Doctors and patients grapple with uncertainty as Tufts moves ahead with plans to shut hospital services for children

Tara Forrest is worried about where her 15-year-old daughter, Alexa Pantoja, who was diagnosed with leukemia in 2020, will receive care.Erin Clark/Globe Staff

Nearly two months after executives at Tufts Medical Center announced they would close hospital beds for children, uncertainty around the controversial decision and the hospital’s ability to continue providing pediatric services is growing.

Tufts leaders initially said they would keep inpatient beds for children open until July 1, but with staff already departing for new jobs, the pediatric hospital may be forced to shut down sooner, doctors and nurses told the Globe.

The future of outpatient pediatric services also appears uncertain: Tufts leaders said they plan to keep outpatient clinics open, but this, too, will depend on having enough staff to provide care.

“People feel very insecure about the viability of the plan,” said Dr. Daniel Rauch, chief of pediatric hospital medicine.

Much depends on the 140 Tufts doctors who treat children. Hospital leaders are imploring doctors to work with them to develop plans to close inpatient services and transition patients who require overnight stays to Boston Children’s Hospital, their powerful competitor 3 miles across the city.

But doctors are upset that senior executives kept their plan to close the hospital’s 41 pediatric beds secret until January and asked for help only after making a final decision. The doctors are evaluating whether to stay with Tufts, to provide outpatient care, or seek jobs at other hospitals.

“Staff are leaving,” Rauch said. “Our ability to deliver care is rapidly changing. They’ve killed the service here.”

Tufts executives have faced a backlash since announcing the plan to close pediatric hospital beds — from parents of sick children and from hospital staff, who pride themselves on serving poor families and immigrants who have few other options for affordable care.

Hospital leaders said they’re “working through these difficult changes,” but declined to share specifics. They said they still intend to maintain outpatient services — including day surgery and the pediatric emergency room — while closing inpatient services that require children to stay overnight in the hospital. The newborn intensive care unit will remain open, hospital leaders said.

More details could come by April 1, when Tufts expects to file plans with the Department of Public Health.

“We are working every hour of every day with our physicians and staff and with BCH to collaborate in new ways,” said Dr. Michael Tarnoff, chief executive of Tufts, in a statement. “Changes in pediatric care require new levels of collaboration. As expected, this work isn’t easy.”

The upheaval has left families of sick children worried and confused about where they will get their health care.

Tara Forrest, whose daughter is a Tufts patient, said the lack of information is provoking anxiety for families already dealing with serious illnesses.

“We haven’t been told anything yet,” she said. “We’re all just kind of in a state of limbo.”

Forrest’s daughter, Alexa Pantoja, was diagnosed with an aggressive form of leukemia in 2020 and spent nine months in the hospital receiving chemotherapy. Now 15, she still has regular appointments with her seven specialists at Tufts, who are watching to make sure the cancer doesn’t come back.

Tufts plans to transition all patients who need inpatient care to Boston Children’s for treatment. But some families could choose to go to Boston Medical Center, Massachusetts General Hospital, or another hospital instead.

Forrest will try to follow the doctors she and her daughter have come to know and trust, but most Tufts doctors have not yet decided whether to stay or go.

“The uncertainty right now is the hardest part,” Forrest said.

The doctors have much to consider. Some may be able to remain at Tufts but with fewer responsibilities than before. They could treat patients who need outpatient services but would have to give up caring for the sicker and more complex patients who require overnight stays.

Doctors could look for jobs at other pediatric hospitals, but a new job could require moving to another part of the country.

The doctors also have the option of moving to Boston Children’s, but many are reluctant because they would lose the titles and responsibilities they’ve gained during their time at Tufts.

Paul Donovan, a spokesman for Boston Children’s, said the hospital is in the process of hiring nurses and extending offers to doctors from Tufts, and is working with Tufts to ensure “continuity of care for patients.”

But the two hospitals are very different. Tufts is much smaller — 41 pediatric beds compared with more than 400 at Boston Children’s — and staff can provide more personalized attention to each patient, Tufts doctors and nurses said. They worry that type of care isn’t possible at a bigger facility like Boston Children’s.

“We’re not at Boston Children’s because we don’t want to be at Boston Children’s,” said Dr. Andrew Scott, medical director of the cleft and craniofacial team at Tufts. “We’ve elected to practice in a different model and different way of doing things.”

Scott said he plans to continue seeing patients in his clinic at Tufts. But if a patient needs surgery and requires admission to the hospital, he wouldn’t be able to operate at Tufts. Instead, he would have to refer the patient to a surgeon at another hospital — or he would try to perform the operation at another Boston hospital where he has privileges. “It fragments their care,” he said.

Already, amid the turmoil, community pediatricians are sending fewer referrals to Tufts, which means less work for the doctors.

Tufts leaders have offered to continue paying doctors for 18 months, but that is little incentive for people whose jobs will change significantly if they decide to stay.

“They’ve made it pretty clear that pediatrics is not in their vision of where the medical center is going,” Scott said. “That stings a bit.”

Dr. Sylvia Yoo, interim director of pediatric ophthalmology at Tufts, said she hopes to stay at Tufts but is waiting for more clarity about how outpatient services will operate when the inpatient beds close.

“It’s really unclear how the details will work out,” she said. “There’s a lot of unknowns.

“We would like to stay,” Yoo said. “In the back of our minds, it depends on how everything works out.”

Among pediatric nurses, about 30 recently left Tufts or are in the process of leaving for other jobs, said Mary Havlicek Cornacchia, cochairwoman of the nurses union at Tufts. Other nurses expect to retire early or be laid off.

“It’s leaving a big staffing crisis,” she said. “We were already on the tight side to begin with.”

With so many departures, it’s unclear how long pediatric services can continue, Cornacchia said. “We’re already coming apart at the seams.”