PUBLIC HEALTH COUNCIL A regular meeting of the Massachusetts Department of Public Health’s Public Health Council was held on Wednesday, November 14, 2007, 10:00 a.m., at the Department of Public Health, 250 Washington St., Boston, Massachusetts in the Henry I. Bowditch Public Health Council Room. Members present were: Chair John Auerbach, Commissioner, Department of Public Health, Ms. Helen R. Caulton-Harris, Mr. Harold Cox, Dr. John Cunningham, Dr. Michèle David (arrived at 10:15 a.m.), Dr. Muriel Gillick, Mr. Paul J. Lanzikos, Ms. Lucilia Prates Ramos, Mr. José Rafael Rivera, Dr. Meredith Rosenthal, Mr. Albert Sherman, Dr. Alan C. Woodward and Dr. Barry S. Zuckerman. Dr. Michael Wong was absent. Also in attendance was Attorney Donna Levin, General Counsel, Department of Public Health.
Chair Auerbach announced that notices of the meeting had been filed with the Secretary of the Commonwealth and the Executive Office of Administration and Finance. Chair Auerbach noted the changes in the order the docket items would be heard as follows: 1) Tobacco Control, 2) Baystate Medical Center Determination of Need Application, 3) Final Promulgation of Amendments Regarding Adjudicatory Cases, and 4) the Hospital-Acquired Infection Regulation proposal. He noted further that there would be a two-minute break after the presentation to give people time to leave etc. He asked the Council Members to introduce themselves. The Council Members introduced themselves to the audience.
PRESENTATION: “REINVIGORATING TOBACCO CONTROL IN MASSACHUSETTS”, By Dr. Lois Keithly, Director, Massachusetts Tobacco Control Program: Chair Auerbach made introductory remarks, “The first item on the agenda is, as I said, a very exciting one. There are few issues that are more important in terms of Public Health than the issue of tobacco control and, for many years, the groundbreaking work that was done on tobacco control in Massachusetts suffered from a series of very dramatic budget cuts that required the elimination of a number of effective programs. We are very happy now that, with legislative support and with gubernatorial support, we have seen a reversal of those cuts, and we are seeing new funds being added once again to this critically important Public Health area, where we know many lives are at stake. And so, to present some of the recent achievements and new plans, I am very delighted to introduce the Director of the Department of the Tobacco Control Program, Dr. Lois Keithly. Dr. Keithly, thank you, and we look forward to your presentation.”
Dr. Lois Keithly described her programs accomplishments for 2007:
Governor Patrick recommended 16 million dollars for the program; the legislature appropriated 12.75 million dollars, an enormous and substantial increase in funding;
Restoration of funding for compliance checks on retailers who sell to minors (illegal sales rates to youths have been cut in half during the past year);
Under 27/Under 18 counter marketing campaign: creating a presence in the retail store environment;
The84.org campaign targets young people where they live, which is on-line, and it gets it names from the 84 percent of middle and high school students who choose not to smoke cigarettes;
Conducted a film short contest (160 youth participated developing 30 film shorts describing the effect of tobacco upon youth);
50 mini-grants to help youth groups and school programs tackle tobacco locally through civic engagement;
Media campaign to start the next day (November 15) on the anniversary of the Great American Smokeout;
Target anti-smoking campaign on high risk communities, the state’s most vulnerable populations, including residents on MassHealth, those that do not have health insurance, the poor, and uneducated;
Current campaign looks to provide both those negative emotional ads from the previous campaign and the more supportive ads to talk about quitting smoking being a fight that smokers can win;
Evaluation is a key component of the campaign. We will be looking at MassHealth utilization, reports from Yahoo on our Internet ads, and calls to the Quit Line, to make sure that the media campaign increases the awareness of resources that are available, and increases the quit attempts amongst smokers;
TV spots will be shown on broadcast TV, on cable and on the Internet.
Chair Auerbach noted, “…I would like to take this opportunity to note that this is the first public information campaign of this scale on tobacco control in six years, and I want to publicly thank the Governor and the Legislature for their support in restoring the money so that we were able to mount this kind of campaign, and also begin to see some of the impressive changes that were recited. I want to particularly thank the people who were willing to help us, in terms of developing those advertisements, and we are honored today that we have three of them. I would like them each to stand up and accept our appreciation, and I would like to formally award you with the recognition that you are, in fact, Public Health heroes for the Commonwealth of Massachusetts, and it is my belief that your activities will make a significant difference in terms of preventing illness and premature death for thousands of people. Let me introduce, Renaldo Martinez, an activist on the issue of tobacco control and prevention for many years and has participated in a very effective previous Massachusetts campaign that has been used by other states very effectively and your continuing your activity is an inspiration to all of us. I am delighted to honor and recognize the work of Kendall David. Again, your example will make an enormous difference in terms of the health of the people of the Commonwealth; and I am delighted also to recognize Ms. Katrina Bergman. Your courage and your willingness to speak out on this, and be an example to other people, is enormously important. Thank you to the three of you. We are really honored by your presence, and we are really grateful for your work.”
Dr. Zuckerman added for the record, “that the data shows a relationship between change in health behaviors and health which were related to Massachusetts Tobacco Control Program cuts and the improvement when the funding was restored. We have a Governor who is supporting this. There will be a time again, when it will be cut. Somebody needs to bring data that shows this money can be effective, and I would encourage others to look at the data.”
Chair Auerbach replied, “I completely agree with you Dr. Zuckerman and I think the Department will take that recommendation very seriously, and we will make sure that we are accurately gathering information to document the impact of both increases, as well as decreases [of funding].”
Council Member Albert Sherman added, “The Legislature has done an admirable job, given the fact that the Commonwealth has had fiscal problems, and they should be commended too, for finding the money….” Chair Auerbach agreed.
NO VOTE/INFORMATION ONLY RECORD OF THE PUBLIC HEALTH COUNCIL MEETING OF SEPTEMBER 12, 2007: A record of the Public Health Council Meeting of September 12, 2007 was presented to the Council for approval. A copy of the minutes was distributed to the Council Members prior to the meeting for review. Council Member Albert Sherman moved for approval. After consideration, upon motion made and duly seconded it was voted unanimously to approve the Record of the Public Health Council Meeting of September 12, 2007 as presented.
DETERMINATION OF NEED PROGRAM: CATEGORY 2 APPLICATION: PROJECT APPLICATION NO. 1-3B36 OF BAYSTATE MEDICAL CENTER: For the record: Helen Caulton-Harris, Council Member, recused herself from discussion and voting on the Baystate application.
Chair Auerbach announced that first we would hear from the elected officials:
Senator Stephen Buoniconti addressed the Council, “…I am here in support of the request by Baystate Health Systems, specifically, Baystate Medical Center, for their expansion. Specifically for me, I am in support of this program primarily for my daughter. My daughter has spinal muscular atrophy, which is a seriously debilitating condition that renders her in a power wheelchair. She needs medical services regularly, whether it be at Baystate Medical Center or at Children’s Hospital, and the expansion that you are considering is going to help children in our area…. This expansion is going to be beneficial not only for the Emergency Department and the handling of the children, but I believe also there is going to be a focus on establishing specific beds for children, expanding the Children’s Hospital at Baystate Medical Center, which I think is long overdue. And so, as a result of that, for Baystate being a good neighbor to so many people, and you see so many faces here that have been supported by Baystate Medical Center, a good neighbor, who has tried to do a lot of the right things for the neighborhood, for the City, for the region, I believe that this Council should support the application as submitted by Baystate Medical Center.”
Mayor Charles Ryan, City of Springfield: “I have been the Mayor of Springfield for ten years, six of them back in the sixties, a long, long time ago, and I am just completing my fourth year now…. A week ago, the challenger was successful in defeating me, Mayor-elect Sarno is here today…. My wife had open-heart surgery some several years ago and I just couldn’t believe the level of care and devotion, and ability that came from shift to shift. I never saw the same people twice. All I knew is that every single one of them, in my opinion, was very high on the charts of what you could hope to have in a top notch hospital. No longer is it necessary, for most of the complex procedures, for people in Western Massachusetts to go to New York or to Boston because it can be done at Baystate. I think that should be understood. From economic development point of view, this is the biggest thing that has happened to our city in a generation or two. As you are probably aware, Springfield lost its fastball several years ago and kind of bottomed out, and the recovery process is well underway and very successful, and I am sure it is going to continue, but there is no project more essential to our continued recovery than this project of Baystate, in the form that they have put forward in their application, and to have this taken off the table, in whole or in part, would be a devastating blow to our city, as it tries to regain its rightful place among the significant communities of Massachusetts.”
Mayor Ryan continued, “….The only opposition is from the Sisters of Providence and I find that very unfortunate…there has to be a better reason than just saying, I am opposed to it because of the fact that it might hurt me commercially, and that is the bottom line on Mercy’s opposition and I think that is a tactical error…. I think it is unfortunate and I think they stand alone and it is a very lonely place to be because of the fact that everybody I have met, whether they are in government, out of government, in the business community, or users of the medical and hospital facilities…they are really for this application.”
Mayor Ryan further mentioned the community initiative commitment of 9.6 million dollars that Baystate will give to its neighbors (the north end of Springfield, the poorest census track in Massachusetts). He further noted that Baystate was there for Springfield in its time of need a couple of years ago by contributing two and half million dollars, over a five year period for public health needs and another 3.75 million over a five year period for the Springfield school system.
In closing, Mayor Ryan said, “This is an outstanding corporation, headed by the best in this business, who really care desperately about their mission, which is health, which is taking care of the kinds of people we saw in the video a few moments ago, and a lot of other people, because the range of sickness and disease that we can have in the human body is monumental. This is an outstanding organization, and it certainly deserves the support of the Public Health Council of Massachusetts. I hope that your decision will be in the affirmative.”
State Representative Mary Rogeness, “I am a politician of few words, generally and specifically, and the Mayor made a lot of points that all us share. Baystate is a teaching hospital and the expansion includes a lot of high end services. One of the things, as a constituent of the hospital, I have experienced is the shortage of emergency room space.” Representative Rogeness explained how her elderly mother has never been admitted to Baystate in a timely fashion due to the lack of space at the hospital, spending hours in the hallway and in inadequate cubicles. “This expansion,” she said, “by taking some of the stress off of the movement to beds, will serve, I think, anyone who needs to be admitted through the emergency room entrance to the hospital.” Representative Rogeness also noted the economic benefits - the new jobs to put up the new space and the staff to keep it going after it is built; that it is more economic to add the extra space now and it is less destructive to the neighborhood doing it all at once.
State Representative Rosemary Sandlin, “I am in support of the Determination of Need application submitted by Baystate Medical Center…. I know that many of my constituents will benefit from successful completion of this master facility plan. One of the many features of this proposal is to replace an aging emergency room and cut the wait time with a new Level I Trauma facility for the citizens of Western Massachusetts. My district is served by Springfield and Noble Hospital in Westfield and I am thankful that the Department of Public Health staff recommendation would take into consideration the impact this project would have on these hospitals, Mercy, Providence, Noble and Holyoke Hospital. I strongly support Baystate Medical Center’s request.”
State Representative Benjamin Swan said in part: “…This a great lift for the much needed economic development in the City of Springfield. We have two prongs in this. We have the health initiative which is much needed and we all know we need the second benefit, the economic benefit…I really urge your endorsement of this proposal.”
State Representative James Welch: noted the economic boom for the area as a result of the project and said in part, “…Often times when a family member of somebody from Western Massachusetts is going in for a medical procedure, a lot of times the first question is, are you going to Boston for that medical procedure, and I think this project can lead to a statement that says, are you staying in Springfield for that medical procedure? ...I would like to lend my support for the project. I do want to thank you for the seriousness you have given to the project and the overall health and of the health services in Western Massachusetts.”
Mayor-Elect Dominic Sarno, “…I wanted to be here to speak on behalf of Baystate Health Systems. Not only is this a critical project health-wise but critical economic development-wise. I rode the bus up with my brothers and sisters in building trades, and you are talking about a project labor agreement that is going to create three hundred and fifty construction jobs. Baystate has truly been a tremendous community partner for the City of Springfield and its neighborhoods. Behind me sit many of our high school students, with a new leadership, the High School of Commerce, Sci Tech, Central and Putnam. Behind me sits the community centers such as the new North Citizens Council, Dunbar and the Martin Luther King Center… They [Baystate] are one of the top 100 hospitals in the country. We just recently honored them before the City Council for historic surgical procedures that never had been done in the world. They stepped to the plate when no one else would: 2.5 million dollars to the City’s conference to help avoid cuts especially in health and human services, 3.75 million dollars to our educational systems to incubate medical services and teachings at the Putnam Vocational High School. They have just been a tremendous asset. They get it and I would urge you, implore you to please support this initiative…. This is a no-brainer.”
City Councilor Tim Rooke: “…Basketball is a very competitive sport, and there are a lot of injuries, and I can tell you, as a parent and a coach, the wait time to get the attention you need for those kids is a position you don’t want to be in. It’s unnerving. It’s a helpless situation. You can’t do anything, and you can see, when you are in the emergency room, all of the beds and all of the shelves are kind of taken. It is like being on Star Trek, the cylinder thing, all the rooms are occupied. Then you look out in the hallway, and they are lined up along the hallway, by the men’s room, by the exits, and the pain on each and every individual’s face is one of need of attention. I would say, from a medical standpoint, as a parent and a coach, there is a need that exists in the City of Springfield and it is a desperate need, and now I would like to speak as an elected official. It is critical that this if it is voted favorably by this board, that it be allowed to be built in one step. Selfishly, that is because, we have two projects that are on the board right now in the City of Springfield, aside from Baystate Medical Center. That is Putnam Vocational High School, and we have Forest Park Junior High. In order to make sure that those projects stay on budget and on time, we need the work force available, and by allowing it to be done in one phase rather than spread out, not only are you helping the city of Springfield to stay on budget and on time and hopefully under budget, but you are also helping the neighborhood because it will be done much quicker, much sooner….”
Chair Auerbach noted, “We operate the discussion in a very formal way. We have the legal responsibility to consider, in a fair and objective manner, any application that comes in for a major capital change in a hospital. The application is submitted into the Department of Public Health’s Determination of Need Office. Our staff thoroughly reviews that application, is involved in a lot of discussion with the applicant; and then, when all the questions have been answered, comes forward and presents to the Public Health Council you see here in front of you a recommendation. You will hear, first of all, from the staff of the Department of Public Health’s Determination of Need Office what that process has been and what the staff recommendation is with regard to the application from Baystate. Following that, we allow those entities with legal standing to have the ability to present their perspective for a limited amount of time, simply to make sure we have time for active discussion and to get a vote. Those entities with legal standing to present are either the applicant itself or organizations that have formed what are known as Ten Taxpayer Groups. Those Ten Taxpayer Groups can legally present. There are two of those today. Following staff, then we will hear from the applicant – Baystate Medical Center, and the New North Citizens Council Ten Taxpayer Group and from the Sisters of Providence Health Systems Ten Taxpayer Group.” The Chair asked that the applicant and TTGs stick to a ten-minute testimony so that the process can move forward. He noted that the staff and applicant will be brought back to the table for a question and answer period.
Chair Auerbach stated, “I want to state, for those of you who came all the way from Springfield that have strong feelings about the application. I want to say a particular thank you to the young people that are here. I know there are a number of young people here, who have an interest in civic involvement in their community, and they took the time to come down here and we particularly applaud that, and want to encourage you to stay active within your community in civic affairs. There are other people here from the labor community, the health and human service community, from other hospitals, from other institutions. We thank you for your interest and your involvement in this, and I think the Commonwealth is a better place for having people who are very interested in what happens in terms of health care and interested in important issues regarding the delivery of high quality, cost effective health care. We appreciate you being here even though we don’t have a forum for you to offer testimony and public comment.”
Mr. Bernard Plovnick, Consulting Analyst, Determination of Need Program, presented the Baystate Medical Center Application to the Council. He said, “…The scope of the project involves substantial expansion of the existing hospital with construction of a new addition, encompassing 599,108 or 49.4%, is proposed to be shell or unfinished space. The project includes the addition of 30 critical care beds, 18 medical/surgical beds, new heart and vascular procedure rooms, and clinical support space, replacement of 78 adult medical/surgical beds and renovations to 42,115 GSF of existing space. According to the schematic drawings included in the application, the shell space in the future would accommodate a new department, and 158 beds, including 30 ICU beds. In your packet, you have received written comments on Staff’s analysis and recommendations submitted by the Applicant and Parties of Record, Staff’s response to those comments, and a slightly revised version of the original staff summary.”
Mr. Plovnick stated that he would not attempt to summarize the arguments that have already been articulated (in the written material) but would clarify several key points:
In existing DoN Regulations, an acute care hospital may increase its licensed bed capacity without an approved DoN. “However,” he said, “in the case of an application such as Baystate’s for substantial capital expenditure involving new acute bed capacity, the DoN Program routinely makes a finding based upon the reasonableness of the Applicant’s justification of need for the additional beds. This will explain the reason for the extensive discussion of bed need in our review of the current project.”
“I wish to acknowledge the Applicant’s explicit statement during the project review process, that the proposed bed capacity to be constructed initially as shell space represents replacement of existing bed capacity, not additional beds. The original application was not explicit in referring to the shell space as replacement beds, and also made several references to the space as being needed for future expansion and development. Staff welcomes the Applicant’s clarification of this point.”
“In response to comments by the Applicant, Staff clarified a projection of Baystate’s future market share, which Staff, not the Applicant, had made for the purpose of evaluating the reasonableness of Baystate’s plan to increase its medical/surgical bed capacity by 48 beds. Staff assumed, based upon the growth experience in recent years that a reasonable assumption for the annual rate of growth in Baystate’s market share would fall between zero percent and one percent per year. This facilitated a calculation of a range of possible bed need that served as a check of the Applicant’s bed increase proposal.”
Mr. Plovnick said further, “My final point is that during our review, we devoted considerable time and attention to analysis of the proposed shell space. Our serious concern about the significant amount of proposed shell space relates not only to Baystate’s project but to future DoN projects, as well. We believe that it is important that shell space continue to be carefully analyzed and permitted only on a case-by-case basis. If the Council does approve the shell space, consistent with Staff’s recommendation, it is very important that this action not be used as a vehicle that may enable a future applicant to avoid DoN review of all or a portion of the project scope, or to reduce its contribution of resources to support community health initiatives under Factor 9 by proposing shell space which understates the true total capital cost of the project.”
In conclusion, Mr. Plovnick said, “I wish to bring the Council’s attention to the existence of DoN Regulations governing significant changes in project scope following DoN approval. These regulations have made it possible and reasonable for staff to recommend approval of the shell space portion of this project. This regulation requires the Applicant to come back to the Department, which will, with opportunity for input by Interested Parties, exercise a strong oversight role in the ongoing development of the substantial shell space portion of the project. Thus, after careful review and consideration of all comments by the Applicant and other Interested Parties, Staff’s recommendation of approval with four conditions and a maximum capital expenditure of $239,318,527 (March 2007 dollars) still stands and remains unchanged from the original version of the Staff summary.”
Dr. Paul Dreyer, Director, Bureau of Health Care Safety and Quality, noted for the record that the Department received comments from two additional legislators in support of the Baystate project: Senators Michael R. Knapik and Gale D. Candaras. Senator Candaras noted that “it is important for the Council to do all in its power to preserve all of the Springfield hospitals.”
Mark Tolosky, President/CEO of Baystate Medical Center, Springfield, testified before the Council, “…Our purpose today is to share with you how our current aging facilities prevent our patients from receiving the timely, respectful and professional care that each and every one of them are entitled to and deserve. Baystate has a long history as an academic, teaching and tertiary facility, as well as a charitable health care provider, with many of our services going back to late 1800s.”
Mr. Tolosky continued, “We seek your approval as we focus on the challenges of our outdated facility and the need for a replacement facility and an additional 48 beds to serve primarily heart and vascular patients. I am proud to lead an organization that has served our community continuously for 125 years. I am proud of the commitment of our volunteer Board of Trustees, and the diligence that they have shown in overseeing the development of our master facility plan. I am also proud of our leadership team for their hard work and creativity working with our community, our patients, world class designers and architects to develop this plan, and the discipline and professionalism they have shown throughout, keeping our patients’ needs at the core of this application.”
Mr. Tolosky said further, “Baystate has received national recognition for the medical care we deliver and the many traditional and non-traditional services that we provide. We are a top 100 hospital, recognized by the Leapfrog Group as a leader in patient quality and safety, included in the U.S. News and World Report as a Top 100 Hospital in America, a Magnet Hospital for Nursing Excellence, and received the Beacon Award for Critical Care Excellence for the third year in a row, the only hospital in the country to do so. Our most humbling and gratifying recognition recently was by the American Hospital Association with four other hospitals across the country, receiving the Foster McGaw Award for Community Service. We don’t do what we do to win awards. We do what we do to serve our community. Baystate is the region’s only academic medical center, the second largest Medicaid provider in the State, the only tertiary care center and Level I trauma center with pediatric designation in Western Mass., the only Level 3 Neonatal and PICU units in a full service, accredited children’s hospital and kidney transplant provider.”
Mr. Tolosky continued, “We recognize our role as a provider of adult cardiac surgery and interventional cardiac services, and we have the responsibility to continually evolve as needs arise, and we can keep state-of-the art care in Western Massachusetts. Our Emergency Department, one of the busiest in the United States, with 110,000 visits annually, is constantly backed up with patients admitted, but awaiting critical care beds. In addition, we have 184 adult medical/surgical beds, housed in a building built in 1956 and must be replaced. I am truly concerned about our ability to provide competent, compassionate, timely care for the citizens of our community in these conditions. We are the only tertiary referral center for 800,000 citizens in Western Massachusetts. We want these services available so people don’t have to go to Boston, Albany, New York or Hartford. Our community counts on us for this care, and we want to be there for them.”
In closing he said, “I want to emphasize, this project has been designed and phased very thoughtfully, as primarily a replacement facility. We cannot afford to do it all today and, therefore, the shell space is proposed which, we believe will save 80 million dollars and cause the least disruption to our staff and community by getting that done now, and as we can afford it, to build the replacement beds in the future. I want to thank you for your consideration…. We urge your positive response to the Determination of Need recommendation.”
Ms. Trish Hannon, Chief Operating Officer, Baystate Medical Center, addressed the Council. She said that she was responsible for development of this replacement facility plan and that she was a nurse, experienced in providing direct patient care to people from all walks of life. She said, “With your permission, I will speak from my heart. When I enter our Emergency Department, I look at my medical and nursing colleagues and recognize a variety of emotions, ranging from frustration to embarrassment and deep concern. These emotions are mirrored in the eyes of our patients and their family members, who wait in our Emergency Department. This same emergency department built over 20 years ago for a range of visits of forty to fifty thousand, today, we see well over 110,000 patients each and every year. These patients are not in private rooms. These patients are in corridors, toe-to-toe, throughout our hallways. There is waiting and there is more waiting, and they are waiting for privacy and dignity that they deserve but, unfortunately, it is non existent in our organization because of the lack of beds available. These waits, often five hours, seem interminable when patients are suffering an illness.”
Ms. Hannon continued, “Just last week, 49 treatment bays were full. On one given day, we had an additional 27 patients who needed to be admitted, and waiting for a bed. This week, we had 35 patients in addition to the full occupancy of the Emergency Department awaiting beds. This gridlock creates internal crisis for our clinical support staff. Despite all of this, our physicians and nurses, and clinical staff make unbelievable efforts to bring the highest level of clinical quality and compassionate care into an environment woefully short of that privacy and dignity and family-centered care. Last month alone, we were on diversion for ambulances for almost 44 hours. Our high levels of diversion cause patients to be taken out of our community, to receive the tertiary care that they need. There is currently no other option at Baystate Medical Center to address this issue because there are no beds. As the region’s only Tertiary Care Referral Hospital and Cardiovascular Center of Excellence, we are and we need to remain ready to accept patient transfers from all over Western Massachusetts. For the first seven months of this year, 11 community hospitals in our region transferred well over 1100 patients to Baystate. Many of these patients need critical care, cardiovascular care and surgery, and each call that comes triggers yet another wait for a patient in need of a bed.”
Ms. Hannon said further, “I am challenged each and every day to respond to our physicians who call me because our operating rooms and our special procedure suites have been placed on hold. They are on hold because our Post-Anesthesia Care Unit is also filled to capacity with patients waiting for critical care beds. The addition of thirty ICU and CCU, and eighteen medical/surgical beds primarily devoted to heart and vascular care will provide the capacity that we need to serve out patients in a timely and appropriate way…. In addition to the hospital, Baystate Medical Center provides community-based care within three health centers, a women’s health clinic, and six school-based health centers. We have a long history of providing preventive primary and specialty care to the under-served members of our community. We continue to work with our community as partners, as we have throughout the years, to address health issues such as asthma, obesity, teenage pregnancy, sexually transmitted diseases and violence prevention. We remain committed to providing resources to enhance access to care, and address the various disparities that we all know affect our most vulnerable citizens. In order to foster our mission and provide for the health needs of people in our region, Baystate Medical Center must ensure that we have the hospital beds, procedure capacity and appropriate space. On behalf of our patients, staff and community, we thank you for your support of our plan to address our critical facility needs.”
Mr. Vincent McCorkle, President and CEO, Sisters of Providence Health System and representing the SPHS Ten Taxpayer Group addressed the Council. He said in part, “…The SPHS Ten Taxpayer Group engaged in this crucial dialogue, not only to protect the vital services provided through and enabled by Mercy Medical Center but, more importantly, to assure the health care needs of our community will be met, a community that is one of the poorest in the Commonwealth, that has the highest rate of addiction, and the highest teen pregnancy rate, and projects essentially no population growth for the foreseeable future. We all know that the role of the Determination of Need process is the allocation of health care resources and the improvement of health care delivery systems such that adequate health care services are made reasonably available to everyone in the Commonwealth at a reasonable aggregate cost. Our interests in remaining a truly competitive market are focused on satisfying the unmet healthcare needs of our community and ensuring reasonable cost, affordability access and health care choice. We also support Baystate’s plan to replace aging infrastructure. However, the ambiguity in the Baystate DoN application regarding the proposed construction of space for new bed expansion was of major concern. This was validated by the DoN Staff analysis that found the scope of Baystate’s proposal not only included the replacement of all existing beds, but created potential to add an additional two hundred and six new beds. By the way of comparison, the Mercy Medical Campus, only a few blocks away, has 168 licensed beds. It is prudent that the DoN process has subsequently redefined the scale of the Baystate Project. As we currently understand the plan, the full scope of the recommended project is the replacement of existing beds with expansion limited to 48 beds. We remain very concerned, however, about the unprecedented three hundred thousand square feet of empty space and the new debt burden that service on sixty million dollars represents to the members of our community who will, for years, be paying for this empty space. The DoN staff themselves concluded that Baystate made no attempt to justify use of the empty space, and therefore included several conditions to ensure that the build-out of the empty space will not adversely impact delivery for cost of health care in Greater Springfield.”
In closing, Mr. McCorkle stated in part, “…We fully trust that the Council will reach an informed and rational balance in deciding how scarce community resources will be allocated, between the construction of expensive and, in this case, unprecedented bricks and mortar empty space, and important investments in our community’s well established community health needs, such as behavioral health, substance abuse, addiction, and the growing diabetes and obesity epidemics. We look forward to our continued collaboration with the Department of Public Health and Public Health Council to best address the health care needs of the Greater Springfield area.”
Mr. Michael Denney, Executive Director, New North Citizens’ Council TTG, an elected neighborhood council for the community testified before the Council. He said in part, “We have an invested interest in what Baystate does because it affects not only our health issues, but also the quality of life issues for the people who live in this community.” Mr. José Claudio, Director, Community Relations, New North Citizen’s Council TTG said, “…We applaud what Baystate Medical Center is doing. We have 66,000 walk-ins every year, into our council. And one of things that we heard is that the waiting period in the Baystate emergency room takes five or six hours because there is no space and no beds…. We need the beds in our neighborhood and in the city of Springfield because of the shortage….” Ms. Karen McHugh, President, Atwater Park Civic Association introduced herself and stated that she works in conjunction with the New North Citizens’ Council. Mr. Denney said further that Baystate is a good neighbor and that they came to them and all the organizations and committees in their North End neighborhood and asked their input on the project. He also said, “Baystate has already made a commitment to our community. They have a health clinic in the North End, of which they serve everybody, I mean people with no insurance and no money, with no means to ever pay them. Doors are open and they are ready to serve.” Mr. Denney noted further that Mercy Hospital has never come to them for input before implementing any new projects at their hospital. Mr. Denny told a story about his sister dying at Baystate and that there was no privacy for her or the family during that time.
Ms. Karen McHugh, Atwater Park Civic Association explained her elderly mother’s experience at Baystate – long waits in the ER. She said, “It’s a very disheartening environment for elderly people. It is very frightening for them. They see all sorts of things happening around them. They don’t understand why they are not being cared for, and there are bodies-to-bodies, as the picture showed you earlier.”
Ms. McHugh said further, “I am here to represent a neighborhood which abuts the Baystate Hospital. My neighborhood is made up of about 300 historic homes. It is a lovely place. It is a community of families, many of whom grew up in the neighborhood, and live there again, raising their own children, and we frequent the emergency room also. Our concern is – they have spoken to us on a number of occasions and gotten our feedback, and we are firmly in favor of them building this building at once. For three years, my life and all those of my neighbors will be disrupted. We will be dealing with noise, dirt and traffic. We will be dealing with many problems that will negatively impact our life for the better of the community. If you change the proposal in front of you, my daughter, who is in sixth grade now, will be living with construction until she is long out of college, and I don’t think that’s appropriate for any neighborhood. That is why we are asking that you please approve the proposal in front of you.
Ms. Cherylynn Hatchett, Executive Director, Dunbar Community Center in Springfield. “It is an institution in its 95th year of service. It serves predominantly low income African American and Latinos in the Mason Square area… I think what I want to do is give you a perspective as Baystate as a community partner. Baystate is an organization, a critical partner in investing and improving lives in our community. They walk the walk rather than talk the talk, and let me give you some examples of how they do that:
They could limit their resources to the neighborhoods around them but they don’t, they come over to Mason Square;
They make available their marketing expertise, their technology expertise, their human resources, all those things community-based organizations need to build capacity but can’t afford themselves; and
Baystate serves on many boards in the community.”
In closing, she said, “Baystate is determined to work with us, not for us, but with us, to serve the community, the low income people. It is far more than brick and mortar.”
Ms. Dora Robinson, Executive Director, Martin Luther King, Jr. Community Center said, “Baystate has been a major partner, financially supporting a number of youth initiatives, also supporting a number of prevention initiatives in the Mason Square community for youth, adults and families. It is interesting that this DoN application outlines some of the community benefits that will come from the funding, but Baystate has been doing community benefits for many years; and so, it is not really just about this application. Their commitment has been unwavering. It has just been consistent and very supportive and so I am here to fully endorse this application on behalf of those that I serve and represent. I am one of those folks who ended up in the hallways in the ER and so the need for additional beds and services is just so critical. Every time I have gone to the ER I have found myself partially robed in the hall, waiting for services. It is not just an issue of treatment but safety. It is just not safe at this point. I endorse the construction of this.”
Ms. Frances Hubbard, Historian, CHNA #4, noted that Baystate Medical was there in 1992, at the inception of the CHNA program helping to begin a pilot program to reduce sexually transmitted diseases among adolescents. She noted the adolescents in the room, who are 13 to 20 years of age, community health workers who support this effort. In closing, Ms. Hubbard talked about how she had to be transported to Beth Israel Hospital in Boston for a life-saving cardiovascular treatment because there were no beds in Mercy or Baystate Medical Center Hospitals. She said further in closing, “I would suggest that, rather than looking at this proposal as a proposal that supplants other institutions’ capacity for growth, that it be looked at as the growth of a medical center, top notch medical center, whose presence enhances all of the health care, both prevention and tertiary, and secondary services within the area, and that, with the growth of this particular proposal, that all of the services related to health in Western Massachusetts, where the Baystate Medical Center serves the entire area, will be increased, not only in terms of workforce development, in terms of medical education, in terms of prevention, and in terms of meeting the needs of ordinary citizens who seek care. I would urge your consideration in the affirmative.”
Council Member Sherman asked about the shell space planned, “How many floors would be empty shell space?” Mr. Mark Tolosky, President and CEO, Baystate Health and Baystate Medical Center of Springfield replied, “A one-story building that is going to have two underground and three above and the other main building is two underground and five above.”
Dr. Alan Woodward, Council Member stated, “…Your comments from your community are extraordinary, as a hospital. It is clear you have made outreach and investment in your community and the accolades are numerous, and you clearly are deserving of all the awards that you have won, which is a notable group. You have also heard again from the community what we are experiencing across this commonwealth, and if people aren’t aware, the Commissioner is now chairing a statewide boarding and overcrowding and diversion task force. This is a critical problem as we see a growing mismatch between the demand for health care and the resources to provide same, but Baystate obviously has been, shall we say, on the upper end of the bell curve as far as its boarding and overcrowding issues, and it clearly is at a crisis state for your community, in the ability of your providers to provide high quality care…. You tell us your ER department was designed for a capacity of 40,000 and you are now at a 110,000 and yet you don’t tell us when you are building a new emergency department; but, in the meantime, I think what I need to, or we would hope to hear, is a true commitment to eliminate boarding, to address the outflow side of this equation, and you talked about 48 additional beds but primarily for heart and vascular care. Is that going to off-load enough to achieve an elimination of boarding in your emergency department, and what is the timeframe, and can you assure the Department of Public Health and this Council that we are going to see a curve similar to what we hope to see for tobacco use, relative to boarding in your emergency department?”
Mr. Tolosky responded, “…The reason the emergency department backs up is because of the lack of adequate inpatient capacity. We have done every single thing possible to create capacity. We have created a new ED holding room of eight spaces. With licensure guidelines, we have added incremental beds over time with the automatic licensure and occupancy requirements. The initial additional new beds, the 48, the 30 critical care and the 18 medical/surgical beds are really the avenue to get the emergency department decompressed. The ED originally, built in the eighties for 40,000 visits has been reconfigured two or three times, probably in its current configuration is adequate for 70,000 to 75,000 visits. We are seeing 110,000 visits. The primary reason for backlog is, we don’t have a place to push patients on the inpatient side, and it really is the reason why we are very anxious to get out of this 1956 building, but we needed these incremental new beds on the front end because that is the mechanism to decompress the emergency department. I would commit to you that that is the strategy. At least with the volume we are currently seeing and the demands from our community, we believe, when these beds come on-line, that very problematic situation in the emergency room will be, for the most part, remedied as we look at it today. What we would face in three to five years from now is uncertain.”
Dr. Woodward asked further, “How soon will you have those new beds online, if this were approved?”
Ms. Trish Hannon, Chief Operating Officer, Baystate Medical Center, replied, “With your approval, we intend to begin construction in 2009 and be occupied by 2012; and as you can imagine, in the interim, we have a number of issues that we are attempting to deal with; and, with the gracious support of the Department of Public Health, we have opened beds. We have one final area, which is where both Mark Tolosky and my offices are, which may end up having to be converted to support the very issue that you are addressing, Doctor, which is to eliminate boarding, and we intend to enact every single element available to us to be able to do that.”
Dr. Woodward said, “A five-year wait considering what you are hearing from your community now is going to be too long.” Mr. Tolosky replied, “…We can’t go five years. We are looking at every strategy to give us some interim decompression before we get this solution in place.” Dr. John Cunningham, Council Member asked for clarification on the shell space being for replacement beds. Mr. Tolosky responded in part, “…Believe it or not the primary purpose, when we first got into this project, was to not only decompress the emergency department, was to get out of this building built in 1956. This building is an embarrassment to us. That room that you are looking at right there (Powerpoint slides) is 120 feet smaller than a private room would be designed today, and we have two people toe-to-toe in it, built in 1956. The shell space, which is for construction and disruption efficiency, is intended to be the avenue to get us out of the future – I wish we could afford the whole half billion dollar project today. We absolutely can’t. We are trying to get some done early, to get the decompression out of the emergency department, and the shell space is the avenue to get out of this 1956 facility.”
Dr. Muriel Gillick, Council Member asked for clarification of the shell space too, “Is the shell space committed to be used for replacement beds only, or could it be for unspecified expansion of services?”
Mr. Bernard Plovnick, analyst for the project, responded and stated that in the application it was referred to in the context of an expansion but in more recent material to staff it has been referred to as replacement beds. Ms. Hannon responded, “If we could afford to build out and fit out everything today in order to decommission the old building that you see behind me, we would do so. Our intent is to replace 158 beds within this building, with the shell. It is also the future home of our operating rooms. Our operating rooms were built in 1980; and, by 2015, we believe that we are going to need to replace those operating rooms. We also believe that we are going to need to replace our emergency department. We don’t know today what we will know in 2015, but we believe that this is a very prudent effort, not only to plan effectively for the replacement requirements, but also to plan effectively in terms of construction inflation, given the fact that today, as we know it, construction inflation over a period of four or five years can be anywhere from eighty to ninety million dollars.”
Dr. Muriel Gillick asked, “But then, you are specifically not anticipating using that shell space for some unspecified expansion that you haven’t’ referred to in your comments right now?” Mr. Tolosky replied, “That’s correct.”
Council Member Paul Lanzikos stated, “I would like to comment on the impressive breadth of positive support that you have had from your community. We only wish that all hospitals’ tertiary community would be able to share that.” He further asked staff about the Brigham and Women’s Hospital and Cape Cod Hospital projects that contained shell space that have been approved in the past. Ms. Joan Gorga, Director, Determination of Need Program noted the following:
She couldn’t comment on the Brigham and Women’s project because she was not in the DoN program at that time.
Cape Cod Hospital’s shell space was presented as a significant change to the Council over the past summer and the Council approved it with a contribution of community initiatives for the amount of the build out.
DoN staff is not aware of any instance where a request for shell space has been denied.
Dr. Paul Dreyer, Assistant Commissioner, Bureau of Health Care Safety and Quality noted that this project forced them to look more critically at the issue of how they should deal with shell space. “In taking that critical look, we realized that the amendments governing the post-DoN actions, which define minor changes and significant changes, were perfectly relevant to the situation. What the regulation says is that, if any foreseeable change in the scope of a project is a significant change. And so, in this case, the build out of shell space is totally foreseeable, that build out constitutes a significant change and is a vehicle for bringing the applicant back to the Council for approval of that build out.”
Dr. Meredith Rosenthal asked two questions. In brief, (1) Does the applicant have data or an analysis on patient outflows from their market area for urgent or cardiovascular services in particular and elective cardiovascular services as well to Boston or Albany? (2) What are they doing specifically on the prevention side for cardiovascular health?
Dr. David Longworth, Chairman, Department of Medicine, Baystate Health Care responded: “We care deeply about prevention. We serve a disadvantaged population with a high prevalence of diabetes and obesity. In fact, we do have a preventative program in Cardiology. We are in the process of building a Diabetes and Obesity Program to try to address optimal treatment of those epidemics in our community.”
Dr. Longworth said further, “Our Physician Health Organization, in fact, has targeted standardization and optimization of treatment of diabetes and obesity as a goal for the next couple of years, and we are enlisting the participation of primary care providers in our communities to help drive that because we do not believe that sub-specialists alone can, in fact, address those concerns primarily. In our Residency Education Program, there is certainly a focus on diabetes and obesity, and for the past several years, in our Health Centers where our residents do educate in longitudinal care clinics. In fact, we have provided individual scorecards to the residents around diabetic control of the patients they follow, in the hope that we can drive systems-based practice, one of the core competencies, to better improve performance in the people that we are training moving forward.”
Dr. Longworth said with regard to the migration data: In our total cardiovascular service line, 8.1 percent of patients are treated outside western Massachusetts; cardiac surgery is 20 percent; interventional cardiology is 13 percent; and vascular surgery is 11 percent.
Council Member Albert Sherman asked about fire safety concerns in the empty shell space. Curt Rocstro of Stephanie and Bradley Architects assured him that the shell space will have a full fire protection system, along with smoke detection and appropriate egress signing. “The fire protection systems and sprinklers will be in from day one, along with proper egress signing and smoke detection systems,” he said. “What is also included in the budget is a security system with cameras for the shell space,” said Mr. Rocstro. Council Member Sherman asked, “And that you will pledge that the camera system will be monitored.” Mr. Rocstro said, “And we will. We will follow all Life Safety Code requirements for that space. The cameras will be monitored.”
Chair John Auerbach noted, “…Just in summary, I think I will echo the Council, that you have demonstrated a particularly strong ability to establish ties with the community in a way that is admirable and it really speaks highly of your commitment to the larger community…. We hear very clearly your commitment, I believe, and the staff recommendation or understanding that the DoN application would require a return to the Council with an amendment request if there was a desire to add additional beds in the future (beyond the 48 beds above the current licensed number of beds) or develop a significantly different service.” Mr. Tolosky replied, “We would comply with those regulations in the full spirit as they exist from time to time.”
Council Member Sherman moved approval of staff recommendation. After consideration, upon motion made and duly seconded, it was voted (unanimously) [except for Ms. Helen Caulton-Harris who recused herself] to approve