A digital sign outside of the shuttered Carney Hospital reminds passersby of the medical facility’s closing.
When the announcement came that Dorchester’s Carney Hospital was set to close on an expedited, 36-day timeline, community members expressed concerns that the loss of the neighborhood’s only hospital would increase the burden on surrounding health organizations and increase the time it takes for patients to access care.
Now, about a month after the hospital closed its doors on Aug. 31, many of those predictions are coming to pass, even as state and local organizations work to close gaps.
That closure of Carney Hospital came following a declaration of bankruptcy from Steward Health Care, which owned Carney Hospital, in May.
While the for-profit health care company was able to strike deals in a Dallas-based bankruptcy court for the sale of five of its Massachusetts hospitals, the court determined that there were no qualified bidders for Carney Hospital or for Nashoba Valley Medical Center in Ayer, and both hospitals were shuttered at the end of August. Steward CEO Ralph de la Torre announced Saturday that he was stepping down after failing to testify before a Senate panel.
In four of the sales — those of Good Samaritan Medical Center in Brockton, Holy Family Hospital in Methuen and Haverhill, Morton Hospital in Taunton and St. Anne’s Hospital in Fall River — agreements to sell each hospital’s real estate and operations were agreed on.
However, for the fifth hospital — St. Elizabeth’s Medical Center in Brighton — Steward agreed to transfer operations of the hospital, but sale of the land was blocked by asset management firm Apollo. Steward had sold the hospital’s land to Apollo in 2016.
On Sept. 27, the Healey- Driscoll Administration announced it had officially seized the land at St. Elizabeth’s through eminent domain to facilitate the transfer of operations to Boston Medical Center, who agreed to purchase the hospital.
But
for communities in and around Dorchester previously served by Carney,
much of the impact that local organizations were bracing for with the
closure appears to be panning out. At the nearby Codman Square Health
Center, leadership was expecting an increased number of patients at the
center’s urgent care and heightened severity of what those patients
need.
Both expectations have so far come true.
“Sicker
patients means more time you need to spend, which means you have longer
wait times in the waiting room,” said Dr. Guy Fish, the center’s CEO.
Previously,
Fish, who stepped into the center’s top role in August, said the center
saw about 75 patients per day in its urgent care, with an uptick to
about 100 on Mondays due to pent-up demand as the facility isn’t open on
Sundays. Now, he said, Codman Square Health Center is regularly seeing
100 patients on Tuesdays, and often increased numbers on Wednesdays as
well.
Despite early
preparation, the closure hit especially hard at first, and Codman’s
urgent care saw wait times rise to five hours — Fish said those are back
down to about two hours now.
In
response, the health center shifted its triage center, which used to
operate behind the scenes, into the front of the facility, setting up
computers and screens for privacy in a quick change over two or three
days, Fish said.
And
the health center started more aggressively looking to fill open
positions — Fish said they’re still looking for one more provider at the
MD or nurse practitioner level. They’re changes that, without broader
shifts in the health care ecosystem, Fish said, will probably be around
long-term.
“I think
the perspective that we have is that these changes of bringing triage
out front and staffing are likely to be permanent,” Fish said. “We are
looking at this on a week-by-week basis to make that determination.”
Michael
Curry, president and CEO of the Massachusetts League of Community
Health Centers, said that impact has been felt at health centers across
the area. Those same centers, he said, have also identified challenges
where would-be patients show up at the facility only to find it
shuttered with no clear communication about where else they can go.
Still,
despite the uptick in need that the health center has identified, Fish
said leadership at Codman Square Health Center suspects that some of the
patients who would have gone to Carney Hospital’s emergency department
for care are postponing or just not getting the care they need.
“One
of our big concerns is that we have a belief that more medical care
need is in the community than we’re seeing, but that patients who would
readily go to Carney are maybe deferring care due to barriers to care
such as transportation or not knowing where to go,” he said. “That means
that when patients do show up, they’re often sicker and more expensive
to get back to good health.”
He
said Codman Square Health Center hopes to partner with other
institutions to improve messaging and efforts to avoid delays in care.
Emergency care from Boston Emergency Medical Services and surrounding hospitals has also seen an uptick in need.
Beth
Isreal Deaconess Hospital Milton — the nearest emergency department at
about two miles from Carney’s now-shuttered facility — has seen an
impact from the closure of Carney’s emergency services, said Kristina
Murray, a spokesperson for the hospital.
“We
have taken steps to prepare for any increase in volume and our priority
is ensuring uninterrupted care for any patients in need. We have seen
an increase in patients who previously used Carney Hospital, and we are
closely monitoring the situation as it evolves,” she said in a
statement.
For the
city’s EMS department, which is run through the Public Health
Commission, spokesperson Caitlin McLaughlin said they’ve seen some
increase in transport times to hospitals— up about 1.8 minutes from the
same time last year — but a small reduction in response times — about
0.3 minutes — since Carney Hospital closed.
To
account for the anticipated uptick in need, Boston EMS has assigned an
extra ambulance to Dorchester to boost coverage, she said. That is in
addition to the department’s Paramedic 3 Ambulance, which has, for more
than 20 years, operated out of a bay at Carney Hospital. Despite the
facility’s closing, the ambulance continues to run from the same
location, McLaughlin said — an element that had been in question ahead
of the closure.
“Our
priority is to ensure all patients continue to receive the prehospital
care that they need, regardless of where in the city services are
required,” McLaughlin said in a statement.
The
state government is looking to identify new ways to fill gaps as well.
On Sept. 25, the Healey- Driscoll administration announced a
Dorchester-based working group to stabilize and revitalize care in the
area surrounding Carney Hospital — as well as a similar group in Ayer
looking to address needs following the closure of Steward’s Nashoba
Valley Medical Center there.
The
Carney-focused group will be co-chaired by Curry, from the
Massachusetts League of Community Health Centers, and Bisola Ojikutu,
executive director of the Boston Public Health Commission.
“The
focus that we’ll have is to look at impact of this closure in
Dorchester, what it means for access to emergency services, to urgent
care, specialty care, to behavioral health services,” Curry said in an
interview. “What does the destabilization mean for patients, for workers
and for the community?”
Over
a three-month period, the group will convene a collection of community
leaders and city and state officials, selected in conjunction by Curry
and Ojikutu as co-chairs as well as the Healey- Driscoll administration
and the Mayor’s Office, to look at what the impacts of the closure are
and how care can shift to accommodate those gaps.
In
that work, Curry said it will be important to make sure existing health
disparities aren’t worsened. Data from the Boston Public Health
Commission have identified neighborhoods like Roxbury, Dorchester and
Mattapan as suffering from worse rates of conditions like
cardiometabolic diseases, preventable cancers, and opioid overdoses.
“We
can’t let this closure exacerbate those conditions and those outcomes,”
Curry said. “The purpose of this report and the work that we’ll do over
the next three months is to figure out a way to address the inequities
and the feared outcomes of a closure on the most vulnerable among us in
the most vulnerable communities.”
Part
of that might mean increasing resources to community health centers,
the leaders of which Curry said will be part of the task force. He
expects those leaders to advocate for increased support as they grapple
with heightened need and increased severity of patients showing up.
Other
political and community leaders quoted in the release framed the
working groups as an opportunity to reimagine and innovate.
“We’re
going to bring together community and industry leaders to develop a
game plan to not only protect but improve health care in the regions
most impacted by Steward’s greed and mismanagement,” Gov. Maura Healey
said in the release.
Boston Mayor Michelle Wu called it “should be a process that strengthens access to care for Boston residents.”
Fish,
too, said he hopes that effort can think outside the box, pointing to
options like “hospital at home,” where patients who need an acute level
of care can, instead of going to receive that care in a hospital, get
monitoring and nursing from their own home instead.
The American Hospital Association has said that model can reduce costs, improve outcomes and enhance the patient experience.,
“Hopefully
those teams will be able to think out of the box, not in terms of
necessarily there being hospitals that need to operate in an 1800s model
of community hospitals, but with a more modern understanding of what
medical needs there are in communities, what health needs there are
communities in a progressive way that looks upstream to keep a focus on
wellness, particularly behavioral health and prevention,” Fish said.