Massachusetts Nurses Association Statement Regarding Healey-Driscoll Administration Reports on Maternal Child Health Access

Reports mark positive first step in calling for review of essential service closure process, but MNA calls for a more comprehensive region-by-region review of the need for services and a plan for how those needs can be met, one driven by community and health advocates

Report falls short in addressing impact of recent closures on impacted mothers experiencing complex deliveries requiring hospital-based care, needs that cannot be safely met by alternatives proposed by the reports

Until adequate services and plan is in place, MNA calls for moratorium on any future closure of a hospital-based maternal health service and continues to oppose all recent closures

CANTON, Mass., Nov. 16, 2023 /PRNewswire/ -- The Massachusetts Nurses Association (MNA) is hereby submitting its response to two reports released today by the Healey administration addressing the issue of maternal child health access: one addressing access to labor, delivery and postpartum care statewide; and the other addressing similar issues for Northern Worcester County following the controversial, and widely opposed closure of the Birthing Center at Leominster Hospital, the 11^th such closure in the last decade. 

The MNA appreciates the work of the Healey-Driscoll administration on this vital public health issue and sees its work and these reports as a positive step in the administration's commitment to address a growing maternal child health crisis in Massachusetts, yet we believe this must be only the beginning of a concerted, multi-faced effort that directly involves those communities and advocates from those communities most impacted by this crisis, particularly economically disadvantaged and BIPOC residents throughout the state, for whom the previous DPH report on this issue shows are placed most at risk by this crisis.  We are encouraged to see recommendations for a thorough review of access in Northern Worcester County, but believe this should be extended to all regions of the state that have lost access to inpatient maternal health services. We are also encouraged by the recommendation for a review of the essential service closure process and update statutes and regulations to better protect patient safety, expand community information and engagement, and sustain access to services overtime.

Whatever future actions are taken to address this issue, it is essential that this process should extend beyond listening sessions, and must include a comprehensive process that includes and is driven by those advocates and providers representing these vulnerable constituencies, many of whom have been working on this issue for years.

As a result of our evaluation of the report, and our ongoing work and dialogue with impacted communities in regions across the state, we support an immediate moratorium on the closure of any inpatient maternal child health service in Massachusetts unless and until the state conducts a thorough assessment ? region by region ? of all issues related to access to maternal child health services, including the current and projected need for services, how each community and providers in those communities are addressing those needs, in cases where maternal health closures occurred over the past decade, review plans provided to the DPH  following the discontinuation of the services for compliance and identify where services were provided and what data, strategies or approaches are required to provide the level of care deemed essential to that community. 

In assessing the need for services, this assessment must not be limited to maternal child care, but must also investigate and identify whatever wrap around services are required to address the health of these communities, which may include access to healthy food, clean water, adequate health insurance and primary care, appropriate mental health and substance abuse treatment, and programs to ensure access to appropriate nutrition and other social determinants of public health in these regions. 

The MNA has already filed legislation (S.1450/H.2251) that would establish such a process, but the DPH and the administration can implement this process without legislative action right now. 

While we support all efforts to seek alternative options to increase access to maternal child health services, including efforts to fund and establish birthing centers, and increased utilization of certified nurse midwives and doulas, particularly in underserved communities, we also contend that there is no legitimate public health or maternal child health benefit for any of the past closures or future closures of inpatient maternity units in our state, including the most recent closure of the Birthing Center at Leominster Hospital.  In fact, those communities where these new strategies are appropriate and necessary, are also those who will have a population of patients, due a number of social determinants of care, who will experience medical conditions, such as high blood pressure and diabetes that will necessitate access to inpatient labor and delivery care that must be delivered in a hospital setting. 

The administration's report on Northern Worcester County fails to address in any way how patients impacted by the loss of the Birthing Center at Leominster Hospital will be able to access care in a safe setting, particularly those mothers experiencing a complex delivery requiring immediate attention.  It also fails to address testimony submitted by nurses at UMass Memorial Medical Center in Worcester, who report having limited ability to absorb those patients impacted by the closure.  In fact, on the same day the DPH was conducting its listening session with nurses from the MNA, a local news outlet in Northern Worcester County reported on a Fitchburg mother being forced to deliver in an ambulance on the way to an alternative delivery site. 

We were encouraged to see that the executive summary for the report regarding access to care in Northern Worcester County does include a call for a "review of the essential service closure process and update statutes and regulations to better protect patient safety, expand community information and engagement, and sustain access to services over time.

The problem of access to maternal child health services is multifaceted, and we agree that increased reimbursement for these services is necessary, and for some providers serving marginalized communities, funding support from the state may be warranted. But we also believe it is unacceptable for the hospital industry to have no accountability or any enforceable requirement to provide service the DPH deems essential to preserve the health of the community.  While the state currently has a process through the Public Health Council to approve the licensure and creation of all types of beds and services based on the need and justification of those services, we find it impossible to justify the state having no legal or regulatory authority to ensure the continuation of those services, particularly when the state has deemed those services essential to protecting the public health.  In the longer term, the Commonwealth must look to overhaul the existing essential services closure process to give the DPH more authority and the power to enforce their rulings. The MNA, along with other legislators have filed legislation (S.736/H.1175) to provide that authority and it is our hope that this protection can be secured as a result of this process. 

And while the report highlights efforts to engage in processes to establish birthing centers and other options for patients, the fact is, there is considerable work and time required to create these alternatives, as some estimates are that it can take a decade to undergo the regulatory process to establish a viable birthing center.  In the case of utilization of doulas, we understand that MassHealth, which is the predominant insurer for the population most in need of this approach, does not currently  cover this level of care. 

In no instance is it justified or acceptable to force a mother living in one of these communities, as has been done to gateway cities such as Taunton, Holyoke, Leominster and Fitchburg, to travel 40 ? 50 minutes for the acute labor and delivery services previously provided at the Leominster Birthing Center, or that were provided by the previously closed services at Morton Hospital in Taunton, and Holyoke Medical Center.  When the administration's reports talk about providing equitable transportation, if that transportation, by whatever means, is for a mother experiencing an emergent delivery far outside her own community, thus preventing access to timely care, we find that recommendation to be unacceptable.

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Founded in 1903, the Massachusetts Nurses Association is the largest union of registered nurses in the Commonwealth of Massachusetts. Its 25,000 members advance the nursing profession by fostering high standards of nursing practice, promoting the economic and general welfare of nurses in the workplace, projecting a positive and realistic view of nursing, and by lobbying the Legislature and regulatory agencies on health care issues affecting nurses and the public.

SOURCE Massachusetts Nurses Association