White Coat Notes

State: Cambridge Health Alliance child psychiatry beds too critical to close

Psychiatry beds that Cambridge Health Alliance plans to eliminate in budget-cutting efforts are critical to “preserving access and health status” for children and teens throughout eastern Massachusetts, a Department of Public Health official determined after a state review.

The health care system announced in April that it will consolidate separate psychiatry units on its Cambridge Hospital campus, one serving adolescents ages 12 to 19 and another for children as young as 3, reducing the total number of beds from 27 to 16. It also will stop serving the youngest children, beginning treatment at age 8.

People who spoke at a hearing earlier this month overwhelmingly opposed the change, condemning the continued decline in resources for children and teens with acute mental illness and lauding the care that Cambridge Health Alliance provides as exceptional.

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The hospital system, which also includes Somerville and Whidden hospitals, has been facing financial trouble in recent years, including an overall loss of $28.5 million for the 12 months ended June 2012.

The state has no power to stop the proposed cuts, but the Department of Public Health conducts a review to allow public vetting of changes to what are deemed essential health services. In March, after heavy scrutiny during such a review, Partners HealthCare said it would reduce proposed cuts to inpatient mental health services at Brigham and Women’s Faulkner Hospital.

In a letter sent Wednesday, Dr. Madeleine Biondolillo, head of Health Care Safety and Quality, directed Cambridge Health Alliance to provide the state with an explanation of the demand for its child and teen inpatient services and what community-based or outpatient services the hospitals will provide to reduce demand.

“Mental health is a core component of what we do as a critical safety net provider, and we understand how vital the services are to our communities and region,” David Cecere, spokesman for the hospital system, said in an e-mail. “We remain engaged in active discussions with stakeholders, payors, and policymakers to assess our options and determine the next steps.

The Massachusetts Nurses Association, which represents nurses on the units, has opposed the consolidation. Nurse Betty Kaloustian, chairwoman for the bargaining unit at Cambridge Hospital, said in a press release that the closure “will deprive children throughout the region the care they deserve.”

The hospital group also must explain in its response to the state what alternatives exist for those who could be turned away after the reduction.

“I just don’t think they can answer that question,” said Laurie Martinelli, executive director of National Alliance for Mental Illness of Massachusetts.

Few other hospitals treat the youngest children and the number of psychiatry beds serving children and teens has declined steadily to 252, a loss of about 60 beds since 2008.

“This trend could accelerate,” said David Matteodo, executive director of the Massachusetts Association of Behavioral Health Systems, a trade group for psychiatric hospitals. Insurance payments to hospitals are not enough to support these services, he said. During the hearing, he appealed to state officials to take a broader look at the issue.

“What are you going to do when the next one has to close?” he said in an interview Friday.

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