Beyond Poverty: Healthcare Deserts, Part 2

Elimination of maternal care services and emergency rooms, hospital consolidations and closures are on the rise nationwide and across Pennsylvania. These closures are creating healthcare deserts that result in less access to healthcare for families whether they have insurance or not. Lack of access to healthcare is beyond poverty and in some cases helps to create it. In many communities, the hospital is a major employer and closure of these healthcare facilities has a negative, trickle-down impact on the local economy in various ways. Workers, now unemployed, lose their wages and insurance, and local businesses lose their customers.

Ridley Park Borough Council recently faced a packed room of residents angry about a proposed double-digit tax increase linked to property taxes and fees not being paid on the Taylor Hospital property. Officials said these combined fees represent almost 10% of the borough’s $5.4 million proposed budget.

Medical professionals, patients and lawmakers alike have called for government action following each new closure. County and state lawmakers have had enough and have drafted legislation to stop this devastating trend.

LEGISLATIVE REMEDIES

After the closure of Hahnemann University Hospital, Philadelphia City Council passed a law in 2019 that requires the facilities to provide written notice of intent to close a department or the hospital in general, no less than 180 days from the anticipated date of closure. It also requires a written Closure Plan to be submitted to the city’s Department of Health.

In 2021, City Council also enacted the Transparency in Healthcare Bill that requires increased reporting during the sale of a long-term care facility or hospital. The names of all parties (direct and indirect owners) involved in the transaction must be disclosed and, after internal review, must be made public. During the sale process, both parties must disclose information on finances and the operator of the facilities. Workers also have protection from being fired without cause for the 90 days following the sale.

Following Philadelphia’s lead, in 2022, the Delaware County Council passed an emergency ordinance requiring 180 days’ notice before a closure. The law also requires closing plans when closing hospitals, significant units of hospitals (emergency departments, ambulance services, labor/delivery units, behavioral health departments) or long-term care facilities. The closure plan must be submitted to the Delaware County Health Department no later than 120 days from the anticipated date of closure. Failure to comply with either the notice obligation or the closure plan obligation provides the basis for the County Solicitor to institute an action in court seeking either an injunction or the appointment of a special master to ensure compliance with the law.

This is the basis of the emergency injunction filed in September 2023 against Prospect Medical Holdings, Inc., the for-profit California-based owner of Delaware County Memorial Hospital in Upper Darby, to temporarily stop the closure. The case is now headed to the State Supreme Court.

courtesy image Senator Carolyn Comitta

Pennsylvania State Sen. Carolyn Comitta — 19^th District, faced the closure of Jennersville Hospital and Brandywine Hospital in 2022.

“Hospital closures are negatively impacting communities – urban, rural, and suburban – across the Commonwealth and the nation,” stated the Chester County legislator. “In Chester County, we faced two hospital closures back to back in 2022. The closures were announced abruptly and had a destabilizing effect on too many families and households. Since then, we have succeeded in finding a new owner/operator for one of those facilities. There is an agreement in place for a healthcare provider to purchase the second facility and we are working to return acute and emergency services there.”

Fortunately, Jennersville Hospital will reopen as Christiana Care West Grove Campus, and Brandywine Hospital is being purchased by Penn Medicine. Comitta pointed out the negative impact on the delivery of healthcare services.

“However, the closures resulted in a ripple effect across other essential services,” she explained. “Other hospitals in the region faced a surge of patients, and EMS providers, which were already spread thin, found themselves traveling greater distances to answer more calls. In addition, hundreds of staff were laid off.”

Despite that small victory, Comitta is looking to give communities statewide the tools to further regulate closures with the introduction of comprehensive reform legislation. “Communities facing these closures need more time, input, and information. I’ve introduced legislation that calls for creating a transparent process that encourages greater public participation, so communities can quickly set a course of action to restore access to health services.”

Senate Bill 184 would “double the time in which a hospital system must notify state and local agencies of a planned closure from 90 to 180 days. In addition, it also establishes more comprehensive standards for procedure and notification of a planned closure. It includes requirements for an approved Closing Plan and Health Equity Impact Assessment to be submitted to the Department of Health and Attorney General. It also calls for increased community input, data collection, public comment, and public hearings prior to closure.”

Comitta realizes her legislation may not stop hospital closures, but is optimistic that it can reform the process.

“We may not be able to stop or reverse a hospital closure, but we can take steps to put our communities in the best possible position going forward. This experience has also illustrated the importance of transitioning a hospital to a new owner before it closes its doors because once it closes, the obstacles to reopening from both an infrastructure and workforce standpoint, are substantial.”

Help is coming with the inclusion of $50 million for the Hospital and Health System Emergency Relief Grant program to support the vital work of hospitals that continue to struggle financially from the fallout of the pandemic. Comitta is optimistic about support of her bill from both sides of the aisle.

“At the end of this day, this isn’t a political issue. It impacts families from all walks of life and I hope we can come to a consensus to help communities better prepare for, manage, and hopefully avoid hospital closures.”

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