Executive Councilor: State Must Hold Dartmouth-Hitchcock's Feet To Fire On Hospital Contract

May 12, 2017

Executive Councilor Chris Pappas
Credit Allegra Boverman

A major political controversy broke last week when state officials accused Dartmouth Hitchcock Hospital of failing to live up to the terms of a contract to run the state psychiatric hospital.

At issue is the number of psychiatrists at New Hampshire Hospital in Concord. It was discovered the hospital had been short two psychiatrists for some time.

But hospital officials have pushed back against accusations that they misled the state.

Executive Councilor Chris Pappas was one of the first to raise questions about staffing levels at the hospital. He joined NHPR's Morning Edition to give an update of where things stand. 

This all came to light last week. The CEO of New Hampshire Hospital has now stepped down. What have you learned since then about this situation?

To back up a little bit, we had a concerning situation last year when there was a labor dispute at Dartmouth-Hitchcock and the state really wanted to make sure that they could step up to the plate and provide the docs required under this contract. So we were getting weekly status reports from DHMC. I noticed over the last few weeks that the numbers had dipped below where they should be, and when I flagged that for the department and they did a further investigation of those numbers, they found that in fact the numbers we were going off of were even below where the contract required them to be. Instead of 11 psychiatrists, we had between 8 and 10 over the last several months, so they were out of compliance. Health and Human Services commissioner Jeffrey Meyers wrote a letter to Dartmouth asking them to come into compliance, to come up with an action plan to do that. I believe they had until late this week to submit that. I haven’t gotten the details on what that plan looks like, but the state will have several days to review it to see if it’s a viable plan.

The hospital admits to what it calls “minor deviations” from the terms of the contract – do you agree these are minor deviations?

Well, there were deviations, and I think any deviation is a critical deviation because you’re dealing with patients where there’s no room for error in terms of their quality of care. We’ve gotten assurances from the department that they don’t believe the quality of care was compromised, but I believe that’s something we have to look into a little bit further. I think having the right number of psychiatrists at New Hampshire Hospital is absolutely essential to providing that quality of care, so going forward we can’t insist on anything less than what the contract calls for.

The hospital also claims the state undermined the hospital’s recruitment efforts, and that it had kept the state up to date on these staffing levels. The Union Leader reported on emails that appear to show the state had been in the loop on this.

Is there merit to what the hospital has said in response?

Any deviation is a critical deviation because you're dealing with patients where there's no room for error in terms of their quality of care.

  I think it’s ridiculous for the hospital to assert that the state somehow compromised their efforts to recruit the talent they needed to make this contract work. They’ve had the better part of a year to make sure they have New Hampshire Hospital adequately staffed, and they’ve come up short. I think we need to make sure we hold their feet to the fire. I believe there was communication with the state at some level, and whether that be with the CEO of New Hampshire Hospital who has since departed, there was an acceptance of this. But I think from the governor’s point of view, from the council’s point of view, these levels are unacceptable and they’ve got to come up to where the contract calls them to be.

Councilor Andru Volinsky says there needs to be an outside review – do you agree?

I think an outside review in terms of quality of care levels is warranted here. We had a sentinel review after there was a very tragic incident. A woman was discharged and committed suicide shortly after last summer. So that was concerning. The sentinel review went forward. But since we know that we’ve been below the numbers that the contract calls for, I think doing a review to make sure the care has been of high quality, I think that’s a good thing to do.

When this came out last week, Governor Sununu had some pretty harsh words for Dartmouth Hitchcock. He said the state can no longer trust their word. How concerned are you about the relationship going forward between the state and Dartmouth Hitchcock?

We’ve suffered from a lack of communication with Dartmouth-Hitchcock for the better part of the past year. I thought the status reports were going to help us get back to the point where those channels were open, but unfortunately some of those numbers were faulty. And I’m not necessarily blaming Dartmouth-Hitchcock for those numbers being off. It could be the leadership at New Hampshire Hospital that put those numbers in there. When you take a step back, Dartmouth-Hitchcock has a world-class medical facility in the Upper Valley. They have thousands of employees. They certainly have the capability of continuing to be an important partner with the state, so I believe it’s within their capability to meet the terms of this contract. But I think the state has to be firm and I think the governor was trying to do that last week. And we’ll keep insisting that they meet their end of the bargain.

What’s been your impression of the way this has been handled by Governor Sununu and Commissioner Meyers?

No one benefits from name calling or finger pointing and I’m not necessarily saying the governor was doing that. But this did become a very hot political issue during the last campaign for governor. The Republican Party used this as a weapon against Colin Van Ostern and his campaign. They used it against Maggie Hassan in her campaign for U.S. Senate, and I think that’s very unfortunate. The governor called for a rebidding of this contract during the campaign and after it was over, said there’s nothing we can do and we have to accept that Dartmouth is really the only provider that can step up and staff New Hampshire Hospital. I think that’s probably an accurate statement and we’ve got to continue to work with Dartmouth-Hitchcock, but I don’t think anyone benefits from weaponizing this issue politically. We’ve got to get everyone in a room and make sure we’re all working in the same direction and that priority number one is patient care.

What’s the next step?

The department is going to review that corrective action plan and see where things go. And I think there will be some meetings between the leadership at Dartmouth-Hitchcock and the commissioner and governor. I hope they’re productive meetings and I hope that everyone continues to have the commitment to make sure that the care that is provided at New Hampshire Hospital is top notch.