By PAULA TRACY, InDepthNH.org

HOLLIS – Saying that the “abrupt” termination of critical medical programs at Exeter Hospital/Beth Israel Lahey Health have been “devastating to my district,” Executive Councilor Janet Stevens, R-Rye, got the attention of the governor and Executive Council at their meeting Wednesday.

And she got word of a bit of a reprieve for some services being immediately lost.

Attorney General John Formella said he has gotten Exeter Hospital to suspend for six months implementation of some of the proposed cuts of healthcare services “impacting patient care for thousands,” in the Seacoast area and “negatively impacting local municipalities, and directly affecting programs and services vital to seniors as well as low income and disadvantaged populations.”

Formella said hospital plans to cut neurology, pediatric dental, Advanced Life Support through its paramedic intercept program with ambulances, podiatry, allergy and immunology programs by Oct. 11 “provided insufficient notice” to patients, care providers, and the community as a whole causing great concern to those impacted.

Formella said he has engaged in discussions about the hospital’s commitment to continue services in the Seacoast community along with obligations under the final judgment in the merger which requires it to invest $375 million and retain maternity services for 10 years and designated receiving beds for those in mental health crisis. The hospital also has obligations under its affiliation agreement; obligations under the Exeter Health Resources Clinical Services Growth Plan; and compliance with all other relevant provisions of state.

 All are now under scrutiny.

While a six-month pause is in place, Formella said Exeter Hospital has committed to create a detailed proposed transition plan for each of the healthcare services impacted to ensure that there is no lapse in patient care; cooperate with the New Hampshire Department of Justice’s ongoing review as to whether any proposed cuts comply with the terms of the final judgment entered into with the State of New Hampshire on the recent Beth Israel Lahey Health acquisition of Exeter Hospital, as well as other obligations under the Affiliation Agreement and relevant provisions of state and federal law.

Formella said in a statement following the meeting that “we must ensure that healthcare charitable trusts comply with the terms of all agreements as well as state law and do not take action that places patients at risk. Beth Israel has represented to me that it understands its role as a healthcare trust and is committed to regaining the confidence of the community it serves.”

The merger was agreed to last year.

Stevens said she was alarmed when she heard that it terminated advanced life support intercept services for the surrounding 15 communities and then announced it will close Core Neurology, Core Podiatry and Core Pediatric Dentistry at the hospital by Oct. 11 along with occupational health and acupuncture.

Sonya Vartabedian, Exeter Hospital spokesperson, said, “In light of significant challenges facing the healthcare industry, Exeter Health Resources recently announced limited program discontinuances to help ensure the future stability of Exeter. After continued discussions with the Attorney General’s Office, we have agreed to extend our podiatry, pediatric dentistry, neurology, allergy-immunology, and paramedic intercept services and ensure additional support to patients in this transition period. We remain focused on delivering outstanding care and ensuring we have a strong and stable foundation to care for our community long into the future.”

Stevens said they have said there is a lack of use of the programs, but said 4,500 kids could lose dental care.

Formella told the council the situation Stevens raised has a lot of concerns and there have been some “unpleasant” conversations, but his department has at least gotten “one step in the right direction” to halt the further announced changes for now while a contractual review is underway.

In addition to Exeter, Beth Israel Lahey Health https://www.exeterhospital.com/Home operates 14 hospitals mostly in Northern Massachusetts.

After announcing it was terminating the ALS intercept, the hospital agreed to extend it for 90 days prior to the Attorney General’s involvement. 

But after Dec. 20, Stevens said it is expected that advanced medical personnel will no longer be dispatched to meet fire departments enroute in an ambulance to the hospital with people who are in danger of losing their lives.

Stevens’ husband is a retired physician who worked at Portsmouth Regional Hospital.

She said “we cannot let up” noting 50,000 of her constituents could lose ALS coverage, 4,500 kids will lose dental care and nursing health facilities are losing neurology services and are not able to transport them in their fragile state. 

Up to 60 percent of patients of the programs, she said, are being directed to out-of-state care mostly in Massachusetts.

In a Sept. 20 press release she called on Formella to intercede, noting he had the legal standing to intervene in the June, 2023 merger agreement in which hospital officials pledged to invest $375 million, maintain 10 designated receiving beds for those in mental health crisis and continue its maternal labor and delivery unit for 10 more years.

Executive Councilor Cinde Warmington, D-Concord, noted this was a “cautionary tale” as the state considers a merger for Manchester’s Catholic Medical Center with the for-profit HCA Health Care. It is under regulatory review by the Department of Justice following the July 1, 2024 announcement. https://www.catholicmedicalcenter.org/about-cmc/newsroom/news/2024/july-2024/cmc-hca-healthcare-next-step-towards-partnership. The national HCA owns hospitals in Derry, Rochester and Portsmouth.

Warmington noted issues when the for-profit HCA announced post-merger in 2023 it would close its maternity unit at Frisbie Memorial Hospital in Rochester, citing rising costs, leaving about 11 maternity units in the state.

Stevens told fellow councilors the worst news she received was from a fire captain this past weekend related to a pregnant woman who was in labor and was being taken by ambulance to Exeter Hospital on Saturday. He told her Rockingham County Dispatch told them to redirect to Elliot Hospital in Manchester. When they said they were already at Exeter, a charge nurse entered the bay of the hospital waving her arms and put herself between the doors and the ambulance and the building.

Stevens said it was only after a paramedic familiar with the law told her that any patient within 250 yards of a hospital had to be seen. Stevens called the incident “shocking.”

She said Exeter is a community hospital and the merger deal is clearly being violated, putting her constituents at a great health risk.

“It appears the terms of the merger, the affiliation agreement or final judgment were not implemented when issuing the termination,” Stevens told the council. “There was no recognition or acknowledgment of the court-approved final judgment between the Department of Justice and Beth Israel Lahey.”

“It appears that the mission of this non-profit hospital, a commitment to community and providing community-based health care to residents or as Beth Israel Lahey Health promised ‘At your doorstep,’ has been an epic failure,” Stevens said.

She said patient referrals provide no consideration for those on the Affordable Care Act or Medicaid and, told Formella, “while you have managed to negotiate what seems to be a six-month stay in terminating these programs, only two are eligible at this time. The others have either closed and or are opening other practices elsewhere. But I guess my message is we cannot let up on getting information from them which can be applicable to the final judgment.”

Stevens said she fears state efforts are not really progressing.

Formella said he shared Stevens’ concerns that the agreement is not being followed.

“I would agree 100 percent that we need to hold them accountable,” Formella said. “I would say the actions of Beth Israel and Exeter over the past few weeks have raised a lot of concerns, for me, as to whether they are complying…under the law.

“We have had some very unpleasant conversations and as you mentioned we have at least secured a commitment from them that they will  pause any discontinuation of services for six months while we do a complete and full review of what’s happening here,” Formella said.

One caveat, he said, is that if there is another provider who can provide those services, the state will allow them to transition to that, unless it is a violation of the law. 

“I do appreciate the fact that they took at least one step in the right direction and agreed to pause termination of services. I am not going so far as to call it ‘promising.'” Formella said.

Time will tell, he said, whether they are really willing to go as far as they need to fulfill their commitments.

In an interview following the meeting Stevens said, “I’d rather see the data than their lip service,” but she has yet to see anything in writing. Specifically, she wants to know the number of terminated staff and the referrals of patients.

Stevens said she wrote a letter to the state Department of Justice following a briefing with Beth Israel Lahey Health on Tuesday.

“I have not received anything in writing from either the NH DOJ or BILH.  The status is vague,” Stevens said in an email to InDepthNH.org. But she said she is not going to drop this issue.

NOMINATIONS, RESIGNATIONS, CONFIRMATIONS

Also during the Executive Council meeting, Gov. Chris Sununu nominated Mark Dell’Orfano to the Public Utilities Commission to replace Carleton Simpson who resigned and nominated Matt Mayberry of Dover to the Community College System Board of Trustees. Mayberry is executive director of the NH Home Builders Association and was a candidate for the U.S. Congress in the First Congressional District.

The council also accepted the resignation of Lori Harnois as director of the state office of Travel and Tourism and Meggan Hodgson of Stratham as a commissioner on the New Hampshire Fish and Game Commission.

Michael Panebianco of Concord was confirmed as a New Hampshire Circuit Court Judge. James Reis of Portsmouth was also confirmed as a justice of the New Hampshire Circuit Court and John Perrin of Londonderry as justice of the New Hampshire Superior Court. 

NORTH COUNTRY INFRASTRUCTURE

The council approved funding for a number of new North Country infrastructure projects using post COVID-19 American Rescue Act Funding.

This includes $2.5 million for an additional, 19-site campground at Jericho Mountain State Park and $1.4 million to construct a new visitor reception center at Mollidgewock State Park in Errol.

Also the council confirmed creation of a new, $40,000 account to support trails at the Connecticut Lakes Headwaters Tract in Pittsburg and agreed to spend $16,778 on storm repairs.

LACONIA STATE SCHOOL

The council has agreed to enter into an agreement to sell the former Laconia State School property to a developer for $10.5 million.

PLOW DRIVERS WANTED

The council agreed to free up $3.5 million in the highway surplus account to support winter maintenance and employee retention by offering better wages.

The Transportation Commissioner said the state is in need of about 200 more plow drivers for the winter and in years past offering enhancements has been very effective in finding more people to plow. He said he is about at the same spot as last year with a lack of drivers but if he can find 100 more “we’d be OK.”

FATALS UP 400 PERCENT AMONG YOUTH

Commissioner of Safety Robert Quinn told the council there is an alarming trend among young drivers, that fatal accidents for those age 21 and younger are up 400 percent. He said there is a collaborative effort with other departments including the Office of Highway Safety to address the problem. Last year to date the number was two fatalities and this year, it is 10.

“This really is a combined effort with highway safety, DMV, driver education and everything,” Quinn said. 

MULTILINGUAL DRIVER SAFETY MANUAL CONTRACT TABLED

The council tabled a contract with AAA to provide driver’s education manuals in five different languages. Executive Councilor David Wheeler, R-Milford, asked the Attorney General if the state still had a policy of having all business be transacted in English. Formella said he would look into that.

Warmington asked Quinn why there was a multilingual driver’s manual.

He said while the test is in English, the state provides training in various languages.

“We do that for those with limited English proficiency,” Quinn said. 

Warmington opposed tabling the contract.

“We would like people, even if they speak a different language, to be able to access this information about driver safety…

“We have had a very high number of fatalities on our highways,” Warmington said, “and everything that we can do to improve highway safety we should be doing and this is a part of that.”  

COMMENDATIONS 

The meeting was held at Brookdale Fruit Farm in Hollis as the chosen site in Executive Council District 5, held by Republican David Wheeler. Each counselor gets to choose a location in his district for the summer “roadshow” in which the council goes on the road.

There was a special commendation for Brookdale Farm, established in 1847, and another for the more than 400 volunteers who provide hunter education instruction across the state.

The next meeting of the council is Oct. 16 in a location still to be determined.