Jeanne and Joe Maggio have been married for 61 years. Now in their 80s and retired, they have lived in Newton for the past 10 years. So it was frightening when, recently, Jeanne began not to recognize her husband. Once, she ran outside, terrified that there was a stranger inside their home.
Jeanne never felt comfortable in medical settings. But she and Joe found a neurologist a few towns over, at Exeter Hospital—and they liked that doctor. He would have scheduled their dates for the end of the day to give them a little extra time. Everyone was showing each other pictures of their dogs. The doctor also made sure to shut Jeanne in an open MRI machine so she wouldn’t feel claustrophobic.
“He was just nice,” Jeanne said. “He was very careful. And he told me the truth.”
After a series of tests, Jeanne was diagnosed with Alzheimer’s. But these days, things seem manageable. She sleeps better and knows who her husband is. Joe credits the neurologist for taking them to that place.
“The medicine works very well,” said Joe. “He doesn’t have the panic he used to have.”
And then: “Suddenly, here comes this bomb.”
A few weeks ago, Maggios and other patients at Exeter Hospital’s Core Physicians practice received letters informing them that neurological services would be terminated within a month.
It was part of it a much larger sweep of cuts which Exeter Hospital announced around the same time, without warning. Other services on the chopping block include podiatry, allergy care, pediatric dentistry and paramedics assisting local ambulance crews during emergencies.
The planned cuts — which come a year after Exeter Hospital was bought by a large, out-of-state health system — have sparked outrage from patients and state officials.
“To cut the cord when you’re making progress, when you have a relationship with a provider – to end so quickly, it’s unconscionable,” said Executive Councilor Janet Stevens, who represents Exeter and has spoken publicly about the cuts.
Under pressure from the New Hampshire attorney general, Exeter Hospital it has since agreed to halt the cuts for six months. But the situation has left patients like Maggios feeling stranded — and has raised bigger questions about access to care, as more and more hospitals purchased by large health systems.
AG’s office has ‘many concerns’
When the Massachusetts-based health system Beth Israel Lahey acquired Exeter Hospital last year pledged to improve access to care for local patients.
“It starts with a commitment to providing excellent care that’s in your community, close to where our patients live and work,” Peter Shorett, chief operating officer of the nonprofit health system, said in a public hearing before the sale.
Beth Israel backed this up with a series of promises to state regulators. New Hampshire Attorney General John Formella approved the agreement with various conditionsincluding commitments to maintain labor and delivery services, open more psychiatric inpatient beds, develop a plan to grow clinical services and make investments totaling $375 million over more than a decade.
Last Wednesday, state officials was announced Exeter Hospital had agreed to suspend the shutdown of neurology, pediatric dentistry and other services for six months. At an Executive Board meeting, Formella said his office is looking into whether Beth Israel violated the terms of the merger.
“The actions of Beth Israel and Exeter in recent weeks have raised many concerns,” Formella said.
Beth Israel and Exeter Hospital declined NHPR’s request for an interview. They have previously said they are working to ensure the hospital’s future stability amid rising costs and other financial challenges.
“While we have made progress in continuing to rebuild our financial health in the post-pandemic environment, we are evaluating all aspects of our operations, including aligning our staff with patient care priorities and focusing our resources on health care programs and services that Exeter Hospital is uniquely qualified to provide,” hospital spokeswoman Sonya Vartabedian said in a statement last month.
In a statement Tuesday after this story was first published, Vartabedian added that Exeter Hospital and primary care physicians “are focused on supporting our patient population and our highest priority is to ensure that patients maintain seamless access to care in the local the community”.
“We work with patients to address their care needs,” he said. “Patients with questions or concerns can contact their doctor’s office directly for ongoing support. We thank our community for their patience during this time and apologize for any inconvenience they may experience.”
Families fear long drives, limited options
As the attorney general continues to scrutinize the health system’s plans, patients and caregivers continue to feel at a standstill.
Nicole Sheaff lives in Exeter, and her family relies on Core Physicians’ pediatric dental practice — in part because it’s one of the few nearby that accepts Medicaid. The staff is also great with kids like hers who have developmental disabilities and other conditions that can make dental visits a challenge.
When she first learned that the office would be closing, she was shocked.
“I was worried that they would go for years again without cleanings, without any preventive care, without any acute care,” he said.
Schiff was relieved to hear that the cuts were on hold. But the next day, when she returned to the dentist’s office with her child, she said the staff there had not heard any official update from the health system.
As of Tuesday morning, her family still had not received anything from Core Physicians regarding the six-month extension. He has heard that the office is staying open as a private practice, but it is unclear when that might happen. Meanwhile, her child is bothered by tooth decay and can’t make an appointment for treatment.
She wonders if she will have to travel out of the area to get her children dental care or pay hundreds of dollars out of pocket.
“You’re looking at places like Manchester or Nashua,” he said. “And these premises will not be able to absorb customers from the Exeter area. I don’t even, you know, really want to drive an hour for a dentist appointment.’
As of last week, Rockingham County Nursing Home had about 30 residents with Parkinson’s, multiple sclerosis and other conditions relying on neurological services from Exeter Hospital.
At Rockingham County Rehabilitation and Nursing Center, nurse Donna Roe also wonders what’s next. As of last week, the facility had about 30 residents with Parkinson’s, multiple sclerosis and other conditions seeing the neurologist at the Exeter hospital.
In its letters informing patients of the cuts, the health system included lists of other providers in the area.
“On that list, we couldn’t find anyone who was accepting new patients,” Roe said.
He said the six-month hiatus will help. However, it is not yet clear where these patients will go once the practice closes.
The nursing home does not have the resources to drive people to appointments in Boston or other out-of-state medical hubs. That could leave families on the hook for transportation costs. And Roe worries about the effects of long travel times on vulnerable patients, some of whom have dementia.
“When you put someone like that, who may not be able to think clearly, in the back of a wheelchair van or an ambulance, it can cause their behavior to escalate and become combative or confused,” he said Roe. “Their confusion can be compounded when they’re sitting in an ambulance or in traffic for an hour and a half.”
For Newton’s Joe Maggio, what’s happening at Exeter Hospital should be a cautionary tale for politicians and regulators.
“I hope somebody gets it done,” he said, “and whenever they’re going to talk about a merger, put it in writing that you’re not going to close this, you’re not going to close it.”
After learning of the cuts last month, he called several other neurology offices in the area to try to find another doctor for his wife, Jeanne. One didn’t get his insurance. Another said they might not open until next year – and their security didn’t need to either.
He finally got Jeanne an appointment with a new neurologist in Derry in November. But she’s anxious about starting over with another doctor once she finally finds someone she trusts.
“That scares me,” he said. “So I don’t know. But I guess it will happen.”
This story has been updated with an additional statement from Exeter Hospital, which was sent after this story was first published.
