Three years after helping start a fight over the way two community hospitals were consolidating, retired postmaster Sally Tracy sat in the state public health meeting room in Boston and saw one issue after another go her way.
Four months after the two-facility HealthAlliance system in northern Massachusetts agreed to join a larger regional network-requiring determination-of-need approval-the state council with DON jurisdiction etched a dozen provisos into its unanimous approval of the deal with UMass Memorial Health Care of Worcester.
"We got all the conditions-I almost fell out of my chair," said Tracy, speaking as co-founder of a coalition that had opposed much of what Leominster-based HealthAlliance was doing only a few years ago in moves to eliminate duplication of services.
HealthAlliance President Doug-las Fairfax said in this case, community and hospital interests coincided. Acute care will be consolidated at Leominster Hospital, but the system will expand outpatient services six miles north at the Burbank Hospital campus in Fitchburg, including some plum medical programs.
At the same time, the Burbank satellite facility will be able to handle emergencies in Fitchburg and surrounding communities toward the New Hampshire border, including Tracy's hometown of Ashby. The plans get under way immediately.
The story contains lessons about what happens when hospitals logically react to market pressures by merging vital community services but neglect to get support and acceptance of their communities first. It also shows what can happen when both sides soften intractable positions and start listening to each other.
A consolidation trend among community hospitals in the 1990s has stirred a backlash in communities as people oppose losing their access to nearby services in the name of economics. In just the past six months, skirmishes have killed the integration of two hospitals in Cumberland, Md., and imperiled a plan to divvy up services at two hospitals in Manchester, N.H. (Nov. 10, 1997, p. 24).
Burbank and Leominster hospitals began their tandem strategy with an agreement to consolidate in late 1992, vowing to expand the scope of services to north-central Massachusetts and southern New Hampshire while eliminating costly duplication.
But when the strategy built a head of steam in 1995, people in Fitchburg and points north became alarmed that despite assurances their healthcare needs were being met, they "kept seeing downgrading and downsizing and everything going to Leominster," said Tracy, who was an elected official in Ashby at the time.
Not only were acute-care services headed to the southern end of the service area, but Fitchburg-area residents faced the prospect of having to get to Leominster in an emergency-a longer drive ending in a slow route through a congested city in which two bridges over the river were out. To sum it up, "we couldn't get there in time to save a life" when minutes counted, Tracy said.
Meanwhile, she said hospital officials "talked a very nice talk" about how they were serving the entire area, but their version "was not even close to what was taking place," she said.
In response, Tracy and other activists formed the Northern Healthcare Coalition, mobilizing crowds of 300 to 500 for public meetings on the consolidation plans.
Fairfax said he can't speak for what happened before his arrival as president and chief executive officer two years ago, but he remembers his first impressions. Community representatives "had absolutely no trust in the people who were in power at the HealthAlliance."
Ironically, an aggressive move by the coalition provided the platform for eventual conciliation. The coalition and Burlington-based Lahey Clinic, a renowned multispecialty physician practice, split the costs of a $28,000 study to determine the feasibility of Lahey building a hospital in the area to compete with HealthAlliance, Tracy said.
The study instead found strong recognition and preference for the University of Massachusetts Medical Center's regional network. (A merger completed last month with Worcester-based Memorial Health Care created UMass Memorial.)
That restarted talks between UMass and HealthAlliance that had stalled a few years earlier. And last December the deal was inked with UMass Memorial, this time after months of highly public consensus sessions and commitments from the Worcester partner to bolster operations in Fitchburg. In the process of working with UMass, Fairfax said, HealthAlliance began to melt community mistrust.
"We put our money where our mouth was," he said. In carving out a plan for Burbank, "it was apparent we weren't just sprucing it up and giving it a new coat of paint."
The system budgeted $2.5 million in capital expenditures for Burbank, committed to 24-hour emergency services and announced that the facility would house outpatient services, starting with the system's behavioral health department. The kicker, though, was a new $5 million cancer center including a linear accelerator contributed by UMass.
"If they're willing to spend that kind of money at the Burbank center, then they're serious about keeping that facility open," Tracy said. "We are very happy and content to be working with UMass."
UMass agreed to include those commitments as conditions attached to its DON approval. Other conditions include an agreement to provide nonemergency medical transportation and a comprehensive evaluation of emergency services at Burbank. The deal is scheduled to close in late spring assuming final approval from the state attorney general.
The coalition now realizes that a full-service hospital in Fitchburg is "not feasible in this day and age," Tracy said. "You get nowhere by butting heads and taking a position that gets you into a corner."