Staffing Dispute at New Hampshire Hospital Could Mean Trouble for Mental Health Services

May 26, 2016

An ongoing staffing skirmish at New Hampshire Hospital threatens to create a backlog in the state’s already fragile mental health system.

The conflict pits one of New Hampshire's most esteemed medical institutions – Dartmouth-Hitchcock Hospital – against one of the most specialized psychiatric teams.

Essentially, the clinical team consists of 19 psychiatrists, psychiatric nurses and administrators, and most of them refused a contract from Dartmouth-Hitchcock they say was a bad deal. Dr. Robert Murray is one of those psychiatrists, and he’s on staff at New Hampshire Hospital.

"It’s very hard for me to understand or interpret the way Dartmouth has preceded with this matter," he says.

Murray contends Dartmouth-Hitchcock, the state’s highest ranked hospital, spent months making vague promises about what their contracts would be, and the final take-it-or-leave-it offer just fell short.

Dartmouth-Hitchcock’s legal counsel, John Kacavas, says that’s bogus.

"It’s unfortunate that they make that argument for public consumption," says Kacavas.

Kacavas says most of the clinical team shunned a fair deal.

But whoever’s right on that point, the result is clear: most of the clinical team refused the offer, Dartmouth-Hitchcock withdrew it, and that leaves the hospital as the sole bidder for a state contract it currently doesn’t have the staff to pull off. Now there are less than two months to hire a new staff for what is effectively the nerve-center of the state’s mental health system.

Ken Norton, the executive director of the National Alliance on Mental Illness-New Hampshire, is worried about the tight deadline.

"To have that essential piece of our safety net sort of up in the air – it’s a little bit scary," Norton says.

A little bit of background: New Hampshire Hospital is run by the state and paid for by taxpayers. It’s the only public psychiatric hospital in New Hampshire, and Dr. Murray says patients wind up there when their mental health spirals.

The goal is to stabilize those patients and get them back home. 

For years Dartmouth College’s Geisel School of Medicine has overseen the staff at the state hospital. But the college’s contract with the state is up for renewal this year, and that coincides with downsizing at Geisel – 300 job losses.

Dartmouth-Hitchcock Medical Center is trying to absorb a lot of those staff, and when the state had an open call for proposals to manage the state hospital, Dartmouth College stepped back and Dartmouth-Hitchcock was the sole bidder.

The clinical team at the state hospital had planned to transition – staying as New Hampshire Hospital staff, but changing employers from the college to Dartmouth-Hitchcock. But when they saw the contract, most of the clinical team backed out and Dartmouth-Hitchcock refuse to negotiate further, Kacavas says.

"We are not going to give a handful of people preferential treatment because they see this as a calculated opportunity to extract some sort of compensation benefit from us," he says.

So tough words from both sides. But let’s put this disagreement aside of a moment to talk about why it matters.

The state hospital is the backstop of an already fragile network of care. On any given day, there are around 30 people in a mental health crisis boarded in emergency rooms around the state, just waiting for a bed to open up at the state hospital. Often a handful of those patients are children, and some patients wait over a week in an ER before getting sent to Concord.

The state recently settled a class action lawsuit aimed at the mental health system. Tens of millions of tax dollars are being spent to improve care that would reduce hospitalizations. But it’s mostly behind schedule, including a new unit in the state hospital that’s been empty for a year.

Dr. Renee Binder is past president of the American Psychiatric Association, which represents more than 36,000 psychiatrists. She says there’s a disincentive for medical students to enter this field because psychiatrists are paid less and deal with more paperwork than most other doctors. And another thing facilities in D-H's position have working against them? Psychiatric professionals lots of job options, and it’s clear which one is the least desirable.

"Psychiatrists . . . are concerned about issues like safety," Binder says. "They’re concerned about issues such as having adequate support services, including nurses."  

Dartmouth-Hitchcock – if the state accepts their bid to take over the state hospital – has less than two months to hire and train about 15 people to some of the least desirable positions in a tight job market.

Kacavas says the hospital gets the sense of urgency and is looking for staff within its own psychiatry department, and nationwide.

"We have the medical director, the assistant medical director and several of the providers who have accepted employment offers," he says.

Meanwhile most of the doctors from the team that rejected D-H’s offer have created their own company. If Dartmouth-Hitchcock can’t deliver, the team hopes the state will reopen a window for submissions. They say their proposal to run the state hospital will be ready to go.