’m writing today with disappointing news. Despite previous assurances that merger negotiations between Ellis and Trinity/St. Peter’s were on pause, in reality THERE HAS BEEN NO PAUSE. The community is now facing an expedited timeline and the real risk that our top priority — protecting health care from religious restrictions — is in serious jeopardy. Please read below for a detailed explanation of the merger’s current status and ways in which you can help. We need your support and your voice.
There Was No Pause
In March, Paul Milton, President & CEO of Ellis Medicine, told me that Ellis and St. Peter’s were pausing their discussions until after the pandemic was over and their financial status was more clear. He expected that it would take at least 6 months or a year before they would resume due diligence and negotiations. However, in a conversation last week, Paul Milton confirmed that there are plans for smaller agreements between Ellis and Trinity, aligning the two systems well before an umbrella agreement is fully negotiated. Trinity Health is a 41-hospital Catholic healthcare system headquartered in Michigan, which controls St. Peter’s Health Partners.
Trinity and Ellis are working on a Physician Agreement for Trinity to manage Ellis physicians within the next few months. The physicians’ group is one of the most significant assets at the hospital. The purpose — according to Paul Milton — is to enhance recruitment/retention of physicians at Ellis. It is difficult to attract medical professionals to upstate New York, especially for an independent hospital unaffiliated with a larger health care system. However, this type of agreement requires no oversight by the NYS Department of Health (DOH). And, Ellis has no intention of negotiating our priorities into the physician agreement: freedom from religious restrictions, reducing inequities, and providing for oversight and enforcement. What does all of this mean? A giant step toward partnership will happen without transparency or involvement by the DOH and without fully negotiating the community’s needs and priorities.
Next, Trinity and Ellis plan to negotiate a Management Agreement for Trinity to manage the business operations of the hospital (vendors, billing, collections, etc.) a year from now. Again, Ellis has no intention of negotiating our community’s priorities into the management agreement. However, there are several additional issues that many of us believe will be important to negotiate into the management agreement:
Equity. St. Peter’s is one of the most litigious hospitals and aggressive bill collectors in the state Pandemic hasn't stopped area's hospitals from suing patients over unpaid bills (timesunion.com) . For the sake of our community, Ellis must negotiate terms in the Management Agreement to protect our families from exacerbating healthcare-related inequities.
Pension Plan. There is a pension plan for Ellis employees that was frozen about 15 years ago. It is a defined benefit pension plan similar to the St. Claire’s pension fund that went unfunded because St. Claire’s took the religious exemption from ERISA. Ellis must be transparent about its plans to protect the pension plan in the Management Agreement, so our Ellis retirees will not face the same fate.
Notably, the management agreement would require NYS DOH approval. So at the very least, transparency and public comment are assured.
Finally, Trinity and Ellis plan to negotiate a Definitive Agreement covering all aspects of Ellis’ partnership with St. Peter’s Partnership in 1-2 years. Approval by NYS DOH will be required. This is the agreement that will directly affect healthcare at Bellevue, and the one in which Ellis may plan to include the community’s priorities in its negotiations. However, that will be far too late to have any real impact.
It is always worth remembering that the partnership with Trinity has benefits. While Ellis is not in immediate jeopardy of insolvency, partnering with a health care system can bring long-term financial stability and greater opportunity for recruitment and retention of medical professionals. Ellis’ administrators and Board of Directors, a thoughtful and knowledgeable group, spent years working on this search. This Coalition was formed to push the parties to negotiate terms that will protect our community from the risks of associating with Trinity Health.
What Can We Do Now - Plan for Ellis’ Community Forum
Previously, Ellis did not plan to hold a community forum until after the “pause”. However, Paul Milton has agreed that a community forum — similar to the Coalition’s forum in March — would be helpful at this time, and he is interested in knowing what community members want Ellis to address. We have a working group dedicated to providing recommendations for the content of Ellis’ forum. The group will meet via Zoom, 2-3 times between May 24 and June 1. Please email me by May 19 at email@example.com if you would like to join the working group.
If you are not interested in joining the working group, but have topics or specific questions that you would like addressed by Ellis, please email me at firstname.lastname@example.org. Remember, our Coalition is only as good as the thoughts and ideas we all bring to the discussion.
Stay safe and healthy,
As you may already know, Ellis Medicine and St. Peter’s Health Partners are currently finalizing negotiations for a merger. Concerns about the financial stability of Ellis Medicine and its vital role within the community are a driving force behind this partnership; the reality, however, is far less cut and dry.
Ellis is a non-sectarian hospital; St. Peter's Health Partners is part of Trinity Health — a Catholic health system in Michigan. The merger of religious health systems and secular hospitals has raised flags in communities across the country. Catholic hospitals follow a set of ethical guidelines (referred to as Ethical and Religious Directives or ERD’s,) that prohibit the provision of comprehensive patient health services — often targeting reproductive, LGBTQ+-inclusive and end-of-life care.
Religious restrictions combined with the forces of healthcare economics threaten to have a disparate impact on residents who already face barriers in our healthcare system. Access and equity are very much at risk. In response, the Schenectady Coalition for Healthcare Access (SCHA) invites you to attend the Community Forum to Address Capital Region Health System Merger on Thursday, March 4, 6:30- 8:30PM. This free online event is open to the community; registration can be found here.
The forum will feature an expert panel and a Q&A segment. Speakers include: Arthur Butler, Schenectady Human Rights Commission Executive Director; Nikita Hardy, MPA, Schenectady County Human Rights Commissioner and certified doula; Glenn Northern from Catholics for Choice US; Dr. Debbie Stulberg, family practice physician and leading researcher on the impact of religious restrictions on patients and doctors; and Lois Uttley, MPP, Women’s Health Program Director for Community Catalyst and coordinator of Community Voices for Health System Accountability.
Our speakers will discuss, answer questions and hear comments from the community on a wide range of relevant issues, including:
How religious restrictions will affect (and religious biases may affect) equitable access to healthcare
Possible solutions to eliminating gaps in services via other local healthcare providers
Potential community benefits resulting from the partnership
History of SPHP’s aggressive medical bill collection
Process required for partnership approval by NYS Department of Health
Community priorities in the application for certificate-of-need, including an effective enforcement mechanism
Opportunities for advocacy and continuing dialogue
Please help us spread the word about the forum and SCHA to your friends, families, colleagues and group members. We are planning for a robust and productive evening, and we need community involvement.
Information about the Coalition: www.schdy.org
Link to the event on the page of the Sanctuary for Independent Media: https://www.mediasanctuary.org/event/community-forum-to-address-capital-region-health-system-merger/
January 20, 2021
Last week, I had the opportunity to check in with Paul Milton [CEO and President of Ellis Medicine] and Leslyn Williamson [COO and Chief Nursing Officer]. As you know, the Capital Region has seen a significant surge in COVID-19 hospitalizations. Despite the increased pressure on our community hospitals, we are pleased that the administrators continue to be open to our input and address questions about their planned partnership with St. Peter’s.
Ellis and St. Peter’s are still working through due diligence, analyzing financials and governance issues. They report that an agreement will likely be filed mid-April or early May; in addition, they plan to hold community forums in February. As soon as we have dates, we will distribute and advertise them widely. We’ll be asking for your help in publicizing these events, so keep checking your emails as well as the Coalition website.
VNS & Dental Clinic
Many folks in our Coalition have voiced concern about the elimination of Ellis’ Visiting Nurse Service (VNS) last month and the planned elimination of Ellis’ dental program, which includes a dental residency program as well as a dental clinic. VNS and the dental program both serve a significant proportion of Medicare, Medicaid, under- and uninsured patients.
There are multiple organizations that provide visiting nurse care in the Capital Region. There is a shortage of visiting nurses and aides, but not organizations willing to employ them and provide the service. Therefore, the loss of Ellis’ VNS should not have a significant long-term impact. There is a specific concern, however, regarding continuity of care. For anyone who has either personally needed or arranged for someone else’s home care — you know it is not easy to find organizations that have availability and accept the patient’s insurance plan. Coalition members recognize the difficulty in establishing a successful relationship with a new provider and how this challenge could easily lead to an access problem. The Ellis administration reports that they were required to file a closure plan before the VNS service was eliminated, which allows for all VNS patients to continue receiving services until a successful relationship with a new provider is established. Ms. Williamson is actively involved in monitoring patient transitions to new providers, and plans to retain staffing until every patient’s successful transition is complete. She expects that VNS will be fully shut down by March. We will continue to monitor the transition process with her.
The administration reports that they were required to file a closure plan before the VNS service was eliminated, and the plan includes continuing services until a successful relationship with a new provider is established with every single patient working with VNS. Ms. Williamson is actively involved in monitoring patient transition to new providers. She plans to retain staffing until every patient’s successful transition is complete. She expects that VNS will be fully wound-down by March. We will continue to monitor the transition process with her.
Ellis hopes to sell the McClellan Campus, but the timing is entirely unknown. While there has been interest in the building, there is no agreement of sale. However, the administration reports that they are winding down the Dental program, which includes the dental residency program (2-3 residents per year) and the clinic. The administration has been working with Hometown Health to increase their capacity to take on the clinic’s patients; Ellis’ clinic sees thousands of visits per year. Dentists from the community who have supported Ellis’ dental program for many years have formed a Dental Coalition. The Dental Coalition is planning an upcoming meeting with administrators from Ellis and Hometown Health, along with Arthur Butler [Executive Director of the County Human Rights Commission, and a member of our Coalition]. Their goal is to address concerns about the elimination of Ellis’ dental program, as well as work towards identifying and finding solutions for any gaps in service to our community. We will report on their progress.
Members of this Coalition are working hard to ensure that the merger does not exacerbate inequities that already exist in our local healthcare system. In future updates you will learn:
Ways to help advocate for the Health Equity Assessment Act (S.1451A/A191)
How aggressively our hospitals pursue medical bills, and what is being done to push for more compassion and due process in the collections system
Lastly, a brief housekeeping note. In the past we’ve sent updates using an eblast program; unfortunately, many of those emails landed in spam folders. If you missed any previous updates, please go to www.schdy.org.
Stay safe and healthy,
December 8, 2020
We are very happy to report that Paul Milton, President and CEO of Ellis Medicine, has committed to public town halls BEFORE filing with the Department of Health. This will allow the public to have meaningful input. Additionally, because of the expanded due diligence process, filing won’t likely happen before the beginning of April, 2021 (moved back from February 1st).
The process will start with internal staff meetings to assemble a complete list of healthcare services that may be objectionable to St. Peter’s/Trinity based on the Ethical and Religious Directives for Catholic Health Care Services (ERDs). The administration will then work with St. Peter's to understand what limitations on each specific service might be. This investigation and communication with St. Peter’s/Trinity will shed critical light on how the ERDs are being interpreted and applied locally and what services can be included in the partnership agreement without religious objection.
Second, the administration will work on creating a corporate structure that will best support the broadest access to essential services, in consideration of the local interpretation of the ERDs. There are corporate structures and operational details that can maximize the independence of our nonsectarian hospital. Greater independence can equate to less imposition of religious restrictions.
Third, there will be town halls with opportunities to ask questions and share concerns. This is when we can share our stories, experiences, concerns and priorities. By then, the administration will have sufficient information to answer our concerns and inform the public about any potential or proposed change in healthcare services.
Only after this full investigation and due diligence is complete will the hospitals file their application for Certificate of Need with the New York State Department of Health (DOH).
Goals of the Coalition
Transparency. The DOH reviews applications for certificates of need (CON) -- such as the one that would be filed for state approval of the Ellis Medicine/St. Peter’s Health Partners transaction -- behind closed doors, and without conducting any public hearings in the affected communities. The next step is review by the state Public Health and Health Planning Council (PPHPC), which will accept letters to comments and allow limited public comments during the meetings of its Establishment and Review Committee. However, they give only one week’s notice of its agenda. Based on the experience of other communities faced with similar circumstances, the best window for input is when the application comes up for consideration by the PHHPC committee. The Coalition will work to insure that the public is informed of the process and the opportunities for input.
Access to Care. The Coalition will continue to work hard toward ensuring full comprehensive, patient-directed care at Ellis Medicine without religious bias or restriction. We will continue to investigate and bring to light circumstances where religious bias and the restrictions of the ERDs would impair our ability to access needed healthcare. We will continue to investigate corporate structures that facilitate and support minimizing religious bias and restrictions in our healthcare. We are not the first community to face this. What we are looking for is an exemption from application of the ERDs for portions of Ellis Medicine through creative structuring of the partnership. Such exemptions have been achieved before, most notably at the non-Catholic hospitals within the Catholic Dignity Healthcare system on the west coast. There are several organizations in this Coalition who have worked on this for years and are willing to give us resources and their expertise to help the administration.
Long-term Success. The Coalition will push to ensure the partnership documents and application contain sufficient detail and accountability and enforcement mechanisms to create long-term success.
Working with the Administration
It is reassuring to know that the Administration is very attuned to the risks of partnering with a Catholic health system and how it may affect the healthcare and equity concerns the Coalition has identified. It is reassuring that the Administration has committed to a deep investigation of the religious restrictions, including input from the community, BEFORE the hospitals submit their application to the DOH. While our relationship and faith in the Administration is uplifting, we also know that the road ahead will not be easy. The fact that we’ve agreed to a process is a great start.
Stay safe and healthy,
December 3, 2020
We had the opportunity to speak with Paul Milton, CEO of Ellis Medicine and better understand the process of selecting St. Peter’s Healthcare Partners as its partner. Here is a summary, as well as information about the Coalition’s work.
The Board of Ellis Medicine has been looking in earnest for a partner for about four years. Their search was punctuated in 2018 when they sent a request for proposals and met with several hospital and healthcare systems. The Board did a significant amount of due diligence investigating each affiliation opportunity. Their investigation included Albany Medical Center as well as St. Peter’s and others. One of the priorities that became clear, as it was described by Paul, was the need for Ellis’ partner to have a very clear interest in maintaining Ellis hospital and the essential types of care associated with the community hospital here in Schenectady. For example, cardiology and neurology are important services to have in Schenectady, and St. Peter’s has an established track record of enhancing core services at community hospitals.
The two administrations have not yet fully discussed where - and how - healthcare that is typically restricted by Catholic affiliations will be provided. For example, St. Peter’s has assured Ellis that vasectomies and tubal ligations will be permitted at Ellis. However, there did not seem to be a plan for this assurance to be incorporated in the partnership agreements.
We have seen a similar situation in Troy - the merger of Samaritan and St. Mary’s under the St. Peter’s Health Partners’ umbrella created the Burdett Birth Center as an independent, nonsectarian hospital-within-hospital. Initially, vasectomies and tubal ligations were performed at Burdett. It is important to know that tubal ligations must be performed under anesthesia and that for Cesarean births, they are safest (and best practice) when performed during the C-section, avoiding a second surgery. However, just a few years later, Burdett was merged into St. Peter Health Partners and no longer permits vasectomies or tubal ligations.
Moreover, Ellis has not yet determined where and how our community will access healthcare that will be eliminated by the partnership. For example, since the conversation with Paul, we have learned that the Dental Clinic at Ellis’ McClellan campus will be closed.
The Dental Clinic trains several dental residents and serves uninsured and Medicaid patients in need of regular and emergent dental care. The loss of the Dental Clinic cannot be overstated. Hundreds of people will be unable to access dental care. Moreover, the residency program is a significant recruitment tool -- attracting dentists who stay in the Capital Region to practice and raise families here. As you can imagine, it is incredibly difficult to recruit dentists to upstate New York, and in five or ten years, without the residency program, it is very likely we will face a devastating shortage of dentists as they retire.
St. Peter's is the only other institution in the Capital Region that has a dental residency program. The partnership with St. Peter's could be an opportunity to combine residency programs and continue the local Dental Clinic.
Most significantly, the administrations do not have a plan for community conversations until after the partnership proposal is filed with the New York State Department of Health.
Last week, we sent Paul Milton the linked “Community Priorities” found HERE. The document contains:
Terms we wish to see incorporated in the partnership with St. Peter’s.
A process for community involvement BEFORE the partnership proposal is filed with the Department of Health: (1) community forums with the opportunity to ask questions and raise concerns directly to the decision-makers; and (2) a task force comprised of representatives from Ellis, St. Peters and the community to identify and incorporate these and any other newly identified priorities into the documents filed with the Department of Health.
We appreciate the extraordinary effort that Ellis’ leadership has invested in finding a supportive partner - one that is committed to preserving and enhancing core services at our community’s hospital. Our goal is not to undo the work of Paul Milton or the Board of Trustees. Our goal is to support and help the partnership address community priorities in a meaningful, lasting way.
Please continue to inform your colleagues, friends and neighbors about the need for community involvement in the Ellis/St. Peter’s partnership and direct them to this website www.schdy.org.
November 19, 2020
Hello Coalition Members,
Thank you for doing what Schenectady does best - working together to better our community!
We are faced with a significant change in our community that will bring many benefits, but also risks. The success and continuity of Ellis Medicine is very important to our community’s health.
Ellis Medicine has been a cornerstone of public healthcare in Schenectady for over 125 years and our sole community hospital since 2007.
Ellis has done extraordinary work during the pandemic in close collaboration with our County Public Health Department to keep us safe and healthy.
The added resources that a partnership with a larger health system brings cannot be understated. Paul Milton, President & CEO of Ellis, explains that there are medical specialties that are core functions of a hospital, like cardiology and neurology. St. Peter’s has expressed the goal to invest and build upon these and other departments, maintaining access to these important services here in Schenectady.
That being said, there is always a risk that religious biases and restrictions can interfere with access to comprehensive, patient-centered care when a nonsectarian hospital like Ellis partners with Catholic health care systems like St. Peter’s Healthcare Partners and Trinity Health. The mission of the Schenectady Coalition for Healthcare Access is:
We are a coalition of individuals and organizations with the goal of preserving evidence-based, inclusive, and comprehensive patient-centered care in Schenectady County. Specifically, we seek to maintain access to comprehensive reproductive care, infertility care, LGBTQ+-inclusive care, gender affirming care and end-of-life care within our local community, and we oppose any imposition of religious bias or restriction on our ability to learn about, choose and be provided with medical treatment. Our purpose is not only to protect patient rights, but also -- as a matter of healthcare justice -- ensure that such care is locally accessible, equitably distributed and non-coercive whether it is currently available or may become available in the future.
It will be our job to push for transparency and access. This week, I had the opportunity to speak with Corinne Casey for a radio show and podcast about the proposed Ellis/St. Peter’s partnership. The podcast gives an overview of what is at stake and you can listen to it here. https://www.mediasanctuary.org/podcasts/capital-region-hospital-merger-threatens-patient-care/Corinne hopes to do more podcasts with others from the Coalition and the community. (She is a member of this Coalition through her leadership as Compassion and Choices’ New York & New Jersey Campaign Director. To learn more about the work of Compassion and Choices’ work in New York, visit https://compassionandchoices.org/in-your-state/new-york/.)
We will be emailing updates and resources to you as things move forward, but we are nothing without your voice! We see this Coalition as an opportunity to inform the hospital boards and administrators about the community’s concerns and advocate for your needs. Please let us know your experience with Ellis, St. Peter’s or the healthcare industry in general and what concerns you have about the Ellis/St. Peter’s partnership.
You can also email me at email@example.com to set up a time to talk. Your stories are the most powerful way to advocate for our community’s needs.
Please direct your friends and family who share your concerns to the website www.schdy.org. By signing on to the Coalition, it will show their support for the mission and allows us to communicate issues as they arise more quickly. I will update you soon on a recent conversation with Paul Milton - the history of Ellis’ search for a partner, the corporate structure they are exploring with St. Peter’s Health Partners and the specific services they are working to maintain.
Be safe and healthy,