The events leading up to the abrupt closure of a regional hospital in a remote corner of Massachusetts are complicated. But many community hospitals across the country are equally vulnerable, and more will close.
Tucked into the northwest corner of Massachusetts in a valley between the Taconic mountain range to the west and the Berkshires to the east sits the state's smallest city, North Adams.
Cotton, wool, and textile mills fueled the growth of this town generations ago. Today on the sprawling site of one of those industrial complexes, the city boasts a world-class contemporary art museum. Still, incomes are low and jobs are scarce.
Things have been particularly rough lately. Residents endured a mercilessly long winter punctuated by two pronounced arctic blasts. In January, after 170 years, the North Adams Transcript published its last issue. Last week, strong winds and rain toppled the town's cell phone towers, leaving most people without Internet or mobile phone service.
On Friday, events took a turn for the worse.
With only three days' notice, North Adams Regional Hospital, operated by private, not-for-profit Northern Berkshire Healthcare, locked its doors and laid off 500 workers. Now anyone who is sick or hurt and in need of a hospital has to drive over twisting roads for 18 miles north to Southwest Vermont Medical Center in Bennington or 21 miles south to Berkshire Medical Center in Pittsfield, MA. That could be a torturous drive in an emergency, especially in bad weather.
The events leading to the abrupt closure of the hospital and services from the VNA, hospice, and other providers are complicated. What happens next is unclear. Federal and state lawmakers and local officials are scrambling to craft a fix.
Critical Access Death Spiral
This hospital closure is neither unprecedented nor unexpected. Small and isolated hospitals serving rural communities are vulnerable everywhere. More closures will come. In Georgia, one advocate for rural healthcare access bluntly states that critical access hospitals "have about a seven-year death spiral that's a function of the cost-to-charge ratio."
Critical Access Hospitals Crisis in GA a National Bellwether
North Adams Regional Hospital is not a CAH, and that may have aggravated its financial distress. CAH designation was not granted because the hospital failed to meet at least two requirements—it is less than 25 miles from the nearest emergency department, and it has 36 inpatient beds, which is above the 25-bed cutoff.
But that special designation is just semantics for the people of North Adams, Williamstown, and other tiny communities in the region. NARH has provided critical access to the people living around it since its founding 129 years ago.
Governor Deval Patrick (D) and Attorney General Martha Coakley (D), a North Adams native, were in the community on Tuesday to fashion a way to allow Pittsfield's Berkshire Health System, which runs a 302-bed community hospital, to reopen and operate the now-shuttered emergency department at NARH.
A letter from Patrick to the community late Tuesday acknowledged that it could take 10 days before emergency services might be restored.
Meetings, church vigils, protests, legal actions, and uncertainty follow years of financial problems at NARH. But workers, many of whom toiled there for decades, didn't see this coming. Neither did members of the community. Patrick said a deal to keep the hospital open looked imminent—until the very end.
Storming the CEO's Office
A letter to the community from the hospital board on Friday stiffly acknowledges "difficult circumstances" and thanks staff. Union members reportedly tried to storm the office of CEO Timothy Jones. They were stopped by police.
Coakley says she'll press for an investigation into the NARH board and its actions. But whether the board acted properly or not is almost beside the point. This hospital has been in financial straits for years. Reports are swirling that it will soon file for Chapter 7 bankruptcy protection.
I'm reminded of these lines from Hemingway's The Sun Also Rises: "'How did you go bankrupt?' Bill asked. 'Two ways,' Mike said. 'Gradually and then suddenly.'"
People without access to healthcare suffer the consequences immediately. Communities sink into their suffering gradually. In the case of North Adams, going from bustling mill town to once-proud mill town took about 130 years.
The root of the hospital's trouble is familiar—dwindling Medicare and Medicaid reimbursements. Ironically, while the price of providing healthcare to low-income populations is steep, withdrawing care is even more costly.
The stunner in this community is not only that the hospital closed its doors, but that it slammed them shut so abruptly. The people who live in the northern Berkshires need access to medical care.
If a CAH designation would keep NARH operating, then it's time to amend CAH requirements. They were written long before thinning Medicare and Medicaid reimbursements and other economic slings started shuttering community hospitals and hurting people who deserve better from their leaders.