New Hampshire’s mental health system, already in crisis, will go over the cliff if Dartmouth-Hitchcock is awarded the three-year contract to provide psychiatric staffing at New Hampshire Hospital.
Currently, the most challenging aspect of delivering psychiatric services is the shortage of qualified psychiatrists and psychiatric nurse practitioners. Yet Dartmouth-Hitchcock officials recklessly mismanaged the vast majority of the dedicated, compassionate and experienced NHH staff, squandering this commodity.
Despite public proclamations, they refused to disclose basic terms of employment for months, eventually offered considerably worse compensation, and didn’t engage in any negotiations when all we asked was to maintain the same level of compensation. They withdrew their offers one week later and never again contacted us.
The nearly two-thirds of the staff that left NHH on June 30 didn’t quit; in fact, our efforts were always focused on coming up with a solution to ensure adequate staffing.
Dartmouth-Hitchcock officials’ cavalier decision to run off so many qualified providers while bidding on a contract requiring 20-plus psychiatric staff to safely run the hospital is concerning. That these actions occurred while they knew they couldn’t effectively recruit just one psychiatrist during a three-year period for the 12-bed Cheshire Medical Center psychiatric unit is especially puzzling.
Dartmouth-Hitchcock’s staffing plan entails closing its own unit in Lebanon to relocate providers to NHH, some of whom aren’t experienced working in this system.
This is deeply troubling as it effectively shifts personnel holes from one facility to another at a time when patients already face long delays to get admitted.
A panel appointed by Gov. Maggie Hassan found New Hampshire’s inventory of inpatient psychiatric beds declined to 384 in 2013 from 526 in 2005, resulting in a “shortage of beds for the treatment of the mentally ill.” In spite of NHH’s new crisis unit opening, the closures of the CMC and Dartmouth-Hitchcock units caused a net loss of 17 psychiatric beds statewide. Dartmouth-Hitchcock officials would’ve had no need to close their inpatient unit had they simply retained NHH staff.
In addition, busy hospital administrators are staffing units, including the crisis unit, meaning patients might not get the attention they’d ordinarily receive from a psychiatrist fully devoted to their care. This, in conjunction with relocating psychiatrists from Lebanon, represents a transparent attempt to create the illusion that NHH is adequately staffed in an effort to convince the state that Dartmouth-Hitchcock should be awarded the long-term contract.
Dartmouth-Hitchcock is also looking to hire out-of-state temporary psychiatrists, typically three times as expensive as permanent psychiatrists, with New Hampshire taxpayers footing the bill. Frequent turnover of temporary psychiatrists means patients lack opportunities to develop relationships with them, which is vital for optimal treatment.
One need look no further than Maine to see what happens with this type of plan.
Riverview Psychiatric Center in Augusta, Maine, a state psychiatric hospital and Dartmouth affiliate, had its certification revoked by the Centers for Medicaid and Medicare Services after regulators found numerous issues, including the use of stun guns, pepper spray and handcuffs on patients; improper record-keeping; medication errors; and failure to report progress made by patients. That action potentially cost Maine $20 million in annual funding reimbursement.
One of the many problems Riverview faces is frequent psychiatric, administrative and nursing staff turnover.
Dan Wathen, court-appointed master of a consent decree that requires certain rights for Riverview patients, stated, “As an institution, it would be far better to have psychiatrists who are there — that’s their full time position. They’re not just there for a period of three or four months, and then somebody else comes in, and then somebody else comes in.”
All the above should give New Hampshire citizens pause: If this is how Dartmouth-Hitchcock officials act while attempting to secure a tremendously profitable contract, when they theoretically should be putting forth their best efforts, what might they do if they’re actually awarded it?
Why would anyone believe Dartmouth-Hitchcock is going to have a stable, qualified staff in place for the duration of the three-year contract? How has Dartmouth-Hitchcock engendered any sense that it would be a prudent steward of taxpayers’ money?
Can New Hampshire afford to let Dartmouth imperil the state hospital as it did in Maine?
Most importantly, how have Dartmouth-Hitchcock’s actions and track record proven a genuine desire and capability to ensure the best for NHH’s patients?
As the members of the Executive Council did in a bipartisan, unanimously signed letter, we urge Health and Human Services Commissioner Jeffrey Meyers to reopen bidding for the contract immediately so it can be awarded to a qualified vendor.
The citizens of New Hampshire, especially those suffering from serious mental illnesses, deserve nothing less.
Dr. Matthew Davis was a psychiatrist at New Hampshire Hospital for four years and is currently on the executive committee of the New Hampshire Psychiatric Society. Dr. Robert Murray was a psychiatrist at NHH for 1½ years and was a psychiatrist at Riverbend Community Mental Health Center in Concord for 21 years, the last nine as medical director.