Dartmouth Health to take over youth psychiatric services at Hampstead Hospital

Hampstead Hospital in Hampstead, N.H., in an undated photograph. (Concord Monitor file photograph)

Hampstead Hospital in Hampstead, N.H., in an undated photograph. (Concord Monitor file photograph)

By MICHAELA TOWFIGHI

Monitor staff

Published: 12-22-2024 12:01 PM

Gov. Chris Sununu got his final wish in the corner office after the Executive Council agreed to allow Dartmouth Health to take over operations at Hampstead Hospital.

Dartmouth Health will now lease Hampstead Hospital – New Hampshire’s only children’s psychiatric hospital and residential treatment facility – from the state with a seven-year contract.

Cinde Warmington, the lone Democrat on the council, voted no.

Earlier this month, Sununu acknowledged the model was a first for the state. At Glencliff Home and New Hampshire Hospital, the state-owned nursing home and psychiatric facility, a public-private partnership is in place with Dartmouth. There, the private health provider staffs all the clinical positions while the Department of Health and Human Services retains control over executive positions.

At Hampstead, Dartmouth will staff the entire facility from top leaders to clinicians.

Morissa Henn, the deputy commissioner for Health and Human Services, said the full takeover will provide stability at the facility after two fraught years since the state purchased it in 2022.

“What I believe is powerful about this model is that we have the powerhouse of clinical expertise of Dartmouth Health, as well as their mission alignment,” she said. “So it really is a win-win.”

To Warmington, the contract lacked strong enforcement mechanisms.

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“It’s a half-baked contract in my opinion,” she said. “It just doesn’t have the teeth in it, the reporting requirements, the mechanisms and we’ve seen how bad the outcomes can be.”

Dartmouth Health will be required to renew its license each year to operate the facility, as well as report on conditions inside the facility, including the use of restraints and seclusion.

The contract also establishes a joint oversight commission, which will include hospital and state staff, to address everything from readmission to staffing levels, said Henn.

Two existing oversight commissions – one on children’s services and another on health and human services – will also play a role.

In addition, a citizens advisory board will be created to allow for people with lived experience, behavioral health advocates and others to provide advice on hospital operations.

“I want to respectfully disagree on the premise that this has inadequate teeth,” said Henn. “There are numerous, layer-upon-layer accountability mechanisms to ensure that Dartmouth Health is providing the highest quality care.”

Councilors were up against the clock to make a decision on the contract, as it was the last meeting for Sununu, as well as Warmington and Ted Gastas, a Manchester Republican who is retiring.

When Hampstead opened under state ownership, the facility was designed to have 71 hospital beds and 12 more spots for a residential psychiatric treatment facility.

Due to staffing shortages and space restrictions, the hospital has never admitted more than 40 patients and only half of the residential beds were filled at a time.

The new contract intentionally does not indicate how many beds patients should occupy, said Henn.

That is, in part, the first step in recognizing that more beds aren’t necessarily good for children in the state.

“If we are going to move to a future landscape where we are serving kids around families and not removing them from their homes to be treated in placements, we need to begin to understand that resources may need to be shifted at any given moment toward the outpatient offerings that Dartmouth health is offering, or toward the system of care with community-based partnerships that exist,” she said.

Without an arbitrary number, Dartmouth will have greater flexibility in the services it provides and not be held to mandated occupancy requirements.

A provision of the lease will also state that New Hampshire children must be served before out-of-state youth are accepted to the facility. As of Wednesday, Henn reported seven children remained in the emergency room waiting to be admitted.

With the new partnership, current staff at the hospital will be offered positions as full-time Dartmouth employees. The hospital is offering 2 percent raises for those who stay on and Henn said state and hospital leaders would be onsite as soon as possible to talk through the transition.

“My concern is our staff. We have an incredibly dedicated staff at Hampstead hospital who have been through a lot,” said Henn. “I can’t imagine how difficult it must be to work as hard as they do, and go home at the end of the day not knowing what the model holds. ... I believe we don’t have the time to wait.”

Becoming a Dartmouth employee isn’t the desired outcome of over 100 hospital staff, though, who signed a petition presented to the Executive Council at their last meeting, asking to remain as state employees.

In the last two years, some employees have seen a carousel of changes to their insurance and pensions under the shifts in leadership.

The conversation could continue in the legislative chambers, though, with Erica Layon, a Derry Republican, introducing a bill to establish permanent classified state employee positions for the staff of Hampstead.

Joeseph Kenney, a Wakefiled Republican, urged the council to avoid letting staffing disputes be the final stumbling block. The state can, and should, go to Hampstead and give clear information to employees about the transition and their benefits.

Henn estimates the state will finalize a lease agreement with Dartmouth at the beginning of February.

“They’re the best game in town and they’re mission-driven,” said Kenney. “Ultimately, it’s the end user, the child, that we’re trying to provide services for. That’s paramount.”