Windham Hospital’s maternity ward heads for closure, with safety and equity still at issue
A community hospital that’s been delivering babies for 88 years at its site in the Willimantic section of Windham is now seeking final approval from the state to end its obstetrics program.
Windham Hospital leaders say labor and delivery at the facility has become unsafe due to a drop in birth volume and a lack of qualified obstetricians available to consistently staff the unit. But community activists argue a permanent closure will disproportionately hurt the town’s most vulnerable residents.
“It’s a spider web. It impacts us on the economic development side, on the quality of life attributes, on being able to sell the idea that this is a town worth being in, a city that’s growing,” said Rose Reyes, town council member and bilingual educator. “I mean, how do you call yourself a city without a maternity ward?”
The last baby born at the hospital was delivered on June 16, 2020, before obstetrical services were indefinitely suspended. Patients have since been directed and transported to high-volume hospitals in the state’s eastern region for delivery.
Officials from Windham Hospital and its owner, Hartford HealthCare, petitioned the state Office of Health Strategy during a regulatory hearing last week to make those changes permanent.
OHS oversees the Certificate of Need program, which requires certain types of health care providers to get approval from the state for any major changes to health care services, like mergers, investments in new equipment or facilities, access to services or discontinuation of medical services.
The change at Windham Hospital has left health care leaders at odds with local residents over what they consider is best for the community and families.
Dr. Melisha Cumberland, chief of medicine at Windham Hospital, said the low birth volume denied obstetrics providers the opportunities to maintain their skills and expertise needed to safely care for laboring patients. The hospital also struggled to provide the support services needed for maternity care.
“And lack of those resources combined with declining skills of providers, nurses and their auxiliary care team, including the respiratory therapists, really provided a subpar environment for safe, quality care,” Cumberland said. “Windham just cannot put our patients at risk like that.”
Falling birth rates and recruitment issues
Windham Hospital serves about eight towns and 19 communities in the eastern region of Connecticut. It’s based in Windham, where more than half of residents are people of color, including a significant Latino population.
In the early 2010s, the hospital was averaging about 400 births per year, according to Hartford HealthCare’s annual reports. The parent health organization took over operations in 2012.
Hartford HealthCare leaders testified Wednesday that the number of births began to steadily drop, mirroring shrinking birthrates at the statewide and national levels. In fiscal year 2015, the hospital delivered just 212 babies.
National research has linked low patient volume at rural and urban non-teaching hospitals to an increased risk of delivery complications like postpartum hemorrhage, blood infusion, infections and other serious issues.
Dr. David Kalla, East Region medical director of women’s health services at Hartford HealthCare, said that the sole private practice OB/GYN group that the hospital contracted with to perform patient deliveries severed ties with the hospital system in 2015. Kalla said that practice ended the relationship over concerns that there were not enough qualified obstetricians and nurses to safely staff the maternity unit 24 hours a day.
When services were suspended in June 2020, the hospital was staffing the obstetrics program with one in-house obstetrician and one certified nurse midwife. It also was using temporary contracts with individual physicians in the area to cover remaining shifts on a short-term or sporadic basis.
“Recruitment in general in the world of obstetrics and gynecology is extremely difficult,” Kalla said.
He added that it was even harder to attract qualified professionals to a facility like Windham, which was seeing fewer than two births per week in 2019. At the same time, regional centers like Backus Hospital in Norwich were, and continue, to average more than two deliveries per day.
A majority of Windham Hospital’s patients are now delivering at Backus, also owned by Hartford HealthCare.
“The travel distance between Windham and Backus is not an unreasonable distance for women to travel to deliver their babies, even factoring in the lack of highway access in the area,” said Dr. John Rodis, president of consulting firm Arista Health LLC and former president of Saint Francis Hospital in Hartford.
“The trip is less than 20 miles and approximately 25 minutes driving distance, and in an ambulance, it would take even less time,” he told state officials during Wednesday’s hearing.
Patients from the area are now offered free transportation to any other hospital of their choosing for delivery, and Windham Hospital will continue to provide prenatal and postpartum care for women beyond a maternity ward closure.
Opposition to the closure and impact on health disparities
Organizations like the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine recognize the dangers posed by low patient volume, but they have also concluded that “closing hospitals with low-volume obstetric services could have counterproductive adverse health consequences and potentially increase health care disparities by limiting access to maternity care.”
That’s exactly what Reyes -- the Windham town councilor and educator -- fears for her constituents, her students and their families.
“It seems like it happens to the most vulnerable and the least able to fight back communities,” she said at Windham Town Hall, where she joined members of grassroots coalition Windham United to Save Our Healthcare as they testified in opposition to the hospital’s closure plans.
A quarter of Windham residents live below the poverty level, according to DataHaven’s2021 equity profile, compared to 10% statewide.
About 13% of Windham households do not have a vehicle, and 17% of Latino residents in Windham do not have health insurance.
Data also shows that the presence of chronic diseases like high blood pressure, coronary heart disease, asthma and diabetes is higher among Windham residents than those living in other Windham County towns. These diseases increase the likelihood of high-risk pregnancies and delivery complications.
Leah Ralls, president of the Windham/Willimantic branch of the NAACP, said the existing disparities in the community should have been no surprise to the hospital and its owner. And she wanted to know why they didn’t foresee the current issues and invest earlier in the hospital’s obstetrics program.
“Why didn’t they develop a plan to increase the OB services, increase the anesthesiologists, increase the NICU?” Ralls said as she testified remotely. “It feels like there was a depletion of services to our community and not an increase of services to our community, because we could have avoided this.”
Brenda Buchbinder, resident, licensed social worker and co-founder of the grassroots coalition, said she hopes state officials recognize the need for good and safe obstetrics care to stay in Windham.
“It’s now coming on the radar of public awareness,” she said. “The right for rural hospitals to preserve quality of life and care, and not [be] sold as a commodity, is on trial today.”
A 'distressed municipality' and more closures ahead
OHS has not indicated when it will make a final decision. Officials during Wednesday’s hearing asked Windham Hospital and Hartford HealthCare officials for additional evidence and documentation to support their closure request.
In a Nov. 8 letter to OHS leaders, Connecticut Attorney General William Tong expressed his concern about the potential impacts and burden that a closure would have on an “economically distressed municipality” like Windham and its residents, particularly those already facing racial and ethnic health and economic disparities.
Tong urged OHS to closely examine the Certificate of Need application “and balance the benefits of ending obstetric services at Windham Hospital with the consequences of doing so and consider what steps might be taken to bolster community-based prenatal and postpartum service.”
Tong noted in his letter that OHS has only approved closures of two other obstetrics units – at the former Milford Hospital and New Milford Hospital – since a Certificate of Need became required in 2011.
In late September, Nuvance Health announced plans to phase out its labor and delivery unit at Sharon Hospital, a 78-bed acute care hospital serving the rural northwestern area of Connecticut. Hospital leaders also cited a dwindling birth volume that has only been exacerbated by the COVID-19 pandemic.