Sunday, July 14, 2024

The CHA Somerville Hospital emergency room will close next year and be replaced by an urgent care clinic, trustees of the health care system decided Tuesday. (Photo: Marc Levy)

As expected, the Cambridge Health Alliance took the final step Tuesday toward closing its Somerville Hospital emergency room and replacing it with an urgent care clinic. The change stemmed mainly from a continuing decline in patient visits that began in 2009 when the Alliance took over the hospital and closed inpatient beds, trustees said.

Immediately, “usage fell off a cliff” because people didn’t want to come to an emergency department if they would need a transfer for hospital admission, board of trustees vice-chairman Gerald McCue said. State health officials had encouraged the Alliance to keep the emergency room open as one of a few “satellite” emergency departments not attached to a hospital. “It was an experiment that failed for us,” McCue said.

Trustees did not make an exception at their early morning meeting to a policy of barring public comment before discussing and voting. Therefore, four members of the Massachusetts Nurses Association looked on from the sidelines. They had hoped to present a petition with 2,000 signatures opposing the closing, they said. Three state legislators who represent Somerville had asked Alliance leaders to delay a decision until CHA chooses a chief executive to replace Patrick Wardell, who resigned last month.

The Alliance plans to begin the transition to an urgent care center this fall, leaving the emergency room open while renovations proceed. The emergency room will close and the urgent care clinic will open next spring.

Trustees came around

Several trustees said they initially questioned the proposal. “As a patient [of Somerville Hospital], I had a concern,” said Claire Laporte, an attorney and head of intellectual property at a biotech company. She changed her mind when she saw the statistics showing “the incredibly declining use of that facility even as the population of Somerville increased,” she said. 

Besides, roughly 60 percent of visits were for problems that didn’t need emergency room treatment, Laporte said. “When people go to the ER when they need urgent care, that’s a massive waste of money not only for CHA but for their patients,” she said.

Although Alliance officials have said they started consulting the Somerville community about needed changes three years ago, and a community task force recommended the switch to urgent care last year, there was little or no public discussion of the proposal until recently. The Alliance held three community meetings about the change in June and July, when residents and union workers opposed the move and Alliance representatives defended it.

Somerville Mayor Joseph Curtatone has not responded to requests for comment from Cambridge Day.

Looking out for the vulnerable

Alliance officials have said the proposed urgent care center will offer more services than commercial, freestanding urgent care clinics, including intravenous medication. It will also accept patients regardless of their ability to pay, unlike commercial centers.

But after the Tuesday vote, Lisa Valley-Shah, co-chair of the Somerville Hospital nurses union unit and a longtime nurse at the emergency room, said many “vulnerable patients” served by the department won’t get help from an urgent care clinic, including homeless people, psychiatric patients and undocumented immigrants.

Homeless people found a place “to stay the night” or spend time during the day at the Somerville emergency room, Valley-Shah said. “Undocumented people came to us from all parts of the state,” she said. An urgent care center would not welcome such patients, she said.

“Help them connect to resources”

Alliance spokesman David Cecere said the health care system “welcomes all” and “offers interpreters and culturally sensitive care.” Its Healthcare for the Homeless program “works within the community to connect individuals with care and the resources they need to be healthy, reducing dependence on emergency services and providing more integrated care,” he said. In general, lower co-pays for urgent care compared with emergency room treatment will create “even more access” for patients, he said.

As for people with a psychiatric problem, the urgent care center won’t have staff to treat them, Cecere acknowledged. Those who may be a danger to themselves or others will be transferred to an emergency room, Cecere said. He added that many people in psychiatric crisis already bypass Somerville for Cambridge and Everett hospitals.

For people with a less acute situation, analogous to someone with a sore throat who comes to an urgent care clinic, “we will help them connect to resources within CHA” such as primary care centers with behavioral health staff, Cecere said.

Asked if they would have to wait for an appointment, he said some may get immediate treatment, but it’s not guaranteed.

Last year behavioral health patients accounted for 7 percent of Somerville emergency room volume, Cecere said. That’s about 1,100 visits using Alliance figures of about 16,000 emergency room visits for the year.

Accounting for the what-ifs

One worry about the switch is what will happen if someone goes to Somerville Hospital seeking help in the middle of the night when the urgent care center is closed. Alliance officials said they will do “extensive education” to the public about the emergency room closing and install “safety measures – a bell and so forth,” at the hospital entrance, said chief community officer and CHA Foundation president Mary Cassesso.

McCue said the board of trustees should ensure that the hospital has staff on duty overnight. Planners intended to have the urgent care center open from 9 a.m. to 9 p.m. But several trustees suggested that the Alliance open earlier and stay open later to serve families with young children and people with daytime jobs. McCue asked that managers report to the board in October on their response.

Valley-Shah, the emergency room nurse and union official, predicted that some people won’t know the emergency room is closed and will try to get help at night.  She discounted the value of a bell, and several residents expressed similar concerns at the community meetings.

This post was updated July 16, 2019, to correct the number of emergency room visits in 2018.