PITTSFIELD, Mass. -- Politicians, lawmakers and union leaders spent Wednesday scrambling to resolve the fate of North Adams Regional Hospital and four affiliated organizations before they close for good on Friday.
Tuesday’s announcement that Northern Berkshire Healthcare’s trustees planned to close NARH, the local visiting nurse and hospice group and three medical practices within three days, a decision that would cost North Berkshire 530 jobs, appeared to have caught politicians and union leaders somewhat off-guard.
It was unclear Wednesday exactly what direction officials were planning to follow, but several options were being discussed.
They included the possibility of legal action, a thorough review of the hospital’s financial situation, the filing of emergency legislation, possible government intervention, and the clarification of discussions between the financially strapped NBH and Berkshire Health Systems, the county’s largest employer.
A professor of Policy and Health Management at the Boston University School of Public Health also has called on Gov. Deval Patrick to declare a public health emergency that would allow the state to take control of NARH.
"We’re working on every option that we can think of," said state Sen. Benjamin B. Downing, D-Pittsfield, "including conversations with the (Patrick) administration, the (state) Attorney General’s office and others.
"The first goal is to keep the hospital open any way we can so we preserve access to emergency services, and to the extent possible to preserve services beyond emergency services, and jobs."
With only a day left before NARH is scheduled to close, Downing said the discussions are being conducted with "a sense of urgency." But Downing said lawmakers also want to resolve the situation permanently so that it doesn’t flare up again.
"There is a desire to make sure that we don’t claim to have solved the problem only to be back here again in a week or two," he said. "We want to do everything to solve this and do it right."
State Rep. Gailanne Cariddi, D-North Adams, said she met with Downing on Wednesday morning and that they discussed the possibility of filing emergency legislation to keep NARH open.
"I’m working hand-in-hand with him to put together the right language that we can bring forward to keep the doors open at the hospital," she said.
Cariddi said the options available to lawmakers depend on "what the true situation of the hospital is," including a clarification of the discussions that she said have taken place between BHS and NBH.
"Is there a merger? Is there no hope for a merger?," she said. "The light at the end of the tunnel" appeared to be some sort of "cooperation" between the two Berkshire County health organizations, Cariddi said.
Speaking at an unrelated event on Wednesday, Patrick said NBH’s decision to close the hospital was "something that I’m very concerned about," and that his office had been working with the state Department of Public Health "all weekend" to "try and find a solution."
"We thought we had one right up until the point that the board of the hospital made the decision they made here," Patrick said.
In a statement, state Attorney General and North Adams native Martha Coakley said she is "deeply concerned" with the rapid pace of the hospital’s closure, and that her office is considering "all legal options" that would prevent both NARH from closing and maintain access to health services.
"North Adams is my hometown, and I know how important North Adams Hospital is to the communities in the area," Coakley said. "I am deeply concerned by the rapid pace of this closure and am working with all parties -- the governor, the local delegation, the Department of Public Health and others -- to address this.
"We are considering all legal options to prevent this quick closure and maintain access to health care services for this area," she said.
NARH spokesman Paul Hopkins said NBH decided to close the hospital and its affliated agencies abruptly because the organization had less cash on hand than was needed to continue operations past the end of this week, and still fulfill all of its obligations to its employees, including making payroll and providing vacation pay.
He denied that merger negotiations between NBH and BHS had been taking place, while BHS spokesman Michael Leary declined to comment on any discussions between the two organizations.
"Our ability to borrow money was constrained by our past debt load, so additional sources to keep operating were not available to us," Hopkins said in a statement.
Hopkins said the decision to close was as "much about revenue as expenses."
"Patient volumes in almost all areas have been dropping, and the overall cost to continue operations, exceeded revenues," he said.
"The community should be assured that in the past several months we have explored every possibly opportunity, ranging from addressing reimbursement issues to partnering or outright acquisition by other providers," he said. "None of those options proved workable."
Representatives of two unions that represent workers at NARH reached angrily to the decision to close the hospital. One collective bargaining unit called the decison "unacceptable" while the other said it was "not convinced" that NHB’s board and management had fullfilled all the legal requirements needed to close the hospital within such a short time span.
David Schildmeier, a spokesman for the Massachusetts Nurses Association/National Nurses United, which represents about 100 nurses at NARH, said discussions had been taking place between NBH and BHS, but that they broke down over the weekend.
"I don’t know what it is," Schildmeier said. "As of last week, we were told that everything is fine. Then we get a notice (Tuesday) that we’re shutting down in three days."
Schildmeier said a state law that his organization helped pass 15 years ago requires health care organizations to provide 90 days notice when intending to close a hospital, and that the Department of Public Health is required to hold a public hearing. He said NARH did adhere to those requirements when recently closing its psychiatric unit, but did not comply in this instance.
He said it is possible for a health care organization to obtain a waiver from that requirement.
"To our knowledge nothing has been filed," Schildmeier said.
Hopkins said DPH has been aware of the situation facing NARH, and that NBH has been "in daily contact with the agency.
"Although the normal process would involve a notice, in emergent circumstances that process may not be observed," he added.
Typically, the closure of a hospital would trigger the requirement for a public hearing 90 days in advance of the proposed closure. But in this instance, a recent change in financial condition led to the hospital’s decision to close immediately.
NARH confirmed their plans to close with DPH on Tuesday, said DPH spokesman David Kibbe in a statement.
"This is an ongoing process, and the department is working to provide all support necessary to ensure patient care needs are met," he said
Sources at the state’s largest health care union, 1119 SEIU, which represents 200 workers at NARH, said the group is trying to determine the actions that have transpired around the bonds that were issued to NBH, and if there is a way to remedy that situation. The union is also exploring whether the governor’s office or state Attorney General’s office could provide some sort of relief, such as placing NARH in receivership, or temporarily floating or funding the bonds that would allow the hospital to stay open.
In an email message, Boston University Public Health Professor Alan Sager and colleague Deborah Socolar said Patrick would be "justified" in declaring a public health emergency in this case. They referred to a similar action taken by then Gov. Michael Dukakis in 1976 that was done to protect the residents of a Merrimack Valley nursing home.
Declaring a public health emergency would allow the commissioner of public health to appoint "a skilled hospital turn-around expert to manage" NARH and take steps to raise patient volume and revenue, while cutting costs, they said.
Patrick said the closure of NARH leaves a "hole" in the service network for "a very important part of the commonwealth." He also expressed concern for the 530 full and part time employees who will lose their jobs when NARH and its related agencies close, noting that the state had sent a "rapid response team" to North Adams to meet with employees and discuss their futures.
"Obviously, it’s incredibly disruptive and worrisome," he said.