This story has been updated.
Legislators in the Public Health Committee on Wednesday passed a bill that would prevent the closure of certain labor and delivery units in response to cuts in recent years to maternal care in rural areas of the state.
House Bill 1539 would require the state to deny permission to any hospital seeking to close its labor and delivery unit if there isn’t an alternative unit within 25 miles. The bill would also make other changes to the state’s approval process for major health care transactions, known as the “certificate of need,” including requiring approval for certain deals involving private equity and creating an expedited approval process for increasing the number of beds in a health facility.
“The biggest issue is the concern about access to care for people who are giving birth,” said Rep. Cristin McCarthy Vahey, D-Fairfield, who co-chairs the Public Health Committee, during an interview with The Connecticut Mirror. “Given some of the history in the state with closures, we want to make sure that we’re doing everything we can to avoid it.”
Between 2010 and 2022, the share of hospitals nationally without labor and delivery units increased every year. As of 2022, more than half of rural hospitals and over a third of urban hospitals in the country did not have maternity units.
Over the past several years, three hospitals in rural parts of the state have applied for permission to shutter their labor and delivery units, citing reasons including declining birth rates, financial pressures and physician shortages. The state approved closures at Hartford HealthCare-owned Windham Hospital in December 2023 and Johnson Memorial Hospital, located in Stafford and owned by Trinity Health of New England, the following November.
“This is how you kill a small city,” said Rodney Alexander, during a protest on the steps of the state Capitol in November 2023. Alexander is a member of the Willimantic town council and vice president of the local NAACP branch. “How can you convince a young couple to move to Willimantic, raise a family, with no maternity ward?”
In the case of both closures, the Office of Health Strategy, which oversees the certificate of need process, stipulated that the hospitals must hire an independent third-party to study the need for and feasibility of establishing a free-standing birth center in the area. The findings of the Windham study are due April 8 and the Johnson Memorial study has not yet begun, OHS spokesperson Wendy Fuchs said.
Sharon Hospital also applied to shutter its maternity unit, but the state rejected the proposal, to the relief of local physicians and activists who had fought to keep it open. Nuvance Health, the health system that owns Sharon Hospital, is currently seeking state approval for a merger with New York-based Northwell Health. The parties have committed to keeping labor and delivery open for at least five years as part of a deal with state Attorney General William Tong.
Some people who offered testimony during a public hearing on Monday questioned the 25-mile radius, but McCarthy Vahey called it “a place to start the conversation.”
OHS executive director Deidre Gifford said that the agency has sought a good benchmark for how far someone can safely travel for labor and delivery services, but current research doesn’t have an answer.
“OHS posed the question to providers multiple times as to how the agency might establish a guideline for appropriate distribution of those services. Despite these efforts, OHS was unable to definitively determine an appropriate threshold,” Gifford wrote in testimony.
John Brady, a registered nurse and the executive vice president of AFT CT, a union whose members include nurses and hospital staff, recommended that the measure consider travel time, in addition to distance.
“In health care, time is critical. 25 miles on an interstate highway can mean 20-25 minutes, but 25 miles on rural roads can mean much longer transport time,” Brady wrote in testimony.
OHS also proposed its own bill concerning certificate of need, which the committee passed. It calls for clarifying the conditions under which facilities can be fined for terminating services without permission and seeks to establish an expedited application review process for those that “address a significant unmet need.”
During a vote on Wednesday, Sen. Saud Anwar, D-South Windsor, said these bills are just a starting point and he expects “intense conversations” regarding certificate of need as the session progresses.
Last year, legislators demanded reform to the process after it took OHS over a year for to approve a deal for Yale New Haven Health to acquire three Connecticut hospitals owned by Prospect Medical Holdings. Those efforts failed, and McCarthy Vahey said legislators are “determined” to make progress on the issue this year.
The Public Health Committee also passed a Senate omnibus bill that, among other measures, seeks to safeguard against potential changes by the Trump administration by codifying certain current federal laws into state law. This includes language related to fluoride levels in drinking water and the guarantee to emergency services regardless of ability to pay, known as EMTALA.
Correction: A previous version of this story mistakenly reported that more than half of the state’s rural hospitals and over a third of urban hospitals did not have maternity units as of 2022. The statistic was actually referring to national data.