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Council OKs D-H Contract At Hospital



Valley News Staff Writer
Thursday, September 08, 2016

North Conway, n.h. — The state Executive Council on Wednesday removed the final hurdle to Dartmouth-Hitchcock’s take-over of a long-standing arrangement in which Dartmouth College provided professional staff at the state’s hospital for people with serious mental illness.

At issue was a contract for the provision of psychiatric services at New Hampshire Hospital, which provides 158 beds for patients who have been found to pose a threat to themselves or others.

In a unanimous voice vote after a 10-minute discussion, the Executive Council approved a 32-month, $36.6 million deal in which D-H will supply psychiatrists, advanced practice nurses and other professionals at the hospital.

That promised to close the book on an unexpectedly contentious and protracted transition that two weeks ago took up 90 minutes on the council’s agenda. Approval of the contract was tabled on a motion by Councilor Joe Kenney, who said he had concluded the contract lacked the votes necessary to pass.

Prior to Wednesday’s vote, Councilor Chris Pappas, a Democrat whose district includes Manchester, cited assurances by state Health and Human Services Commissioner Jeffrey Meyers that even if the extended deal were approved, “oversight will continue and scrutiny will still be applied to this contract” by Meyers and his staff.

Councilors Kenney — a Wakefield, N.H., Republican whose district includes much of the New Hampshire side of the Upper Valley — and Chris Sununu, a District 3 Republican who is seeking his party’s nomination for governor, both noted Meyers’ statement that the state could end the D-H contract at the department’s discretion.

“I do like the idea we can get out on short notice,” Sununu said.

But councilors from both parties also had some words of support for D-H.

“We should be proud of what they offer the state and continue to offer the state,” Kenney said.

“We also want to send a message today that we support the mission of New Hampshire Hospital,” Pappas added.

The three-year psychiatric services contract, for which the state originally sought bids in February, was originally intended to take effect on July 1. Consideration of that deal overlapped with a Dartmouth College “restructuring plan” that sought to erase deficits at its Geisel School of Medicine by transferring hundreds of jobs and functions, including the entire psychiatry department, to D-H.

Even as the restructuring plan made waves in Hanover and Lebanon, there were ripples of misgivings in Concord. Some doctors and nurses who worked at the state hospital under the contract with Dartmouth worried about how the transfer to D-H would affect their salaries and retirement benefits. Some declined to commit to continue working for D-H. After their bid for union recognition failed, D-H declined to offer jobs to several psychiatrists and psychiatric nurses. Eleven left at the end of June, according to Meyers.

Much of that dispute was unnecessary, said Councilor Chris Van Ostern, a Concord Democrat who is seeking his party’s gubernatorial nod.

“There was an opportunity for cooperation and resolution ... missed by all of the parties involved,” including D-H, the college and the professionals who left, he said.

D-H currently is providing psychiatric services at New Hampshire Hospital under a four-month contract that Dartmouth signed and assigned to D-H, which has its own financial and governance structure. To fill vacancies at the Concord hospital, D-H sent psychiatric professionals from its Lebanon campus, where it temporarily closed nine of 21 psychiatric beds.

Concerns about how vacancies and turnover in caregivers might affect patient care were fueled by the July 27 suicide in Nashua, N.H., of a 63-year-old woman who recently had been released from New Hampshire Hospital.

Meyers said on Wednesday that a look at the hospital services related to the death was underway as part of the state’s so-called “sentinel review” process. That process is confidential, but Meyers said he would look closely at any recommendations for changes in policies, systems or personnel that might emerge from the outside panel doing the review.

Sununu, who had questioned D-H’s hiring practices and speculated on a possible link between caregiver shortages, turnover and the Nashua suicide, cited a countervailing concern for his ‘yes’ vote on Wednesday: “Continuity of care is obviously quite vital.”

James Weinstein, D-H’s chief executive, said in an emailed statement that he was “thankful” for the Executive Council’s action, and emphasized D-H’s role in responding to behavioral issues in the state: “We look forward to continuing to provide the highest-quality care to the state’s most vulnerable populations, and to seeking solutions to the ongoing mental health and addiction crises that have gripped our state for some time.”

D-H will be a regional administrative lead for a program in which the state will use newly available federal Medicaid funds to integrate addiction and mental health treatment programs and services in each of seven regions in the state.

Both systems face severe demands.

Also on Wednesday, New Hampshire’s chief medical examiner issued an update on drug overdose fatalities that projected a total of 480 deaths in 2016. That would be a 9 percent increase over 2015, when there were 439 overdose deaths.

Forty-one adults and five children also were waiting in hospital emergency rooms for high-level mental health care at New Hampshire Hospital, Meyers said. That’s an issue that requires upgrades to mental health services, including assertive community treatment and mobile crisis teams at the local level, he said.

“We’re not going to solve the problem of people waiting in emergency departments by adding beds” at the state hospital, he said.

In brief interviews after the meeting, both councilors who are running for governor acknowledged the need for broader measures to address the issues.

Van Ostern noted the importance of the expansion of Medicaid, which extended insurance coverage to 50,000 people, and the new Medicaid money, which will make up to $30 million a year available to integrate behavioral health care, including addiction and mental illness treatments.

“I think the entire mental health program of the state needs review,” Sununu said.

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