Lebanon
“We are temporarily rebalancing our psychiatry staff by temporarily assigning a small number of providers to NHH from Lebanon,” D-H spokesman Rick Adams said in an email. Nine of the 21 psychiatric beds at D-H’s Mary Hitchcock Memorial Hospital will be unavailable for “a short time,” he said. The other “12 beds in DHMC’s inpatient psychiatric unit will remain open and available for admissions,” he said.
The move is intended to shift caregivers to an area of high need, according to Adams. He described NHH as “the intensive care unit for psychiatric care in New Hampshire.” Most patients occupying the 158 beds at NHH are there under so-called involuntary emergency admissions that require a finding that a mentally ill person poses a threat to himself or herself or to others.
NHH is generally full. On Thursday morning, 19 patients were waiting in hospital emergency rooms or other facilities for space to become available at NHH, according to Jake Leon, a spokesman for the New Hampshire Health and Human Services Department.
State officials expressed confidence that the transition would be uneventful.
“On Friday there will be some new staff, but care will continue as it has before,” Leon said. A new, 10-bed inpatient stabilization unit at NHH has been fully staffed and will open on July 5, he added.
And Adams characterized the upcoming changes as a sign of strength in a state health care system in which D-H holds a place of growing influence.
“The advantage of being a nimble health system is the ability to quickly allocate resources where they are most acutely needed,” he said.
Others were less sanguine.
On Wednesday, Robert Murray, a staff psychiatrist at NHH preparing for his last day of work there, worried about the coming transition: “We still know nothing substantial about who’s going to be here.”
And even the temporary loss of psychiatric care capacity is a matter of concern, said Ken Norton, executive director of the New Hampshire affiliate of the National Alliance on Mental Illness, an organization that advocates for mental health patients and their families. “The safety net for people with mental illness extends well beyond New Hampshire Hospital” into community mental health centers and providers and the inpatient capacity at regional hospitals, he said.
A 2014 report by a blue-ribbon panel appointed by Gov. Maggie Hassan found the state’s inventory of inpatient beds for psychiatric care had declined to 384 in 2013 from 526 in 2005, resulting in a “shortage of beds for the treatment of the mentally ill.”
D-H’s Lebanon inpatient psychiatric units combine teaching with patient care. During inpatient psychiatry rotations, residents, who generally are newly minted doctors who received specialized training, are taught by two full-time psychiatrists, a psychiatric social worker and nurse care manager, psychiatric nurses and activities therapists, according to a handbook posted online from D-H’s adult psychiatry residency training program.
Dartmouth College, which operates the state’s only medical school, first was tapped as the supplier of psychiatric services at NHH as part of statewide efforts to reform mental health care during the 1980s. That effort included construction of a new but smaller state hospital and plans to transfer care into community facilities and organizations.
The contract under which Dartmouth College’s Geisel School of Medicine had been providing psychiatric services at NHH was set to expire Thursday. When the state in February issued a request for proposals for a new contract, D-H, a Dartmouth affiliate with its own financial and governance structures, had stepped forward with a bid to become the new provider. But some of the psychiatrists and advanced practice nurses who were employed by the college to work at NHH balked at the offer to become D-H employees.
A bid by a group of NHH psychiatrists and other professional caregivers to win union recognition from Dartmouth was rejected by the National Labor Relations Board. A plan to have a newly formed limited liability company submit a competing bid for the NHH deal was launched after the bidding deadline had passed.
But the refusal of some providers to sign letters of intent promising to continue to work at NHH, combined with a provision of the proposal request that required a bidder to have qualified professionals lined up to provide contracted services, put D-H in a bind.
But that logjam broke in early June, when state officials disclosed they had reached a deal with Dartmouth College to extend the existing contract for four months. The state Executive Council approved that arrangement, which allowed the state to begin spending up to $2.9 million under the terms of its old deal with the college and made D-H responsible to deliver the promised services.
That transfer was critical, because Dartmouth’s Geisel unit previously had announced a plan to transfer its entire psychiatry department to D-H. That transfer was part of a restructuring effort triggered by the announcement that Geisel was running in the red to the tune of $30 million annually.
The restructuring proposal sparked anxiety and some opposition among Geisel faculty and staff, who cited concerns that their pay and benefits might be adversely affected when D-H started issuing their paychecks. At NHH, psychiatrists and other professional employees said some of their number would lose tens of thousands of dollars in unvested retirement contributions.
But most went along, according to Adams. He said that 280 Geisel faculty and staff had been offered jobs at D-H, and that 85 percent, or about 240, had accepted, including 145 faculty and staff in the psychiatry department. That number also included “a majority of the physicians and half of all providers at NHH,” he said.
Matt Davis, a former staff psychiatrist at NHH who was a leader in the drive for union representation for affected professional employees, said eight psychiatrists and four advanced practice nurses had ended up without jobs at NHH.
Adams had a different tally. He said that nine of the 15 psychiatrists at NHH had accepted employment offers from D-H and would remain on the job, but none of the four advanced practice nurses had.
Both sides agreed the departing employees had spurned initial offers from D-H. Adams said the departing caregivers had “rejected our offers of employment,” while Davis said D-H had then taken the offers to those individuals off the table, and rebuffed their efforts to continue discussions.
D-H anchors a network of clinics and smaller hospitals with about 500 beds and 1,000 physicians. It recently shut the inpatient psychiatric unit at Cheshire Medical Center in Keene, N.H., and began affiliation talks with Elliot Health System, which operates at 296-bed hospital in Manchester.
Rick Jurgens can be reached at rjurgens@vnews.com or 603-727-3229.