Six months on from HSHS: a look back at how it all began

This is the first in a five-part series you will see every day this week in the Leader-Telegram that reflects on the first six months since the HSHS and Prevea withdrawals in the Chippewa Valley. We will examine where things currently stand as well as where we go from here.

EAU CLAIRE — Six months ago, health care in the Chippewa Valley faced seismic changes.

On January 22 the Hospital Sisters Health System announced the permanent closures of not only its two HSHS hospitals, HSHS Sacred Heart in Eau Claire and HSHS St. Joseph in Chippewa Falls, but also the closure of all Prevea branded clinics and medical facilities.

The announcement released then stated that "the system will close HSHS Sacred Heart Hospital in Eau Claire and HSHS St. Joseph's Hospital in Chippewa Falls as part of a complete exit from the Western Wisconsin region. Prevea Health, a physician network offering primary and specialty care, will also close all its locations across Western Wisconsin's Chippewa Valley."

Both hospitals had more than a century of history. The Hospital Sisters of St. Francis arrived in Eau Claire and started a hospital in the home of James Fitzpatrick in 1889, with a full-fledged hospital built a year later. St. Joseph's Hospital goes back even further, with the Hospital Sisters of St. Francis using their home in 1885 to nurse sick men working in lumber camps, before a three-story hospital was built in 1888.

Losing a healthcare system with such significant roots sent a shock throughout the region. Healthcare workers protested outside Sacred Heart Hospital just days later. Several registered nurses told the Leader-Telegram at the time that other medical facilities were experiencing an over load without the hospitals closing; a withdrawal, in their eyes, would further exacerbate matters.

This was especially true considering that, without the hospitals, Eau Claire's Mayo Clinic would be the only locally available critical care unit, and would remove the only hospital option that was available in Chippewa Falls.

Though the statement claimed that the hospital closures would be "completed on or before" April 21, the area was informed in March that both hospitals had received a set closure of March 22.

It was a loss of not just the two hospitals, but also 19 clinics, an inpatient rehab hospital, a cancer center, a wound clinic, a home health and hospice center, a grief center, and more for the Chippewa Valley.

"POTENTIALLY ILLEGAL"

City attorney Stephen Nick sent a letter to the hospital system in February, stating that the closures could be "potentially illegal," citing the lack of correspondence to the city manager "as required by state law." The letter requested that the hospital system maintain care until April 21, which did not occur.

Nick referred to the Federal Worker Adjustment and Retraining Notification act in his letter, stating that "all impacted parties" never received the required notice of at least 60 days. Nick referred to the city as one of the impacted parties.

Two months later, Nick called for the Wisconsin Department of Health Services to investigate the hospital system, stating that, if a hospital had not followed its regulations in care, that its license could be given away to practice healthcare within the state.

"HSHS CEO Damond Boatwright said that HSHS considered the closure for 18 months to two years prior to a public announcement," said the city attorney. "This left patients without needed healthcare and employees without jobs on less than 60 days' notice."

"Decisions of the president, and approved by the board, not only led to hospital closure, but a decision to conduct closure in a manner that failed to sufficiently consider the well-being of patients, employees, the local community and residents of our state," continued Nick. "That is an actionable failure to meet licensing requirements."

The Wisconsin DHS responded to Nick, stating that they simply did not have the authority to investigate the hospital system.

"None of those sources of authority currently contain any timing requirements for hospital closure notifications nor any conditions regarding a hospital's financial fitness," said Kisten Johnson, DHS secretary-designee in a response to Nick. "They also do not allow us to open an investigation into the behavior or decision-making of a hospital's CEO absent an allegation that the CEO's actions constitute a violation of the Medicare Conditions of Participation."

Boatwright, President and CEO of the HSHS system, acknowledged the highly negative reactions to the closures in the area in a recent statement for this series of stories for the Leader-Telegram.

"As a Catholic health care provider, we are humble enough to understand that we can always do things differently and better," said Boatwright. "When facing challenging situations, we must simultaneously stay true to our core values and make sound financial decisions to sustain our ministry."

He clarified that the Wisconsin Department of Health Services was notified as soon as it was determined that keeping the hospitals open was unsustainable. He also responded to the belief that there was no discussion with other medial providers in the area.

"Discussions did occur with the other medical facilities in the area," he countered. "HSHS pursued multiple strategic alternatives to preserve our ministries in Western Wisconsin, including potential partnerships with local physician groups and facilities, as well as potential arrangements with larger health systems serving the area. When we concluded we had no other option but to close, we did have discussion with local medical facilities, with the intention to ensure an efficient and effective transition of patient care, as well as to place our highly trained and competent colleagues with area providers who would offer to accept our patients."

He concluded by stating that the inability to sustain the system in the Chippewa Valley was a "wake-up call" for other hospitals, citing a report by the nonprofit Center for Healthcare Quality and Payment Reform. The nonprofit's report stated that approximately 700 rural hospitals throughout the country were also in danger of closing.

"As painful as this process was, it highlights why providers, policymakers, civic and business leaders must join forces to find solutions to maintain access to affordable, quality health care in areas like the Chippewa Valley," he said. "Until we address the regulatory complexities, reimbursement challenges, escalating operating costs, unnecessary competition for patients, and other hurdles that endanger nonprofit hospitals that care for all patients, regardless of their ability to pay, I fear more communities will suffer the same fate."

Tomorrow: We look at the political responses to the closures on both a local and a state level.