Testimony of New Jersey Public Advocate Before the State Health Planning Board
Certificate of Need for the Closure of Muhlenberg Regional Medical Center

National Conference Center at the Holiday Inn

399 Monmouth Street, East Windsor, New Jersey

Thursday, June 26, 2007

Introduction

Good morning.  My name is Elizabeth Speidel, and I am with the Division of Public Interest Advocacy at the Department of the Public Advocate.  Thank you for this opportunity to present testimony.  The Public Advocate understands that Plainfield and the surrounding communities are confronting a very distressing situation with the loss of their hospital.  We understand that the Department of Health and Senior Services is also facing, and will continue to face, the difficult task of overseeing hospital closures throughout the State.  This task is further complicated because the hospitals in greatest financial distress tend also to be the ones that serve a high proportion of patients who rely on Medicaid or have no health insurance.  The loss of such hospitals poses health risks to already vulnerable and underserved populations. 

We come before you today to recommend three actions to the Board and the Commissioner:

• First, we recommend that, in rendering a final decision, the Commissioner describe more fully the kinds of concerns raised by the public and explain the Department’s response to those concerns or its reasons for not responding. 
• Second, we ask that the Commissioner explain how her decision regarding the closure of Muhlenberg Hospital would affect the Department’s obligation under the Eliminating Health Disparities Initiative (N.J. Stat. Ann. § 26:2-167.1) to improve health outreach and outcomes in vulnerable racial and ethnic communities.
• And third, we ask the Commissioner to include a health planning expert in the proposed Community Advisory Group to ensure that it can competently perform its contemplated functions.  

We request that the Board address these issues in its recommendations and that the Commissioner address them in her final decision.

Community Recommendations

The community surrounding Muhlenberg has been actively engaged for months in an effort to keep its hospital open, and we commend it for its work.  Its members and representatives have expressed a number of concerns and made many recommendations during the two public meetings held by this Board.  At least some of this community input is reflected in the conditions to the Certificate of Need proposed by the staff of the Department of Health.  Yet the staff recommendations do not fully canvass the community’s comments or explain how the conditions respond or do not respond to those comments.  As a result, it is not made explicit to what extent the staff recommendations took into account the full scope of community input.  

For example, the Staff Recommendations refer to requests from the public for “an independent community needs assessment and financial audit prior to rendering a determination on the Muhlenberg closure” and “a postponement of any decision so that community groups could find a buyer for the facility willing to maintain it as a general hospital.” (Staff Summary, p.

7).  Yet the Summary does not explicitly respond to these suggestions one way or the other. 

We request that the Board’s recommendations and the Commissioner’s final decision address the concerns and recommendations raised by the community in greater detail.  We do not suggest that the Board and the Commissioner describe and address individually every comment submitted or every person’s testimony.  But we urge the Commissioner to categorize the comments into broad subject matter areas and then to explain either (1) how the conditions to the Certificate of Need address these concerns or (2) why the Department chose not to address these concerns.

Health Disparities 

The Commissioner has an obligation pursuant to the Eliminating Health Disparities Initiative (N.J. Stat. Ann. § 26:2-167.1) “to develop and implement a comprehensive, coordinated plan to reduce health disparities between White and racial and ethnic minority populations in the State in identified priority [medical] areas.”  Most of the hospitals that have closed over the past 18 months, or are at risk of closure, have been located in working class, minority communities.  The financial distress of such hospitals is often directly related to their extensive provision of services to patients who receive Medicaid or charity care.  We ask the Board to recommend and the Commissioner to include in her decision an analysis of how the closure of Muhlenberg would affect the ongoing effort to eliminate health disparities between these communities others.

Community Advisory Group

The proposed conditions include the creation of a Community Advisory Group to assist in the transition that would follow the contemplated closure of Muhlenberg Hospital.  This group would be charged with significant tasks, including “provid[ing] on-going community input to Solaris on ways that it can most effectively and efficiently meet the primary, preventive, maternal and child health service needs, emergency health, transportation service needs and any remaining inpatient and outpatient needs of all residents in MRMC’s service areas” and “examin[ing] the need for the continuation of outpatient prenatal/obstetrics, pediatric, behavioral health and other primary care and emergency services in the Plainfield area, should the latter be approved for closure.” (Staff Summary, 15, 16). 

We believe that these conditions require the participation of a health planning expert.  This expert might come from the community, from Solaris, or even from the Department of Health, but we cannot see how the Advisory Group can conduct the analyses outlined in the conditions without a health planning expert among its members.

The decision about whether to close a hospital is never easy.  We recognize the challenges this situation presents, and we commend the community members and the Department for their commitment to ensuring that the health needs of Muhlenberg’s patients continue to be met. 

Thank you for this opportunity to testify.

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