UMass will not delay closing Leominster maternity unit, despite state urging

WORCESTER — UMass Memorial Health is moving ahead with its plan to close the health system's maternity unit in Leominster Sept. 23, despite vocal opposition from lawmakers, nurses and community organizations that the move will harm the health of infants and mothers.

In a Monday email to the hospital system's medical providers, UMass Memorial called the decision a "very difficult one" that came down to a "severe workforce shortage" and a steady decline in the number of births at the unit.

"Soon, the maternity unit will be insufficiently staffed to provide high-quality care consistently at all times, posing significant risk to mothers and newborns," reads the email from Dr. Eric Dickson, UMass Memorial president and chief executive officer, and Dr. Tiffany Moore Simas, chair of obstetrics and gynecology. "Based on this, we believe the most clinically appropriate course of action is the closure of the unit."

The move comes after the state Department of Public Health said the UMass plan to ensure that Leominster maternity patients had access to quality care after the unit shut down was inadequate. The Department of Public Health also said UMass should not contemplate closure until a fully developed and implemented plan is in place, and urged UMass to consider a closure date beyond Sept. 23.

The Department of Public Health issued a statement in response to the latest news from UMass: “The administration is committed to ensuring continued access to maternal health services across Massachusetts. We will continue to work with UMass to ensure that patients will continue to have options and access to care.”

When UMass first announced in May its intention to close the unit, it cited falling birth rates and staff shortages as the primary reasons for the move. Opponents claimed the real reason was financial, as many of the unit's patients are low-income, resulting in low reimbursements from MassHealth, the state's Medicaid insurance program, that don't cover the costs of care.

To keep costs down, opponents said UMass funneled maternity patients from the Leominster hospital to Worcester.

State Rep. Natalie Higgins, D-Leominster, preempted the official word from UMass, stating she and other state lawmakers met Monday morning with hospital officials and were told closure would happen on Sept. 23.

"Obviously, none of us are very happy to continue that conversation. It's very clear that the only conversation that we're interested in is how to keep the unit open," said Higgins.

The hope, said Higgins, is that the state Department of Public Health, Massachusetts Executive Office of Health and Human Services and Gov. Maura Healey will declare an emergency in maternity care due to the unit's closure and will put a stop to it.

A request for comment from Healey's office was not returned.

"Our community will be heartbroken when (the news of closure) becomes official later (Monday). We will do everything possible we can to fight it," said Higgins.

At a press conference Monday afternoon at The Village Worcester, lawmakers, nurses and activists said the Leominster unit must remain open. They believe shutting it down would not only compromise the health of infants and mothers in North Central Worcester County, but also weaken the quality and safety of maternity care countywide.

They claimed UMass maternity operations in Worcester can't absorb an influx of hundreds of patients from the Leominster-Fitchburg region.

UMass Memorial confident it can accommodate patients in Worcester

UMass believes it has sufficient capacity in Worcester to absorb those patients, the health system said in a Monday statement.

"The maternity center at UMass Memorial Medical Center can accommodate up to 5,300 deliveries each year based on number of rooms. Right now, the unit experiences between 4,500 and 4,600 deliveries annually. Were all of HealthAlliance-Clinton Hospital’s deliveries to take place at the Medical Center, a sum projected to amount to less than 500 deliveries each year, the Medical Center would still have capacity."

Emerson Hospital, Heywood Hospital and St. Vincent Hospital also said they can take on patients, UMass said.

UMass Memorial Medical Center in Worcester delivered 4,142 births in 2020, according to the Department of Public Health. To meet the expected increase in maternity patients coming to Worcester, UMass said it has a full staff of registered nurses at the ready. It also assigned more doctors and advanced practice providers to improve efficiency in triage and postpartum care.

As for the number of births in its Leominster unit, UMass claimed its birth numbers fell from 762 in fiscal 2017 to 511 in fiscal 2022, per filings with the state. However, some Leominster nurses said the current number would be roughly 600 if UMass didn't funnel patients to Worcester in order to consolidate costs.

DPH lacks authority to keep maternity unit open

Some lawmakers and activists are pushing for tougher regulations that would give the state Department of Public Health the legal authority to require that a hospital keep an "essential" service open. Currently, the Department of Public Health can rule a service essential, which it did in August when it decided that the inpatient services offered at the Leominster maternity unit are essential to the communities that the hospital serves.

However, the Department of Public Health has no legal authority to require UMass or any hospital to keep an essential service open that is slated for closure. Higgins is not aware of any proposal before lawmakers that would give the Department of Public Health such authority, but if one were presented, she said she would support it.

UMass Memorial: Primary concerns addressed

Earlier this month, the Department of Public Health highlighted two primary problems with the closure plan. One was transportation, as the Department of Public Health felt UMass hadn't locked up options for patients who didn't have the means to travel to other birthing centers once the Leominster unit closed.

Monday's letter from Husch Blackwell, the law firm that represents UMass Memorial, to the Department of Public Health spells out the transportation plan. It includes non-emergency, 24/7/365 curb-to-curb service for pregnant mothers who have barriers traveling to one of the other four area hospitals with birthing centers. The plan also includes transportation for family members traveling to the Medical Center in Worcester during scheduled visiting hours. These services come from a contract the hospital signed with GoGo Technologies Inc.

UMass said it continues to negotiate with the Montachusett Regional Transit Authority to supplement transportation services provided by GoGo. All transportation services for patients and their families within the Leominster hospital's service area will last for at least three years.

Ambulance service: DPH called for a better plan

Ambulance service was the second significant weakness the Department of Public Health cited in the UMass closure plan.

Monday's letter from Husch Blackwell stated that based on conversations UMass had with public and private emergency medical service providers, the impact on the EMS system in the Leominster-Fitchburg region will likely be minimal. For nonemergency situations, the hospital's transportation plan with GoGo should suffice. In the case of an emergency, patients will consult their medical provider, and will either be referred to the closest hospital emergency department or the facility where they plan to deliver their baby.

Most pregnant mothers don't require EMS transportation, according to UMass.

"The Hospital’s non-emergency transportation plan is anticipated to ease the burden on the EMS service by reducing the number of patients who seek ambulance transport because they do not have private transportation," the law firm's letter reads.

When EMS is needed for a longer ride to a hospital that leaves a community short in ambulance service, assistance from a neighboring city or town ‒ known as mutual aid ‒ can fill the need in that community, according to UMass.

Staffing: Primary reason for closure

A maternity unit that provides services at a level like the one in Leominster must have an obstetrician with full privileges on-call 24 hours a day, based on state Department of Public Health regulations, said the Husch Blackwell letter.

The unit has two OB/GYN on staff to meet this requirement, but UMass said that number is insufficient because that level of on-call is very demanding and doesn't provide a safe level of care.

"This is the primary reason why we must make the closure recommendation," said the law firm's letter.

A minimum of five OB/GYN is needed to to cover all shifts in the maternity unit and temporary staff is helping out with 24-hour coverage, said UMass. But temporary help it not consistently available.

Additional details in the UMass closure plan

The Leominster hospital emergency department could be called into service when a patient arrives in labor. When that happens, delivery could occur in the department, or the doctor on-duty could determine there is sufficient time to transport the patient to Worcester, said UMass. A doctor or Advanced Practice Provider will accompany the patient in the ambulance if there is a possibility of giving birth during the trip to Worcester.

● Obstetric training of the Leominster emergency department staff will be ongoing. OB/GYN doctors at Leominster hospital and Worcester are available for consultations, when needed.

● Information about the unit's closure is presented to the community in the four main languages of the Leominster hospital's patients: English, Spanish, Portuguese and Haitian Creole.

● $600,000 will be spent over three years to help support prenatal and postpartum care needs for the most vulnerable residents in North Central Worcester County.

● A consultant, Heath Resources in Action, is assessing maternity needs in the communities served by Leominster hospital. The report should be finished in October and UMass said that study is beyond its requirements to the Department of Public Health.

UMass: Met DPH requirements

Ultimately, UMass said it followed the Department of Public Health procedure for essential service closure and has a plan in place to continue access to quality maternity care for patients in the Leominster-Fitchburg area.

"Out of respect for the DPH process, we have not been as public with our plans as we would have liked. As a result, unfortunately, some — not all — who oppose the closure have had loud voices and have grabbed headlines — often spreading misinformation that could harm patients," reads the Dickson/Simas email. "Our duty must be to prioritize the health and safety of our patients. It is with that duty in mind that we will be closing our unit as this review process concludes."

Contact Henry Schwan at henry.schwan@telegram.com. Follow him on X: @henrytelegram.

This article originally appeared on Telegram & Gazette: UMass Memorial Health responds to criticism of Leominster closure