PAWTUCKET, R.I. (WPRI) ─ A new report outlines how the closure of Memorial Hospital left nearby communities without access to emergency care and had a ripple effect on other area hospitals.
The independent report, compiled by public health research and consulting firm John Snow Inc. and paid for by Care New England, was slated to be completed a year after the Pawtucket hospital shuttered in January 2018.
The R.I. Department of Health said it initially had a difficult time finding a consultant, and the completion date was pushed back multiple times. The final report was released this month.
The conclusion: Memorial’s closure “removed a ‘nucleus’ of health care services for communities with high healthcare need,” resulting in “long-term impacts on the community and other area providers in the absence of strategies to mitigate those impacts.”
Among the findings: that emergency room visits, which hovered around 30,000 per year, would have stayed steady had the hospital kept its doors open.
Care New England cited low inpatient rates as one reason for shuttering the cash-strapped hospital, but data shows while those inpatient numbers dropped, emergency visits plateaued.
The consultant proposed a series of actions for Care New England ─ Memorial’s parent company ─ including the maintenance and promotion of a health care campus at the former site of the hospital.
Sandra Powell, the associate director of health for the state’s health department, called it a “critical issue.”
“We want to make sure that when people need access to urgent or emergency services they’re able to get that access,” Powell said. “The report calls for all of us to dig into this area and think about certain recommendations ─ again, with stakeholders ─ that we want to put forward in order to address this shortfall.”
The report said those the hospital mainly served — residents from slices of Pawtucket, Cumberland and Central Falls — had a higher rate of emergency room use than the state as a whole.
The report labeled those from the hospital’s service area as “vulnerable” and described them as more likely to be a minority, speak Spanish, be uninsured or have public health coverage, live in poverty and reside in a household without a vehicle.
Their ER visits, according to the report, were for both emergency and primary care issues. Now, those individuals and people across the state are using the emergency room less, the report found.
According to some health workers who were interviewed for the report, former Memorial Hospital patients who would have previously walked to the hospital either take Uber or non-emergency medical transportation to access health care — or forego care altogether.
“One [worker] described how one client she serves, who speaks primarily Spanish and does not have her own transportation, only ever went to MHRI for care,” the report recounted, using the acronym for Memorial. “Once it closed, she reported this client underwent much stress trying to determine where to go for care.”
Pawtucket Mayor Donald Grebien welcomed the report. “This supports everything we’ve all been saying,” he said. “There’s been a drastic impact on the Blackstone Valley.”
The report examined potential reasons for the decline in emergency department usage, hypothesizing that the population could now be traveling out of state to Attleboro-based Sturdy Memorial Hospital’s new urgent care center for non-emergencies, or using the walk-in clinic on the Memorial campus.
According to Care New England, about 30 people are using the company’s Pawtucket walk-in on a daily basis.
Another possibility: former Memorial patients are forgoing emergency services when needed.
The report said focus group participants talked about patients not wanting to go to Kent Hospital because they would have a hard time getting home.
Dr. James Fanale, president and CEO of Care New England, said the overall decrease in ER usage by Rhode Islanders reflects a long-term goal of discouraging people from using the emergency department for primary care needs.
“The reduction of emergency use throughout the state has been occurring for a large number of reasons, not just because Memorial closed,” he said.
Another key point of the report — the dispersion of patients from Memorial resulted in “an immediate system-wide impact,” evidenced by increased wait times at emergency departments at other area hospitals like The Miriam.
The report said access to emergency care was hindered, not just from the higher volume of patients, but because of the nature of their visits or other factors like language barriers.
Jane Bruno, a spokeswoman for Miriam owner Lifespan, said the East Side hospital has seen a nearly 30% increase in Medicaid visits over the past two years, while total patient volume has grown by about 13%.
“Overall, the closure removed critical health care services for communities with substantial health care needs and shifted the tremendous costs of caring for these populations from one health care system to another,” Bruno wrote in a statement.
Behavioral health visits began to skyrocket at Memorial before it closed. Now the Miriam — which the report said has a lack of mental health beds and less experience with such patients — is being bogged down by behavioral health visits in their ER. The report said Miriam is “crippled” as a result, creating greater ER wait times and a backlog.
Powell said the health department is looking closely at diversion, a practice where some patients are sent to other hospitals when an emergency department is dealing with anything from overcrowding to equipment issues. (Eyewitness News previously found diversion skyrocketed following Memorial’s closure.) She also said they’re looking at ways to improve access to primary care.
She and Grebien said the health department and local communities will now engage in conversations about how to best serve residents and tackle the issues highlighted in the report.
Currently, Care New England is required to maintain its walk-in clinic at the former site of Memorial and provide transportation to patients who need it.
As for bringing a true emergency department back to the site, Fanale said it’s not going to happen at the hands of CNE.
“It’s a statewide issue,” he said. “It’s not just a Care New England responsibility to say that you need to put a hospital in that region that causes the whole rest of the organization to be financially challenged.”
Care New England said the property is under an agreement to be acquired by New York-based Lockwood Development Partners, which aims to turn it into veterans housing. An email to Lockwood was not immediately returned.
Grebien said he’d like to see an emergency care facility return to Pawtucket, though he’s unsure if the Memorial site would be the best location.