Headlines
As published as an opinion in The Hartford Courant, March 30, 2008.
Hospital Needs Plan to Recover
By Bill Curry
In January 2007, after years of mulling it over, UConn's board of trustees signed off on plans for a new 350-bed hospital for its Farmington Health Center. Their reason: at 224 beds, the current John Dempsey Hospital is too small to meet the needs of a world-class academic and research institution, or even to meet its own financial needs.
Some quick facts: Only 108 of those beds are general care beds. The specialized care beds that cost more than they take in include 40 neonatal intensive-care beds, 20 high-risk maternity; 34 psychiatric and 12 in a prison lockdown ward. In 2007, Dempsey ran a $7.8 million deficit, 96 percent of it in neonatal, maternity and psychiatric care.
The hospital's original plan, drawn up 40 years ago, called for 400 beds. Fierce lobbying by other hospitals in the area defending their turf cut that number nearly in half. Their assault has been nonstop ever since. Years ago, Dempsey was forced to give up its pediatric unit, a critical part of any long-term strategy for building a customer base. To cut costs it later sought a strategic partnership with Hartford Hospital, only to have others shoot it down.
When UConn brought its latest plan to the Capitol, the fine lobbyists in the employ of its competitors were on it like so many robins on a June bug. They got legislators to order up a "needs-based analysis" at the bargain basement price of just $400,000.
The Connecticut Academy of Science and Engineering oversaw the work but farmed most of it out to consultants. The result is a rather opaque document in which the consultants' analyses and the academy's findings sometimes contradict one another.
The consultants padded the 170-page tome with old research and lots of statistics and graphs, some of which are even relevant. In modern consultant style, they throw in lots of "findings" that merely summarize conflicting opinions gathered in interviews.
It's mostly familiar stuff: The hospitals are fighting over "market share, financial issues and 'payor mix.'" Everyone should try to get along better. A state expecting flat population growth doesn't need to license more beds.
The consultants' bottom line is more or less on the money. Dempsey is "obsolete in terms of modern health care delivery and extremely constricted." With a worsening doctor shortage, the region has a vital stake in its continued good health. So does the state economy, into which the health center pumps a billion dollars annually.
The consultants say a big new hospital should be built in Farmington, but the state needn't own or operate it. They recount the many different relationships universities, doctors and hospitals have with one another and urge UConn and other hospitals to explore joint ventures to build and operate the new facility.
The academy's findings are less clear and tilt a little less UConn's way. Where the consultants recommend a hospital at least as big as UConn proposes, the academy specifies a "health care facility" of indeterminate size and function, to be operated by another hospital.
The academy wants the state to monitor negotiations among the hospitals with an eight-month deadline for forging new partnerships and plans. Its language prompted state Rep. Pat Dillon, D-New Haven, to joke that the parties seemed to need marriage counseling.
Fudging the question of the size and scope of the new hospital doesn't help a legislature apparently desperate for guidance. Telling the hospitals to get over themselves isn't a plan. Neither is ordering them to resolve a vital conflict without a hint as to how.
The problem isn't immature hospital executives. It's a broken regulatory system and a government that looks to lobbyists for leadership. If the State Office of Health Care Access were doing its job lo these many years, we wouldn't have needed to waste $400,000 on consultants.
Legislators wanting only to please their local hospitals are overmatched. The Office of Health Care Access and the Department of Public Health have a duty to provide real health care planning. Gov. M. Jodi Rell has a duty to provide real leadership.
This is bigger than a convention center or a football stadium. Against all odds, the health center has grown into a first-rate institution. If it stops growing it will become second-rate. Other nearby hospitals now struggling quite publicly to deliver quality care will become third-rate. The consultants have defined the problem. Now a leader must describe a solution.