State begins investigation of Nuvance; doctors speak out
SHARON — The Connecticut Office of Health Strategy (OHS) has begun a new investigation into Sharon Hospital’s parent company, Nuvance.
An earlier investigation was started last October. The new investigation was launched on Feb. 2 and cites “discrepancies between the conditions described in the 4/19/21 Settlement Agreement and Sharon Hospital’s statements and actions as well as comments from members of the community,” according to Tina Hyde, Manager of External Affairs for OHS, in response to a query from The Lakeville Journal.
The state has sent a list of 33 questions to Nuvance, with many of them focusing on the nonprofit hospital group’s efforts to recruit new staff for the labor and delivery unit.
In response to a query about the investigation, Dr. Mark Hirko, president of Sharon Hospital, sent the following statement: “The Office of Health Strategy (OHS) recently notified Nuvance Health that it is investigating Sharon Hospital’s compliance with the 2019 settlement agreement regarding the affiliation of Western Connecticut Health Network, Inc. and Health Quest Systems, Inc.
“We appreciate OHS’s close attention to these matters and are confident that OHS will find no wrongdoing in its investigation. The independent monitor approved by OHS and retained by Nuvance Health to assess our compliance twice yearly continues to report that we are fully compliant with the settlement agreement, with the most recent positive assessment reported in December 2021.
“Sharon Hospital’s plans to phase out Labor & Delivery services and to consolidate our ICU services into a new, modernized Progressive Care Unit continue in compliance with OHS requirements. We remain committed to our Sharon Hospital transformation plan, which will ensure Sharon Hospital’s long-term stability and allow us to continue to best meet the needs of our community into the future.”
Doctors say they see dishonesty
Nuvance, which was still known as Health Quest at the time, promised the state in 2018 that it would keep the labor and delivery unit at Sharon open for five years.
Without waiting for the state to approve the plan, Nuvance has already announced that it will close maternity in Sharon this year.
Doctors at Sharon OB/GYN say that Nuvance has sent letters to their pregnant patients telling them they will have to deliver their babies at another hospital and that Sharon’s unit will close in spring.
Doctors in the region who are associated with Sharon Hospital have expressed outrage at what they consider to be dishonesty on the part of Nuvance, and efforts to actively make it difficult for doctors and staff to care for patients.
Last October, members of the regional medical community voted 25 to 1 to oppose Nuvance’s plan to close labor and maternity; to close the intensive care unit; and to limit surgery to daytime hours.
The doctors then sent a letter to the state’s OHS in December with a list of concerns about “Nuvance’s response, dated Nov. 22, 2021, to your questions, dated Oct 29, 2021, about possible noncompliance with the CON of Nov. 2, 2018.
“We believe that many of Nuvance’s responses are misleading or inaccurate.”
At that time, most of the doctors did not want to be interviewed on the record about their concerns.
Last week, by contrast, several doctors asked to be interviewed and to be allowed to share their concerns.
It’s not possible to convey everything that was said in three interviews (one with two physicians in person, two with two physicians by phone) with this reporter, but there is a general sense among the doctors that Nuvance is not living up to its promises to serve the community; that the company is rushing ahead to close sections of the hospital without waiting for the state’s permission to do so; that if Nuvance is allowed to go ahead with its stated intentions the community will suffer badly; and that a solution must be found.
Labor, maternity and OB-GYN
One of the first to comment about his concerns was Dr. Howard Mortman.
Mortman has been with Sharon OB/GYN Associates since 1991. He and his family live in Sharon, and he is passionate about the need for Sharon Hospital to maintain its maternity unit to protect the safety of mothers and children in the Tri-state region.
Mortman particularly objects to Nuvance’s claim that it’s unsafe to deliver babies at Sharon Hospital because the staff is small at Sharon OB/GYN. Mortman points to the many babies delivered safely through the years here.
Nuvance commissioned a study last spring by the American College of Obstetricians and Gynecologists. Mortman believes they were hoping the study would support their claim of unsafe conditions.
“That blew up in their faces,” Mortman said. “ACOG gave us a perfect chart review, which is very rare. And they said we provide a vital service to this community, that Nuvance should do everything in its power to support us, that we are a gem.”
Mortman also says that Nuvance is talking about the closing of the labor and delivery unit as a done deal. In fact, he said, the state’s OHS has to give Nuvance permission to do so — and that permission has not been given yet.
Nuvance first tried to close labor and delivery three and a half years ago. There was an enormous public outcry in opposition to the plan. At that time the company wanted to take on Danbury Hospital as well, and Mortman believes that OHS told Nuvance they would not be given permission to buy Danbury unless they kept maternity in Sharon open.
Labor and maternity remained, but Nuvance has continued to say it will be closed. Mortman said this has led to maternity nurses leaving to seek more stable employment elsewhere; he also said that “within the last year, Nuvance has tried to recruit our most vital labor and delivery nurse — our nurse manager —away from Sharon Hospital to Danbury Hospital.”
Delivery rate remains stable at Sharon
Nuvance’s stated plan to close maternity has not discouraged mothers from planning to give birth in Sharon. Mortman said that three and a half years ago, when the first announcement was made that maternity would close, deliveries dropped to 180. But in the year following, it rose to 210 and has remained there.
“Our numbers are stable even though in COVID there are fewer babies being born,” Mortman said. Nuvance’s own dashboard of statistics shows that Sharon Hospital has the highest scores for safety and patient satisfaction among the seven Nuvance hospitals, he said.
“And that’s with no public support from the company for our unit.”
Recruitment of high-quality doctors
Nuvance has also said that new doctors can’t be recruited for labor and delivery, making it unsafe to deliver babies in Sharon. But Mortman points to the hiring this year of Dr. William Schweizer, who comes to Sharon with decades of experience at and training from New York University.
“He’s a superstar, and we were able to recruit him even though Nuvance is saying they’re going to close maternity,” Mortman said. “We have a rotation of five OB-GYN doctors; that is an abundance of providers.”
However, he said, it will in fact become unsafe to deliver babies in Sharon if the maternity unit is closed.
At the moment, Nuvance is training the emergency department doctors in how to deliver babies in situations where a mother can’t be transported in time to Nuvance hospitals in Danbury or Poughkeepsie.
Pediatric and obstetric emergencies
Mortman’s decades of experience as an obstetrician have taught him that any delivery can suddenly take a bad turn in any number of unexpected ways.
“ER doctors are not qualified to be the last person available to care for obstetrics and for children,” he said. “It will put children at risk, mothers at risk, doctors at risk and the hospital at risk.”
An important partner in every birth is the pediatrician. Edward Kavle is one of three physician owners at Northwest Hills Pediatrics, which has offices in Torrington, Winsted, Avon — and at Sharon Hospital, although the group has no ties to Nuvance.
The group also has a number of RNs and APRNs to assist in care.
“Our only affiliation with Nuvance,” Kavle said, “is they employ us independently to cover the labor and delivery unit. Dr. Jason Perkel and I cover the unit usually four out of seven days and two weekends out of each month. The other doctors who cover are Amy Tocco and Suzanne Lefebvre.”
Maternity is the gateway department
Kavle has multiple concerns about Nuvance’s plan to close labor and delivery, ranging from patient care to a more global concern about the community.
“At every other hospital I work with, there is an understanding that maternity is the entrance into primary care for the community,” he said. “When you lose that, the next thing you lose is primary care and then you lose specialty care and the medical options for patients become smaller and smaller.”
Kavle noted that primary care options in the region are already severely limited, and there have been no improvements despite Nuvance’s promise that they would work hard to recruit new doctors. He agrees with Dr. Mortman that Nuvance in fact seems to be trying to discourage doctors and nurses from remaining and working in Sharon.
“I hear from the primary care doctors who work for Nuvance that they are unhappy with their contracts and their low pay and that they are unhappy that they are only allowed to refer their patients to Nuvance doctors. Nuvance may say they want to help but in reality, people aren’t being recruited.”
Within their own practice, Kavle said Nuvance has been unprofessional in the way it handles financial matters. It took several months to renew the practice’s contract with Sharon Hospital.
“To get our contract renewed took five months and two or three month-long legal extensions of the previous contract,” Kavle said. “I remember calling the administrator on call on a Wednesday night and telling them I could not work after midnight on the final day of the termination of the contract extension. That was what it took to get the contract done.”
Nuvance also delays making its payments, Kavle said.
“We are paid monthly by Nuvance. During the past few years while we have covered the unit it usually takes Dr. Perkel multiple contacts with them for us to get paid every month.”
Several doctors have also reported small roadblocks thrown into the path of them getting their work done, things like supplies and cleaning of facilities.
Like Mortman, Kavle said he has seen nurses leave Sharon Hospital because Nuvance has been consistently saying they will close labor and delivery, leaving those nurses unemployed.
Nuvance has been paying “traveling” nurses a premium to staff the hospital in recent months. This is not necessarily a bad thing from a medical point of view; he and Mortman agree that many of the “travelers” are highly competent. But that cost adds to the amount of money that Nuvance claims is being lost every year at Sharon.
The dangers of a distant hospital
Northwest Hills Pediatrics will not leave Northwest Corner families without care, Kavle promised.
“Our primary care pediatric practice will not leave Sharon if Maternity closes. We will continue to provide excellent primary care to our patients in the outpatient setting. Remember, we were recruited here when the previous pediatric group — which was employed by HealthQuest — left en masse over difficulties they were having with that administration.”
However, he said, once the labor and delivery unit closes, the pediatricians will no longer have hospital privileges.
He gave the hypothetical case of a mother in her 28th week having an emergency delivery. If there is no longer a labor and delivery unit, that delivery will be handled by emergency room doctors who are not specialists in obstetrics.
“An ER doctor trying to deliver a baby is like me trying to treat a heart attack,” Kavle said.
Nuvance has said that mothers can go to its hospital in Danbury, which is a one-hour drive if there is no snow on the road and no traffic.
Kavle points out that if a pregnant woman in, for example, Cornwall is in medical distress, the ambulance will take her to Sharon Hospital and that is where she will remain. The volunteer ambulance can not travel the extra distance to the larger, more distant hospital.
“Once that mom and baby are there, it’s hard to move them. That means the delivery will be at the ER in Sharon — with no OB-GYN and no pediatrician there. It’s dangerous.”
Nuvance cites the example of New Milford Hospital, which no longer has a labor and delivery unit. A similar case is Winsted.
“Those hospitals are different,” Kavle said. “You can get from Winsted to Charlotte Hungerford in Torrington in 8 minutes. You can get from New Milford to Danbury in 25 minutes.”
In the Northwest Corner, the one hour drive will be challenging enough in summer.
“But in winter? I was only working here for a week before I realized that I had to have snow tires,” Kavle said.
A shortage of primary care doctors
It isn’t only the maternity-associated doctors who have concerns about Nuvance and its plan to close labor and delivery as well as the intensive care unit, and to reduce surgery to only daytime hours.
The primary care doctors also have concerns about Nuvance and its future plans, and its treatment of the Sharon Hospital medical community.
There is still a thriving OB-GYN practice in the area, and a strong pediatric practice. But many of the primary care physicians are so busy they can no longer take new patients; and many of them are in the early to mid 60s or older and are beginning to contemplate retirement.
Michael Parker is a primary care physician who has had a practice in Sharon for 33 years. He said that Nuvance has been very clear that its goal is to “change Sharon Hospital to a small rural facility of limited capacity.”
The hospital would essentially become a hub, with most patients transferred to the company’s other, larger hospitals in Poughkeepsie and Danbury.
“They have made no attempt to make our hospital solvent,” Parker said. “And in fact, they hinder our ability.”
The doctors are not consulted
Dr. David Kurish, an independent physician who has had a practice in Sharon for 40 years, is similarly concerned.
He concedes that it’s expensive to run a hospital and that the maternity unit probably does lose money for Nuvance.
“But it’s an essential service.”
Like most doctors in the region, he said that even though Nuvance is a medical group and a nonprofit, he trusts them less even than Essent, the company that bought Sharon Hospital in 2002 and converted it to a for-profit entity.
“Under Essent, we had oncology, pain management, a state of the art maternity unit — that they built. I would have stacked our hospital up with any hospital in the country. We had a lot to work with then. But since then, it’s been cut, cut, cut. And the doctors have had less and less influence over what happens.
“Now we have no influence.”
Dr. Parker agreed, and said that Nuvance has not been honest about its efforts to work with and communicate with the doctors.
“They have not been willing to talk to the medical staff. They’ve never invited the medical staff to discuss a way forward.”
Kurish said, “I hate to see it all destroyed because of dollars.”
He leans toward a return to community ownership of the hospital. If it’s true that Sharon is losing about $5 million a year, he said, it might be possible to raise that money from local donors.
He is encouraged that the state is actually looking into Nuvance and whether it is in compliance with its earlier Certificate of Need.
“It’s a breath of fresh air that there is a problem, and looking into it.”
But Kurish wonders whether the state will have the clout to stop Nuvance from closing the hospital — which he feels will be the inevitable outcome.
“I don’t trust Nuvance,” he said. “Not at all.”