MEDIA – In light of Crozer Health’s move to recoup $24 million in expenses from Delaware County and several municipalities — or ending various mental and behavioral health, substance abuse and paramedic services — Delaware County Council passed a unanimous emergency ordinance requiring a padding of time if certain closures are to happen in the future.
“It is not an exaggeration to say Delaware County is facing an emergency here,” county Councilman Kevin Madden said, particularly for medical services in vulnerable areas of the county, the need for which has only been exacerbated by the COVID pandemic. “It’s incumbent upon us to ensure the health and well-being of our residents and the idea of a for-profit provider using a short time frame of change that would have such a significant impact on our population as a means of extracting further recompense is something we cannot accept.”
He said passing the emergency ordinance, effective immediately, was a matter of ensuring the public safety.
“All this is is giving the county and the hospital system time and planning,” Councilwoman Elaine Paul Schaefer said of the emergency ordinance. “That’s all this is. It’s pretty reasonable.”
Then, she added, this drastic measure is needed as she added, “This is a crisis we’re facing. This is a crisis that is occurring right now and centered upon our most vulnerable communities … The termination of services like this without notice will put thousands of our vulnerable residents at risk and we are just asking for time and planning to make sure that the transition of health care for these residents – thousands of them – goes smoothly.”
Last week, Crozer chief Kevin Spiegel sent a letter to to leaders of Glenolden, Prospect Park, Tinicum, Norwood and Ridley Park, telling them that a $336,000 funding arrangement for the Advanced Life Support response vehicle, also known as the chase car, providing paramedic services for these communities needed to happen by April 22. If not, 90 days of notice of discontinuation of these services would occur on that date.
In addition, outpatient behavioral and mental health and substance abuse services in the Crozer Health system that assist approximately 6,000 Delaware County residents are likewise being jeopardized by what Spiegel is saying is a $20 million need for reimbursement from the county.
By a 4-0 vote, council passed the emergency notice which requires 180-day notice to the county of any decision to close an entire or most of the units of a hospital or “significant impact units” such as emergency departments, ambulance services, labor and deliver units or behavioral health departments.
Also, a closure plan must be submitted to the Delaware County Health Department no later than 120 days from the anticipated date of closure.
That plan must provide for continuity of patient care, diversion of emergency department patients to other departments, dealing with medical records, and a formal communication and engagement plan for the affected community. Failure to comply could result in the county solicitor seeking court action.
The emergency ordinance also requires hospitals and long-term care facilities to provide
Notice of Intent of plans to purchase, sell, or transfer ownership interest in a hospital or facility no less
than 45-days prior to the anticipated transaction.
Those in favor of the ordinance included Madden, Schaefer and fellow council members Richard Womack and Christine Reuther. County Council Chair Dr. Monica Taylor was absent from the meeting.
Spiegel said processes are already in place as required by state law and by the Pennsylvania Attorney General’s Office.
“This just puts another layer in there which could harm the sale,” he said of the emergency ordinance’s potential impact of Crozer Health’s sale to ChristianaCare Health System, which is expected to close by the end of the year.
Spiegel said discussions have been occurring with Delaware County’s Human Services for one to two months regarding the behavioral, mental health and substance abuse outpatient services.
He said COVID has increased staffing prices by 25 percent and supply costs by 15 percent.
“We went to the county and talked about additional support for the behavioral health program and we got to a roadblock,” Spiegel said, adding that the third-party administrator for Delaware County has been denying 30 percent of their claims, mostly on technical issues, not clinical denials. “Which really makes it almost impossible to really stay in business and be financially viable. We’re about $20-plus million upside down in providing behavioral health services. We went to the county in good faith to try to negotiate it. We always wanted to get that time going with the notice of cancellation. We are still open to negotiate with the county but we did submit that legally and on time.”
He said he’s never been in a county where the county doesn’t provide for the pre-hospital care.
“Most cities, from my past, they provide police, fire and EMS,” he said. “Here, that’s left up to a voluntary agency or a for-profit company to do it at their own expense. And, you know, we can’t do it for free … We can’t run it at a loss.”
He said the notice given to municipalities was in compliance with the law.
After the vote, Spiegel said, “Crozer Health system is proud to provide both behavioral health and EMS services to this county and the communities that we serve for many, many years. That’s something we’re very proud of. Funding – appropriate funding – from the county is essential for us to continue to provide these services.”
He said that discussions with the county hadn’t gotten anywhere and “the lack of response really prompted the notice.”
“Hopefully now that everybody knows about it, maybe hopefully we can resolve these issues and that’s our intent,” Spiegel continued. “What we would really like to do is have the county and us sit down and work it out.”
Before his vote, Madden noted that council can’t compel a private organization to do what they decide is in their best interests.
However, he added, “What we have to ensure is if there are changes, they’re done in an orderly fashion that allows our public to find alternative means.”
Womack acknowledged that many have been impacted by COVID – including Crozer Health, those who have loss their jobs and others.
“Everybody took a loss,” he said. “And to almost walk out and say that, ‘Ok we’re going to give you a short notice that we’re leaving’ is really unacceptable to the residents of Delaware County.”
A Darby Township resident, he said he knows what these residents face.
He said time is needed for these municipalities and this ordinance will give them that time.
Reuther said the Pennsylvania Legislature has put the responsibility of ambulance services on municipalities and over time, local hospital systems bought and took over these services as the skills needed for them increased.
“They could do it more efficiently and they also had a line toward moving patients to their hospitals,” she said.
She said parts of the county that tend to disproportionately rely on hospital-based EMS services also tend to be the most underreimbursed insurance areas as well, due to the need for Medical Assistance or underinsurance.
“It is not the county’s responsibility that we wound up in that situation nor is it the responsibility of the individuals,” Reuther said. “It is the changing health care system … In the meantime, we have a problem. Ten days is not a lot of time, especially with municipalities that have already set their tax rates for the year.”
Meanwhile, she said Crozer Health – within the last six months – was the successful bidder for mental and behavioral health services needed in Delaware County.
“Now, they’re telling us that over the course of COVID … that they lost all this money,” Reuther said. “So, why in the last six months would they submit this proposal?”
In supporting the emergency ordinance, Reuther said, “If they’re going to shut down anything else, I want the 180 days (notice).”
During the public comment section, John McBlain of Aldan, who formerly served as Delaware County Council chairman, thanked council for considering this emergency ordinance and urged them to adopt it.
“Less than 10 days ago without any prior discussion or notice, at least seven municipalities received letters telling them within 10 days if they didn’t recompense Crozer, that the services would be terminated and that constituted their notice,” he said. “(It) points out the need for the planning, for the notice provisions that you provided for in this ordinance and for an orderly plan.”
McBlain agreed that a future discussion on the handling of EMS services would be a great thing to do.
“As the world changes, we need to continue to do that,” he said. “But generations of Delaware County residents have trusted Crozer for their health care – everywhere from maternity services to regular services. Crozer has been recompensed by the people of Delaware County over a very long period of time and they’ve done very well for a number of years.”
Owned by for-profit Prospect Medical Holdings, Inc., Crozer Health has been going through a list of changes in the past few months.
Last month, Crozer announced the temporary closure of intensive care unit and surgery unit at the 215-certified bed Delaware County Memorial Hospital in Upper Darby by May 31 due to staffing issues because of the pandemic.
Two months earlier, the inpatient obstetrics unit at DCMH, where approximately 1,800 babies were born annually, was closed. These services moved to Crozer-Chester Medical Center in Upland, leaving only two hospitals in the county providing maternity care – CCMC and Riddle Hospital in Middletown.
In February, Crozer Health closed its inpatient hospice unit at Taylor Hospital in Ridley Park due to the need for patient safety, declining admissions to inpatient hospice and challenges presented by the national nursing shortage.
Also in January, Crozer suspended emergency department, pathology, lab and medical imaging services at Springfield Hospital due to COVID overload and suspended the inpatient Acute Substance Abuse and Residential Substance Abuse (First Steps) Program at Crozer-Chester Medical Center.