WOONSOCKET – A public hearing conducted by Attorney General Peter Kilmartin and the state Department of Health on the proposed acquisition of Landmark Medical Center by the Steward Health Care System of Massachusetts made one thing absolutely clear Monday-- area residents and public officials, Landmark's employees and most importantly its patients all want the 114-bed acute care facility and its Rehabilitation Hospital of Rhode Island (RHRI) to remain open.
The list of more than 50 speakers stepping to the podium during two-hour hearing sessions held in the afternoon and evening at Harris Hall included just one person voicing opposition to Steward's plan to acquire Landmark and convert it to for-profit operation under a transaction expected to pump $30 million into the fiscally troubled local hospital.
The proposed acquisition would be the first conversion of an acute care hospital to for-profit status in the state but was also described Monday as Landmark's only hope for exiting four years of court-guided receivership and continuing to serve the city's high number of low to moderate income residents.
The sole voice of opposition to the conversion came from a Providence doctor, Howard Schulman, who criticized Steward as having “no track record” for running hospitals given its creation as a corporate entity taking over the Caritas Christi Healthcare system operations in Massachusetts in 2010 and also took exception with the leadership of Steward's parent, Cerberus, a New York investment firm. Schulman's testimony during the evening session drew a disapproving response from the audience of Landmark supporters filling the room who in turn applauded former Landmark patients who credited the hospital with saving their lives. Schulman said he has also published media opinion pieces opposing the transaction and in turn submitted written copies of his comments and background materials for inclusion in the hearing's record.
The sessions also included introductory testimony from both Landmark and Steward on the reasons they are seeking to partner in running the Woonsocket-based healthcare operation.
Landmark's CEO Richard Charest stated during his remarks to the gathering that he has lived and worked in the community for most of his life and for more than 40 years of that time in varying capacities for Landmark and its predecessor organizations, Woonsocket Hospital and Fogarty Hospital (now home to RHRI).
“In that time I have come to learn how much LMC and the Rehabilitation Hospital of Rhode Island mean to our community,” he said.
The local community has changed over the years, suffering through a banking crisis and the more recent economic downturn, but Landmark and RHRI “have remained steadfast in their commitment to providing high quality care to the people of Northern Rhode Island and Southern Massachusetts,” he noted.
Despite that commitment, the two local healthcare facilities are now in “dire risk of closure, and I tell you that with sincerity,” Charest said. Landmark would not have the money to operate had it not been for the $5 million investment by Steward that the company and Caritas committed to Landmark while working on the proposed acquisition during the past 18 months.
Landmark, which has worked on its fiscal problems under a court-appointed receiver for the past 4 years, selected Steward as its potential savior after a search of both regional and national, non-profit and for-profit options, he explained.
Landmark remains the dominant provider of short-term, acute hospital care in Northern Rhode Island while handling more than 40,000 emergency visits last year and 108,000 outpatient visits, according to Charest.
Landmark operations also handled $15 million in free care charges and another $6.5 million in charity care charges.
Its two facilities in Woonsocket and North Smithfield employ 1,200 people annually many living in the Northern Rhode Island area, according to Charest.
That level of area employment makes Landmark “a significant component of the financial underpinning of the City of Woonsocket, a city whose troubles are also well known to all,” he said.
Even with its longstanding fiscal burdens, Charest said Landmark continues to provide “a high quality” level of care that includes the “best door-to-balloon times in the state for all angioplasty programs,” a treatment option for coronary artery disease and heart attacks.
Landmark also served patients who are among the state's poorest and who face long term and chronic unemployment.
“Despite aggressive cost cutting efforts and the development of highly efficient operations, we have not been able to stabilize the organizations for longterm survival,” Charest said of Landmark and RHRI.
If Landmark were to close, Charest said the state would face higher spending for unemployment for displaced employees, increased Medicaid costs and also see a higher burden of uncompensated care placed on its other hospitals.
At the end of an extensive search for a partner, Charest said Landmark determined Steward to be “the best fit for Landmark and Rhode Island because of their expertise in turning around struggling community hospitals, and their regional proximity.”
“They have already assisted us greatly,” he said while detailing Steward's administrative efforts to make the local operations more efficient and cost effective.
Sister Marie Pullo, Steward's senior vice president for mission, detailed the Massachusetts organizations operation of 10 community hospitals under a for-profit network that employs 17,000 full-time employees and have relationship with 2,200 medical contractors.
The organization's mission is to provide “high quality healthcare right in the communities where our patients live,” she said.
Steward's for-profit status makes it a tax paying entity in those communities and its fiscal plan also make it an investor as well, according to Pullo.
Steward has invested $100 million in its Massachusetts facilities in renovations, new construction and other hospital improvements, she noted. “Steward is not just investing improving local hospitals were are making a longterm investment in our communities,” she said.
In addition to helping to create more than 4,000 new jobs in the communities its serves, Steward also paid more than $80 million in property and sales taxes in Massachusetts in 2011, she said.
The proposed acquisition would make Landmark a “financially viable” and “high quality source of healthcare for the people of Northern Rhode Island,” she said.
The testimony given on Landmark's behalf from its staff members and patients was emotional for the speakers, occasionally causing their voices to break or drawing tears, but also at times optimistic.
Dan Couture of North Smithfield told the gathering how he suffered a heart attack last Christmas Day and because of the quick action of Landmark's angioplasty staff members in inserting stents into two blocked arteries, lived to tell of the experience.
The close proximity of Landmark also made a difference, Couture said. “Those precious moments counted because I was at death's door,” he said. “Woonsocket can't afford to lose a hospital like Landmark,” he said.
Jacques Stalaen Jr., a local manufacturing company owner talked about the importance of Landmark in providing care to his employees, but also shared a story of suffering a heart attack and getting to Landmark in time to be saved.
Arriving at the ER, Stalaen said “I flat-lined and if it were not for Landmark's staff, I would not be here today.”
Landmark cardiologist Sajid Siddiq told of other patients saved by being able to get into treatment quickly due to the location of Landmark in their community and related how how one man said “he could not thank us enough for having the hospital here.”
Ann Cleary, a longtime Landmark nurse, said she believes the real treasure at Landmark lies in its more than 1,000 caring employees.
Those employees have faced cutbacks in staffing, a reduction in compensations and changes in work responsibilities and yet stay committed to their patients, many of whom would have no other option for care.
“As a team, we do wonderful things at Landmark,” Cleary said.
Sue Connolly, a registered nurse at the Rehabilitation Hospital of Rhode Island, said the cutbacks are apparent in many aspects of the facility but not in the care it provides.
“We don't have a lot but we do a lot with what we have,” she said. “And we do all care about very much and care for our patients,” she said.
The city's fire officials, Chief Gary Lataille and Lt. Steven Encarnation, rose to explain how the loss of Landmark would place rescue patients on the road for a 12 mile run to Providence, trips that would reduce their prospects for a positive outcome in treatment and also further burden area departments with the costs of such trips.
Woonsocket's Mayor Leo T. Fontaine and Cumberland's Mayor Dan McKee outlined what the closing of Landmark would mean to their communities both in terms of medical care and also the economic impacts of lost jobs, and the Woonsocket officials such as Sen. Roger Picard, Woonsocket City Council members John F. Ward and Al Brien, and City Economic Director Matthew Wojcik also spoke in support of the conversion as the best option for their community.
But the most important testimony remain that from the patients like Micahaela Curley of Woonsocket, who had made her way to the podium with the help of a walker. Curley related how she had stayed at Landmark while waiting to get a bed at a Providence facility during a bout of serious kidney failure. She eventually went to Miriam Hospital for treatment lasting months and lost part of both of her legs during that time. Monday night she could stand on her artificial limbs thanks to the rehabilitation care she receives through Landmark even today.
Telling how she had been able to go from walking with a walker to walking with crutches earlier in the day on Monday, she offered she didn't accomplish that alone.
“Isn't that what we are supposed to do, help each other,” she said in support of the proposed acquisition.