ‘overly burdensome’ state regulatory process,” with great interest, because nearly half a century ago, in the 1970s, I staffed the committee that wrote those Certificate Of Need regulations.
The concept of applying to close a whole unit of hospital service never even occurred to us. Yet, over half of all CON hearings listed on the Office of Health Strategy (OHS) site are for reduction in services, mostly in Windham (Hartford Healthcare), Johnson Memorial (Trinity) and Sharon (Nuvance).
I retired from the Connecticut Health Department as Director of Research and Vital Records, but in the 1970s, when I served as Operational Planner, Connecticut Commission on Hospitals and Health Care, the intent of CON regulation was to slow down or prevent the purchase of expensive new equipment like MRIs and CT scanners that would receive limited use but increase income for the hospital.
I am a doctor of public health with a specialty in the economics of health care. All economics is about money, and health economics is about the specific ways that money affects and deforms the health care system. For example, I started at the Yale School of Public Health in 1969, soon after Medicare and Medicaid became law. However, the American Medical Association opposed government payments, so we ended up with a mostly private pay health care system that has become more and more dysfunctional as the decades pass.
As the article states, there needs to be a comprehensive review of CON regulations as they are applied now, but that review needs to be based on quality-of-care requirements, not the business concerns of the hospital industry. Certificate Of Need regulations started in the Health Department, where health was the priority and cost concerns were directly related to quality of care. Now, in a 180-degree change from when they were written, CON applications go to the Office of Health Strategy [OHS], a part of the governor’s office, where cost control has long been a primary concern.
In Windham, dedicated mothers and providers have been working for years to bring Hartford Health Care to account for the loss of Windham Hospital’s ICU and birthing services. They have galvanized the public, but gotten no serious response from the institutions.
[What to know about the closure of Windham Hospital’s birthing unit]
When Hartford Health Care took over Windham Hospital, their business office looked at the service array and saw an ICU with a low number of cases (falling birth rates are a nationwide phenomenon). They didn’t care that the ICU was an integral part of the OB GYN services provided to women. From a profit-making perspective, it was the perfect unit to get rid of. From a human perspective it was all wrong.
Shutting down the ICU forced the Mansfield OB GYN practice — that had been providing services to area women — to leave Windham Hospital for Manchester Hospital, because the doctors felt it was not safe to provide birthing services without the backup of an ICU. As a result, Windham Hospital was effectively without a birthing center and women had to go elsewhere for hospital care to give birth.
Windham Hospital’s ICU was shut down in 2015, despite objections by medical staff, legislators and community members. In June 2020, the Maternity Unit was closed without community input, with no CON filing and no financial or health care statistics to support the decision. Hartford Health Care filed the CON to shut down the ICU in September 2020 and the CON hearing was held on Nov. 10, 2021. On Nov. 8, 2021, Attorney General William Tong wrote to the Office of Health Strategy asking for statistics pertaining to the consequences of the closures, and pointing out that a disadvantaged hospital area like Windham should not have further cuts to services without clear data showing that such cuts would not further harm health outcomes. The AG received no response to this request.
In June 2022, the Office of Health Strategy denied HHC’s proposed closure of Windham Maternity due to unmet health benchmarks. In August 2022, HHC appealed that decision and on Dec. 1, 2023, OHS ruled that Windham Hospital could close Windham Maternity. The tradeoff meant waiving, i.e., ignoring, the unmet health benchmarks and gave HHC jurisdiction to appoint an independent monitor to conduct a feasibility study for a birthing center in Windham.
2023’s Maternal Health Law is a well-intentioned bill, and can be strongly supported with one crucial exception — birth centers. As written, that law makes much of free-standing birth centers. However, virtually all the research cited was done in very large urban areas like New York City, and is simply not applicable to Connecticut, especially Eastern Connecticut.
Consider the absurdity of building and staffing a free-standing birthing unit in a small municipality, like Windham, that already has, or had, a perfectly fine birthing unit inside the hospital. At best, birthing centers are a distraction; at worst they are a cynical brush off from the powers that be to the country bumpkins who will believe anything.
The Maternal Health bill in 2024 needs amendments to restore maternity units and ICUs, and the attorney general needs to use the power of his office to get answers to quality-of-care questions and enforce the rules that ensure quality of care.
Christine Pattee lives in Coventry.
