Sunday, June 16, 2024

The CHA Somerville Hospital emergency room is due to be closed this year. (Photo: Marc Levy)

The state Department of Public Health will hold a public hearing on Cambridge Health Alliance’s plan to close the emergency room at Somerville Hospital and replace it with an urgent care center. Alliance officials had said last year the proposal was not subject to a state hearing and associated requirements because Cambridge Hospital operates an emergency service nearby.

The hearing is scheduled for 6 p.m. Jan. 30 at The Center for Arts at the Armory, 191 Highland Ave., Somerville. State law doesn’t allow the health department to prevent the closing, but if it determines that the emergency room is “an essential service” it can require the Alliance to submit a plan “for assuring access” to necessary services after the emergency room is closed.

The legal notice of the hearing said it would not be “adjudicatory” – determining whether the emergency room closes – but “rather a public forum” for comments. If the state requires a plan, it will review the proposal and can approve it or submit “comments,” and the Alliance must respond to the comments.

“Based on prior applications of the regulations, we believed that we were not subject to the DPH hearing requirement because we will continue to provide emergency services at the Cambridge Emergency Department located less than two miles away on the Somerville/Cambridge line,” Alliance spokesman David Cecere said Friday. “CHA sought community feedback before it made its decision to convert the Somerville ED to an urgent care center, and we look forward to receiving community feedback at the DPH hearing as we plan a safe and smooth transition.”

Two-year process

State rules say hospitals that want to close essential services don’t have to undergo a public hearing if there is a replacement service within five miles. But they give DPH discretion to hold a hearing nevertheless.

The Alliance has said it developed the plan to close the emergency service after a two-year process that included consultation with the Somerville community. At several local meetings sponsored by the health care system last year, its officials said the number of patients using the Somerville emergency room had been dwindling for years, and an urgent care center would serve needs of the community better. The decision was called unrelated to the 2016 incident in which a woman died when she couldn’t find the entrance to Somerville Hospital’s emergency room, despite looking desperately for a way in as she suffered an asthma attack.

The Somerville facility is one of only six “satellite” emergency rooms in the state at hospitals that don’t have inpatient beds. An emergency patient who needs to be admitted to the hospital has to be transferred to another site.

The Alliance proposed enhanced services at the new urgent care center, including intravenous medications. Officials said it will accept uninsured patients and will not require people to submit a credit card, unlike many commercial urgent care clinics.

But it would be open only between 9 a.m. and 9 p.m., while the emergency room was open 24 hours. If patients with a mental health emergency arrived at the urgent care center, they would be sent to the Cambridge Hospital emergency room.

Worries about closing

At community meetings, some residents said they worried about what would happen to patients needing emergency treatment and arriving when the clinic was closed, Alliance officials promised extensive public education and perhaps a telephone at the entrance.

The Massachusetts Nurses Association, which represents employees at the Somerville emergency room, argued that the closing would endanger residents in Somerville and nearby communities, especially since another emergency room in Medford closed recently. The union said the plan would lead to overcrowding at the Cambridge Hospital emergency room and that heavy traffic could delay treatment.

The union also argued for a public hearing. “Our position from the beginning was that this closing definitely required a public hearing by DPH to determine if this was an essential service for the community,” union spokesman David Schildmeier said Thursday.

“Hospital networks, like Cambridge Health Alliance, hold a public trust and obligation to meet the needs of the residents they serve, and the state has an obligation to ensure that the licenses granted to these facilities to provide care ensure the protection of the public health of those communities. No provider should be allowed to close a service, especially a 24-hour emergency service, without independent public vetting of that process,” he said.

Legislators called for hearing

Four state legislators who represent Somerville also weighed in supporting a hearing. Reps. Denise Provost, Christine P .Barber and Mike Connolly; and Sen. Patricia Jehlen wrote a letter to Health Commissioner Monica Bharel requesting a hearing because of “concerns we have heard in the community about the impending closure.”

“Many residents have heard only recently about this plan, and are alarmed by the prospect that there will be no emergency department which they can reach easily on foot, and by public transportation, since ambulance charges are very high and not always covered by insurance,” the legislators wrote Aug. 8.

The “urgent care model of care delivery can provide timely and affordable care” for many medical problems that formerly were treated in the emergency room, but “the unavailability of such care after hours could leave our community of 90,000 people without good options,” the letter said. If the state approves an Alliance plan to ensure essential emergency service after the emergency room closes, the state should monitor the situation, the legislators said.

In 2013, the Alliance proposed to eliminate 13 of 27 psychiatric beds for children and adolescents and stop treating children under 8, sparking protests from Cambridge councillors, parents and mental health professionals and advocates. The state ruled that the plan eliminated an essential service; the Alliance withdrew the proposal after the Legislature approved additional state aid to maintain the beds.