Jeanne and Joe Maggio have been married for 61 years. Now in their 80s and retired, they’ve lived in Newton for the past 10 years. So it was scary when, recently, Jeanne started not recognizing her husband. Once, she ran outside, terrified there was a stranger inside their home.
Jeanne has never felt comfortable in medical settings. But she and Joe found a neurologist a few towns over, at Exeter Hospital — and this doctor, they liked. He’d schedule their appointments for the end of the day, so he could give them a little extra time. They all would show each other pictures of their dogs. The doctor also made sure to book Jeanne in an open MRI machine, so she wouldn’t feel claustrophobic.
“He just was just nice,” Jeanne said. “He was very careful. And he told me the truth.”
After a battery of tests, Jeanne was diagnosed with Alzheimer’s. But these days, things feel manageable. She’s sleeping better, and she knows who her husband is. Joe credits the neurologist with getting them to that place.
“The medication's doing pretty good,” Joe said. “She doesn't have the panic she used to have.”
And then: “All of a sudden, here comes this bomb.”
A few weeks ago, the Maggios and other patients of Exeter Hospital’s Core Physicians practice received letters informing them that neurology services would wind down within a month.
It was part of a much bigger sweep of cuts that Exeter Hospital announced around the same time, without warning. Other services on the chopping block include podiatry, allergy care, pediatric dentistry and paramedics who assist local ambulance crews during emergencies.
The planned cuts – which come a year after Exeter Hospital was acquired by a large, out-of-state health system – have drawn outrage from patients and state officials.
“To rip-cord care when you're making progress, when you have a relationship with a provider – to have it terminated so quickly, it's unconscionable,” said Executive Councilor Janet Stevens, who represents Exeter and has been speaking out publicly about the cuts.
Under pressure from the New Hampshire attorney general, Exeter Hospital has since agreed to pause the cuts for six months. But the situation has left patients like the Maggios feeling adrift – and has raised larger questions about access to care, as more and more hospitals are bought up by large health systems.
AG’s office has ‘a lot of concerns’
When Massachusetts-based health system Beth Israel Lahey acquired Exeter Hospital last year, it promised to enhance access to care for local patients.
“It starts with a commitment to providing extraordinary care that’s in your community, close to where our patients live and work,” Peter Shorett, the nonprofit health system’s chief operating officer, said at a public hearing ahead of the sale.
Beth Israel backed that up with a series of promises to state regulators. New Hampshire Attorney General John Formella approved the deal with a number of conditions, including pledges to maintain labor and delivery services, open more inpatient psychiatric beds, develop a plan to grow clinical services and make investments totaling $375 million over more than a decade.
Last Wednesday, state officials announced Exeter Hospital had agreed to hold off on discontinuing neurology, pediatric dental care and other services for six months. At an Executive Council meeting, Formella said his office is looking into whether Beth Israel violated the terms of the merger.
“The actions of Beth Israel and Exeter over the last few weeks have raised a lot of concerns,” Formella said.
Beth Israel and Exeter Hospital declined NHPR’s request for an interview. They’ve previously said they’re 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,” a spokesperson for the hospital, Sonya Vartabedian, said in a statement last month.
Families fear long drives, limited options
As the attorney general continues scrutinizing the health system’s plans, patients and caregivers are still feeling in limbo.
Nicole Sheaff lives in Exeter, and her family relies on Core Physicians’ pediatric dentistry practice — in part because it’s one of the few nearby that accepts Medicaid. The staff are also great with children like hers, who have developmental disabilities and other conditions that can make visits to the dentist a challenge.
When she first learned the office would be closing, it came as a shock.
“I was concerned that they would be going for years again without cleanings, without any preventative care, without any acute care,” she said.
Sheaff was relieved to hear the cuts were on hold. But the next day, when she was back at the dentist’s office with her kid, she said staff there hadn’t heard any formal updates from the health system.
As of Tuesday morning, her family still hadn’t gotten anything from Core Physicians about the six-month extension. She’s heard talk of the office staying open as a private practice, but it’s not clear when that might happen. Meanwhile, her child is experiencing discomfort from cavities, and she can’t make an appointment to get them treated.
She’s wondering whether she’ll have to travel out of the area to get her kids dental care, or pay hundreds of dollars out of pocket.
“You're looking at places like Manchester or Nashua,” she said. “And those facilities are not going to be able to absorb clients from the Exeter area. Nor, you know, do I really want to drive an hour for a dental appointment.”
As of last week, the Rockingham County Nursing Home had about 30 residents with Parkinson’s, multiple sclerosis and other conditions who rely on neurology services from Exeter Hospital.
Over at the Rockingham County Rehabilitation and Nursing Center, nurse practitioner Donna Roe is also wondering what comes next. As of last week, the facility had about 30 residents with Parkinson’s, multiple sclerosis and other conditions who see the neurologist at 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 could not find anybody who was accepting new patients,” Roe said.
She said the six-month pause will help. But it’s still not clear where those patients will go once the practice shuts down.
The nursing home doesn’t 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 somebody like that, who may not be able to think clearly, in the back of a wheelchair van or an ambulance, it can set their behaviors off, so they can escalate and get combative or confused,” Roe said. “Their confusion can worsen sitting in an ambulance or traffic for an hour and a half.”
For Joe Maggio, in Newton, what’s happening at Exeter Hospital should be a cautionary tale for politicians and regulators.
“I hope that somebody smartens up,” he said, “and whenever they're going to talk merger, get it in writing that you're not going to shut this down, you're not going to shut that down.”
After learning about the cuts last month, he called multiple other neurology practices in the area to try to find another doctor for his wife, Jeanne. One didn’t take their insurance. Another said they might not have an opening till next year – and it didn’t take their insurance, 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, after finally finding someone she trusts.
“That scares me,” she said. “So I don't know. I guess it's going to happen, though.”
