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N.H. Vote On D-H Mental Health Contract Delayed



Valley News Staff Writer
Thursday, August 25, 2016

New London — The Executive Council put off action on a contract that would directly engage Dartmouth-Hitchcock to provide professional services at New Hampshire Hospital, a 158-bed, state-owned facility for people with severe mental illness.

The council voted to delay its decision on a 32-month, $36.6 million deal after a lengthy meeting where state officials addressed concerns about the adequacy and continuity of staffing at the hospital in Concord and about the investigation of a suicide by a recently released New Hampshire Hospital patient.

The council opted for postponement despite a warning from New Hampshire Health and Human Services Commissioner Jeffrey Meyers that inaction could make it harder to recruit and retain psychiatrists and other professional staff at the hospital.

“I do have significant concerns about any delay,” Meyers said.

But that didn’t persuade a panel where two of five members are running for governor. One of those candidates, Republican Chris Sununu, of Newfields, issued a statement during the meeting, which was held at Colby-Sawyer College in New London, declaring his intention to vote against the contract, which gives the state two options for three-year renewals.

Sununu’s statement expressed “serious concerns about the validity of the long-term administration and operational practices of Dartmouth-Hitchcock, including questionable hiring practices and a recent suicide of a patient in their care.”

An email message for Executive Councilor Colin Van Ostern, a Concord Democrat seeking his party’s nomination for governor, seeking comment after the meeting, was not immediately returned.

During the meeting, Sununu argued for things to slow down. “We still have some flexibility,” he said. “We’re not up against any absolute deadline here.”

Sununu also revisited a suggestion that contract bidding be reopened. That was the thrust of a June letter signed by all five councilors.

But Gov. Maggie Hassan, a Democrat, argued against reopening the bidding, saying that it would “convey a complete destabilizing of the process” to those on the outside.

After Hassan called a five-minute recess that stretched longer, Councillor Joe Kenney, R-Wakefield, moved to table the contract until the council’s next meeting, which is scheduled for Sept. 7. That motion passed in a voice vote.

Meyers, who declined to identify the patient, said the woman who died in a suicide was released “as a result of a clinical decision made by two board-certified psychiatrists,” including one who had 30 years of clinical experience.

“Staffing did not affect that decision,” he said. “The availability of beds did not affect that decision.”

The 63-year-old woman jumped to her death from the third floor of a building on July 27 in Nashua, N.H., just hours after being discharged from NHH, according to news reports.

No one working at the hospital has been disciplined or subjected to personnel action in connection with the patient’s release or suicide, Meyers said.

If a review should uncover any mishandling by someone on the staff at the hospital, he could direct the contractor to remove that person, he said.

Meyers said the state “sentinel review” — a confidential process required by state law when patients are injured while in custody — would be done by a panel comprising a former state Supreme Court justice, a former high-ranking state trooper, an assistant attorney general, an attorney with experience in mental health law and an out-of-state psychiatrist. No HHS employees would be members of the panel, he said.

“That review will go forward as quickly as possible,” he said.

“We understand and fully support the process of the sentinel event review to be undertaken at New Hampshire Hospital,” D-H spokesman Rick Adams said in an email sent in response to a request for a comment on the meeting.

A request for proposal for the contract under consideration was issued in February.

Dartmouth College, which supplied professional staff at NHH for decades but had embarked on a restructuring plan aimed at reducing deficits at its Geisel School of Medicine by transferring hundreds of jobs to D-H, opted not to bid.

D-H stepped forward to fill the void, but eventually found itself scrambling for staff after some psychiatrists at New Hampshire Hospital balked at seeing D-H replace Dartmouth as their employer. Meyers said that 11 professionals employed by Dartmouth for HHS had left at the end of June. Ten had worked at New Hampshire Hospital, he said.

During the meeting, Meyers circulated a tally sheet that showed that the number of advanced practice nurses at the hospital had declined from four to one since the end of a contract with Dartmouth College.

Dartmouth’s contract ran out at the end of June, but it continued as the contractor at NHH under a four-month arrangement in which the college handed over staffing responsibilities to D-H. The Dartmouth-Hitchcock Medical Center in Lebanon shut down some psychiatric beds and transferred psychiatrists to Concord.

The July 27 suicide of the recently released patient added fuel to the controversy, setting the stage for what Kenney, whose district includes most of the Upper Valley, described as the longest presentation and consideration of a proposed contract — about 90 minutes — in his 2½-year tenure on the Council.

The period since the expiration of the original Dartmouth contract has gone pretty well, said Robert MacLeod, the chief executive at New Hampshire Hospital.

“The hospital is staffed safely and reliably with board-eligible physicians,” he said, but he noted that the complement of professional employees includes three psychiatrists who work at Dartmouth-Hitchcock Medical Center and will eventually need to be replaced.

While there is only one advanced practice nurse currently on staff, there should be five by the end of September, MacLeod said. In the meantime, the vacancies in those jobs reduced the “depth” of services at NHH, especially when psychiatrists are absent for illness, vacation or training, but “doesn’t impact the services,” MacLeod said.

Sean List, a lawyer for psychiatrists and advanced practice nurses who tried to form a union at NHH, said that the council’s postponement of action showed a bipartisan concern about the state’s most vulnerable people.

“It’s pretty clear that Dartmouth-Hitchcock and the Governor’s Office thought they could just steam roll through this process,” List said. “Maggie Hassan received a message today that she can’t ignore that” concern.

Meyers said after the meeting that the postponement would have no immediate effect on the provision of critical services at NHH.

While assertions by HHS and hospital officials that the end-of-June transition went smoothly have elicited some skepticism, bigger issues about shortcomings of the state’s mental health system haven’t sparked a lot of discussion.

On Wednesday, 40 patients were waiting in emergency rooms around the state for space to become available at New Hampshire Hospital, MacLeod said.

Meanwhile, a monitor appointed by a federal judge has criticized the state for failing to meet its obligations under a consent decree that calls for expanded mental health care and services in communities. And providers regularly complain about the state’s low reimbursement rates for Medicaid patients receiving mental health care.

Those issues were hovering in the background when the Council, in a separate vote, briefly discussed and approved a contract that would make D-H the administrative lead for western and southwestern New Hampshire for a $150 million program aimed at better integrating mental health and addiction treatment programs with general health care.

Rick Jurgens can be reached at rjurgens@vnews.com or 603-727-3229.