Executive Council Approves Hampstead Hospital Lease with Dartmouth Health

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Paula Tracy photo

Outgoing Gov. Chris Sununu presided over his last Governor and Executive Council meeting Wednesday at the State House in Concord.

By PAULA TRACY, InDepthNH.org

CONCORD – A seven-year renewable contract between the state and Mary Hitchcock Memorial Hospital (Dartmouth Health)  to operate the state’s new psychiatric hospital for youths at Hampstead Hospital passed the Executive Council on a vote of 4-1 Wednesday.

It had been tabled for two weeks by the state’s Executive Council, with questions about state control, oversight and the future of more than 200 state employees there who will now become workers of Dartmouth Health.

Executive Councilor Cinde Warmington, D-Concord, an attorney by profession in healthcare matters, asked to table the contract, saying while she supported the creative concept, there were still some gaps. When that was not supported, she ultimately voted against the contract. 

By law, the council needed to approve the contract at its final meeting of its two-year term or the deal would fall through leaving the hospital in a precarious position with the likelihood the state would be left on its own to run it, according to Gov. Chris Sununu.

As of Wednesday, the state reported there were seven children in emergency rooms across the state waiting for psychiatric beds and treatment.  Though they have more beds, Hampstead Hospital is currently at staffing capacity, though they hope to add more if they have adequate staffing. There are about 70 beds but fewer than 40 are now occupied. 

The contract was Sununu’s final and top priority for completion of his eight years in office.

But it was in part delayed by the concerns of the employees.

A petition to the council signed by 110 of the current 112 employees, including counselors at Hampstead Hospital, indicated they wanted to remain state employees, which is not part of this contract. 

They will now become employees of Dartmouth Health or leave, which is a fear expressed by several councilors.

The petition said the contract creates uncertainty with no guarantees regarding wages, paid time off, a likely shift in health-care coverage and no guarantees to an employer match to retirement plans and a loss of access to the state pension plan. 

This got the attention of several Executive Councilors who asked for more time to consider the deal before voting at its Dec. 4 meeting.

Morissa Henn, deputy commissioner of the state Department of Health and Human Services, said she recognized that it has been a very turbulent time for staff at the hospital and noted that Dartmouth Health has made assurances that all will receive a minimum of a 2 percent pay increase Thursday morning if the deal was struck.

Councilors said that was new information that the employees were not aware of.

In 2022 the state purchased the hospital which once served adults and children and the state contracted operation for two years by Wellpath until the end of June when its contract ended. The state used federal, post COVID-19 ARPA funds for the purchase and plan to also co-locate the Sununu Youth Services Center on the 100-acre Hampstead campus when it closes the youth detention center in Manchester. 

Henn said after considering multiple operational models with Dartmouth Health, the contract is now for them to take over and lease the facility from the state for about $1.2 million a year with an advisory oversight board allowing for state input.

Two weeks ago, some councilors said they worried that there was not enough state control and wanted to see the details, particularly as they relate to employees.

Councilor Warmington said she thinks this is a good model for the state to go forward and that Dartmouth Health is the right partner.

But she had concerns that the contract did not prioritize New Hampshire patients, some of whom are sitting in “inhumane” situations in emergency rooms. She added the state has a state obligation for oversight and the contract she said does not have adequate reporting requirements.

The third issue she said was that the contract had no minimum number of beds required in the contract.

She said the contract is “half-baked” and doesn’t have the “teeth” in it she would like to see.

Henn said she agreed that prioritization of New Hampshire youth is important and will be in the final lease to be signed in February. She said Dartmouth Health “completely agrees” with that.

As for reporting requirements, Henn argued that there are numerous “layer upon layer” aspects of the agreement that relate to standards and Hampstead will have to be licensed, which comes with its own reporting requirements.

Currently, Hampstead Hospital is exempt from that federal requirement because it is operated by the state.  

There are other areas of accountability Henn said, a new citizen advisory council and access for oversight with the state Office of the Child Advocate.

“It really is a win-win,” she said.

To Warmington’s final point that there is no lower threshold for census, Henn said there needs to be flexibility for the contractor. If the state is moving toward an in-home or community-based model she said the contract needs to take into consideration community-based options.

Henn said she understood the councilor’s request to wait and further delay the contract and that would not be good for the employees at the hospital.

“I believe we don’t have the time to wait,” Henn said.

She said she wants to be able to tell the staff tomorrow exactly what their job is and about a minimum 2 percent raise that has been offered by Dartmouth Health.

Executive Councilor Janet Stevens, R-Rye, said there are children waiting in emergency rooms for care.

“We can’t overlook the human capital component,” Stevens said.

Executive Councilor Joe Kenney, R-Wakefield, said the state needs a good working environment for everyone at Hampstead Hospital.

Executive Councilor Ted Gatsas, R-Manchester, said he knows there is a statewide shortage of nurses. What is the worst case scenario at Hampstead with change, he asked, noting if 100 people leave the hospital, the next governor will have a crisis on her hands.

Henn said that is not likely and important for Dartmouth Health to be ready tomorrow with wage packages to show them.

Sununu said the final agreement will not be completed for a few months. 

“We still have another bite at the apple,” he said. But he said there is a July 1, 2025, drop dead deadline.

“There are huge financial implications,” and a domino effect if the contract was not passed, Sununu said.

Warmington said the fact that there are signing bonuses and raises which will be offered and the employees don’t know, that is “bizarre.”

She made a motion to table.

Kenney said that would essentially kill it and he would not support it. There was no second to her table motion.

Sununu said this partnership with Dartmouth Health will ensure one of the country’s most prestigious health systems is taking care of New Hampshire’s kids. 

“This is an amazing win-win opportunity that ensures world-class care while saving an estimated $20 million annually in overhead costs to the state,” he said. 

The sole source contract, which would be effective upon passage, provides for the agreement to be for seven years with the option to renew three times in five-year increments with a base rate of $1,157,494 a year with a 2.5 percent increase annually. It also calls for the state to remain for one year and to collect administrative fees of up to $5 million. 

A link the 138-page contract is here https://media.sos.nh.gov/govcouncil/2024/1204/12A%20GC%20Agenda%20120424.pdf

ARPA LEFTOVER FUNDS FOR AFFORDABLE HOUSING GO INTO ‘WATERFALL’ ACCOUNT

What is left of almost $1 billion the state received from the post-COVID-19 recovery funds from the federal American Rescue Plan Act is fewer than $10 million. What could not be spent by various state departments it was distributed to will be redirected and go to advance affordable housing developments through the New Hampshire Housing Finance Authority.

Because the money must be obligated by the end of this calendar year or go back to Washington, the Executive Council entered into an agreement with the quasi-governmental and Manchester-based NHHFA in the amount of up to $10 million.

Taylor Caswell, commissioner for the state Department of Business and Economic Affairs, told the council at a breakfast meeting at the Bridges House that it is not clear exactly how much money will flow into this “waterfall” account but he said he is sure it will not be more than $10 million.

The state is in desperate need of more affordable housing, and it has become a top legislative priority.

The measure was a late item agenda.

‘LIVING LOCALLY, WORKING NATIONALLY’

Outgoing Republican Gov. Sununu told 10 members of the House of Representatives during their swearing in Wednesday that he would be “living locally and working nationally.”

He said he has not signed any contracts with anyone but would like to work in media and private business.

Sununu decided not to seek an historic fifth term.

He will be replaced by Gov.-Elect Kelly Ayotte, a former U.S. Senator and New Hampshire Attorney General, who won the Nov. 5 election over Democrat and former Manchester Mayor Joyce Craig.

Ayotte attended the council meeting and its breakfast and had lunch Wednesday at T-Bones with the Executive Council following the meeting.

Ayotte sat in the same spot at the meeting that she used to sit as Attorney General.

When they next meet, she will be at the head of the table Jan. 9, 2025.

WARMINGTON, SUNUNU, GATSAS PART

Councilor Warmington said it has been an honor and privilege to serve on the council. She ran unsuccessfully in the Democratic primary for governor and Wednesday was her last Executive Council meeting.

For the governor, it was meeting number 335 of the Executive Council and he said he is thankful to be rising from the table for a final time. He then went on to hold his last press conference which lasted more than an hour.

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