PAWTUCKET – On Monday afternoon, Jan. 1, a bitter blast of wind swept across the empty parking lot in front of the now closed Emergency Department at Memorial Hospital of Rhode Island. A sign on the door read: “Hospital is closed, for any medical emergencies call 911.” The message was repeated in Spanish and in Portuguese.

There were no ambulances, no pedestrians, and no traffic entering or exiting. No one was picketing outside. There were no TV cameras rolling. There were no other reporters present to capture the barren emptiness of the scene on New Year’s Day. The temperature was 13 degrees Fahrenheit, but the wind chill made it feel as if it were -8 degrees, according to weather reports.

This was the stark landscape of what happened when Memorial Hospital’s emergency room officially closed its doors, effectively shutting down the 100-year-old acute care community hospital.

Determining the impacts
The saga, however, will continue, as Care New England looks to close its deal with Partners Healthcare by the end of January of 2018. In addition, Care New England will continue is primary care outpatient services in Pawtucket as part of two medical residency programs affiliated with Brown University Medical School, waiting for the licenses to be transferred to Kent Hospital in Warwick.

Two different models of health and health care, Health Equity Zones in Pawtucket and Central Falls, and the Neighborhood Health Station in Central Falls, operated by Blackstone Valley Community Health Care, may prove to be the ultimate beneficiaries of the decision to close down Memorial Hospital, focused on community-based needs and initiatives.

Another factor to watch: the future success of Integra, the system-wide accountable care organization at Care New England, may involve the need to keep the estimated 20,000 outpatient primary care patients in Pawtucket as Integra members moving forward. [ConvergenceRI has requested from Care New England provide the actual numbers of outpatient primary care patients associated with Memorial that are members of Integra but has not yet received as response.]

The impact of Memorial Hospital closing its emergency department on other hospital emergency facilities, such as The Miriam Hospital and Rhode Island Hospital, will be the focus of stakeholder meetings convened by the R.I. Department of Health, in conjunction with Care New England.

The initial data seemed to support that there has been a slight “bump” in the number of monthly EMS transports from Pawtucket, Central Falls, Lincoln and Cumberland going to Miriam in November of 2017, according to R.I. Department of Health Data. [See graphic chart, image number three above, “Monthly EMS Transports from Pawtucket, Central Falls, Lincoln and Cumberland.”

The high cost of alcoholism
As tabulated by the R.I. Department of Health, the actual data of emergency department transports to Memorial Hospital in 2017 for incident “impressions” reported by emergency personnel revealed some surprising findings: more than 830 were for alcohol intoxication, alcohol dependence with withdrawal, and alcohol use, unspecified; more than 520 were for mental/behavioral/psychiatric disorders; more than 115 were for anxiety disorders, unspecified; and more than 115 were for altered mental status.

Translated, out of 6,492 “impressions” for emergency services transports to Memorial Hospital in 2017, almost one-quarter – some 1,590 – were for alcohol intoxication and mental health issues – and that does not include more than 90 “impressions” for opioid abuse, opioid related disorders, opioid abuse with intoxication [uncomplicated], and poisoning by heroin, undetermined.

The data findings lend credence to the potential repurposing of the former Memorial Hospital as a center for addiction treatment, recovery, recovery housing and job training facility.

The decision to close
On Thursday afternoon, Dec. 28, 2017, the R.I. Department of Health granted Care New England its reverse Certificate of Need to close the Emergency Department at Memorial Hospital, effective Jan. 1, 2018.

“We spent weeks carefully weighing Care New England’s applications to understand how these changes at Memorial Hospital would affect the most vulnerable residents of Pawtucket and Central Falls, and the state’s health care system as a whole,” Alexander-Scott said in the new release issued with the decision, in order to ensure that residents continue to have access to the high-quality care they need.

The process included holding two community meetings, one on Nov. 27, and a second on Dec. 5, attended by a combined total of 197 people, with a total of 37 people offering public comment.

The 24-page decision issued by Dr. Nicole Alexander-Scott placed a number of conditions upon Care New England moving forward. [See link to decision below.]

The conditions and requirements included that Care New England:

• Open a walk-in clinic in Pawtucket, to be open seven days a week.

• Provide $300,000 to Pawtucket and $200,000 to Central Falls each year for two years to offset emergency medical services costs associated with transporting patients to other hospitals.

• Put in place a transportation plan for patients and patients’ families so that individuals with non-emergency chronic conditions won’t have to incur additional costs associated with traveling to receive services that are only offered at another hospital.

• Maintain Memorial Hospital’s Family Care and Internal Medicine Centers in Pawtucket at their current hours and staffing levels.

• Invest $100,000 annually in the Pawtucket and Central Falls Health Equity Zones. Rhode Island’s HEZs are nine distinct areas throughout the state where organizations are coming together to put health programs and policies in place to prevent chronic diseases, improve birth outcomes, and improve the socioeconomic and environmental conditions of their neighborhoods.

• Make outplacement and career transition services available to staff through an outplacement firm hired by Care New England. Care New England will continue to organize job fairs which will include representation from all operating units of Care New England, other employers through the state, the R.I. Department of Labor and Training, and the health system’s Employee Assistance Program.

Overflow to other hospitals’ emergency rooms?
Another condition imposed by the R.I. Department of Health was that Care New England, in conjunction with the R.I. Department of Health, licensed hospitals and health care providers, convene a stakeholder group within the next month to propose solutions and pilot programs to alleviate problems related to an overflow of emergency patients at other facilities.

Among the approaches to be considered would be changes to emergency medical dispatching, mobile integrated health care, and directing EMS calls to walk-in or urgent care facilities as appropriate.