The number seems small: just 13 psychiatric beds out of nearly 2,750 in the state.
But a plan by UMass Memorial Medical Center in Worcester to convert those beds for medical and surgical care has generated deep concerns from the state and stiff opposition from nurses, mental health advocates, and elected officials.
Officials at the state Department of Public Health said Monday that UMass Memorial’s plan “does not adequately meet the needs of the patients in the community” and asked the hospital to delay.
The dispute centers on a difficult tradeoff — either answer the growing demand for mental health services or the need to treat other patients.
Hospital executives said the change is necessary because UMass Memorial was so full so often last year that it turned away more than 500 patients suffering from serious ailments such as strokes, heart problems, and traumatic injuries.
“There’s been times we are so crowded that the helicopter has had to fly right over our hospital and fly to Boston,” said Dr. Eric W. Dickson, chief executive of the hospital’s parent company, UMass Memorial Health Care.
But critics say the hospital’s plan will leave vulnerable and sometimes poor patients lacking easy access to critically needed care. Other psychiatric facilities in the region are too far away, they said, and don’t provide the same care as a full-service hospital such as UMass Memorial. The hospital’s 27-bed psychiatric unit serves patients with depression, anxiety, schizophrenia, and other mental disorders.
“They are prioritizing medical/surgical patients over the psychiatric patients,” said Lisa Goss, a union nurse who works in the psychiatric unit.
The need for mental health services is rising, fueled in part by the opioid crisis, as addiction and other mental illnesses often occur together. Across the state, patients often have to spend hours or days in emergency rooms waiting for a psychiatric bed.
Executives at UMass Memorial, a private nonprofit in New England’s second-largest city, acknowledge the need for mental health care. But at their flagship hospital, the demand from patients with other severe medical issues is far higher, they said. They argue that about 70 percent of the patients they admit for psychiatric issues don’t need to be in a big general hospital and could receive care at freestanding psychiatric facilities.
Dickson, an emergency physician who became chief executive in 2013, said UMass Memorial desperately needs more space to accommodate patients with serious physical illnesses. The hospital has 258 beds for medical and surgical patients, and it wants to add 18 more.
The only alternative would be to construct a new building, which would be too expensive, Dickson said.
He describes the situation bluntly: “Somebody’s going to die if we don’t move forward with this.”
The number of psychiatric beds statewide is on the rise. About 332 new beds are slated to open over the next three years, adding to the 2,748 available now, according to the state Department of Mental Health.
In a plan filed with state health officials, UMass Memorial officials note that four other health care providers are planning to open or already have opened new psychiatric beds in Central Massachusetts. They expect to refer an average of 431 patients per year to other facilities.
These include two for-profit psychiatric hospitals: TaraVista Behavioral Health Center, which recently opened 30 of 108 planned beds in Devens, and Westborough Behavioral Healthcare Hospital, which is building a facility for 152 beds and expects to start accepting patients by early August.
“We admit patients now from the UMass system and we anticipate that our capacity to do so will continue to grow as we add [staff],” TaraVista chief executive Michael P. Krupa said by e-mail. The nonprofit Harrington HealthCare System recently opened 16 psychiatric beds in Webster, and a spokesman said Harrington has room for additional patients.
These sites are a distance from Worcester: Webster is about 20 miles away, and Devens nearly 30. UMass Memorial has proposed offering a twice weekly shuttle to Devens for “a nominal fee.”
But critics said these locations are too hard to reach for local patients and families, especially those without cars.
“The option in Devens is not an option,” said Sarai Rivera, a Worcester city councilor who formerly worked as a clinical therapist. The City Council unanimously passed a symbolic order opposing UMass Memorial’s plans in March.
Critics also said UMass Memorial should maintain all of its psychiatric beds because the hospital can admit patients with both severe mental and medical conditions, something that freestanding psychiatric hospitals cannot do.
“We’re very concerned,” said Laurie Martinelli, executive director of the Massachusetts chapter of the National Alliance on Mental Illness. “UMass Memorial is a full-service hospital. When people are there for mental health issues, they’re also there for medical issues. Once you go to behavioral health facilities . . . medical issues you have cannot be dealt with.”
UMass Memorial noted that its neighbor, Saint Vincent Hospital in Worcester, is planning to add seven psychiatric beds. But a Saint Vincent spokeswoman said the plans are “very preliminary” and the hospital’s psychiatric unit is already full most of the time.
UMass Memorial is planning to partner with a private company to open a psychiatric hospital in Worcester, but that isn’t expected to open until 2019.
“Before we close any beds, I want to make sure the other beds are open and ready to go,” said Senator Harriette L. Chandler, a Worcester Democrat.
Dozens of people testified at a public hearing about UMass Memorial’s proposal in late March — most of them against. The Public Health Department required the hospital to submit a detailed plan about how it would ensure patients have access to necessary care after the beds close. But after reviewing that plan, health officials said Monday that it was lacking.
In a letter to the hospital’s lawyer, health officials said they were deeply concerned that UMass Memorial wants to close its beds on or about June 1, before additional beds become available in the region, which “will impact the timely admission and treatment of persons in need of inpatient psychiatric care.”
State officials cannot technically stop the hospital from moving forward, but they can raise concerns and ask for more information.
The Massachusetts Nurses Association said the hospital isn’t doing enough to address concerns. If it moves forward with its plans, about 20 union nurses in UMass Memorial’s psychiatric unit will be displaced, but they will be able to apply for jobs in other departments, according to hospital officials. “All we’re doing is trying to make sure that we can continue to serve this community’s needs,” said Dickson, the chief executive. “We just can’t wait.”