Rockville General Hospital has been a fixture in Christen Ellis’ life for decades.
She’s been a nurse there for over 30 years. It’s where she gave birth to her kids and where her mother got surgery when pancreatic cancer made it nearly impossible for her to eat. It’s where both her parents eventually entered hospice care during the final days of their lives.
“It was a very tight-knit community of people that all cared for one another and the community all together,” she recalled.
Today, the small hospital, situated in a borough along the northern border of Vernon, is a shell of its past self. The parking lot sits mostly empty. Entire wings are deserted. Once a comprehensive 102-bed hospital at the heart of its community, Rockville now offers only emergency, one-day surgery, and behavioral health services.
There are multiple reasons for the hospital’s diminishment.
In August, Prospect Medical Holdings, the California-based company that owns Rockville, Manchester Memorial and Waterbury hospitals, got hit with a debilitating cyberattack that crippled many of its facilities around the country. Last month, the presidents of Prospect’s Connecticut hospitals warned the governor that the financial situation at all three hospitals is so dire they might have to close if the state doesn’t expedite approval of a pending deal to sell the facilities to Yale New Haven Health.
While the cyberattack continues to generate headlines, the damage to Rockville started years earlier.
Financial troubles at Eastern Connecticut Health Network, which consists of Rockville and Manchester hospitals, began years before Prospect purchased them in 2016. But the elimination of services at Rockville started in earnest with the arrival of the pandemic, when the hospital received permission from the state to halt surgical services to free up space for COVID patients.
Records submitted to the state, however, show that ECHN took the cuts further, shuttering most of Rockville’s inpatient units. More than three years later, longtime employees, union leaders and state lawmakers from the area say, services remain extremely limited.
Rep. Kevin Brown, D-Vernon, said he’s received complaints from constituents about the cuts, as well as unsafe staff-to-patient ratios at the hospital. Many residents have limited transportation, he added, which makes the 20 minute drive to Manchester not just a barrier to routine care but potentially life-threatening in the case of emergencies.
“A loss of services or, ultimately, a loss of the hospital itself would be just absolutely detrimental to this community,” said Brown.
The state was notified — through both required annual reporting from the hospital and testimony from employees — of the unauthorized service cuts at Rockville several times over the last two and a half years but ultimately did not impose any fines or penalties against the hospital.
Hospitals are required to submit annual financial and utilization data to the state Office of Health Strategy, or OHS. These reports, as well as follow-up questions from the agency to the hospital, indicate OHS knew about the unauthorized changes.
The reports paint a bleak picture of the hospital’s deterioration.
In September 2019, Rockville’s medical/surgical and intensive care units had a combined total of 28 staffed beds. By September 2022, they had just 11. Over the same time period, the average number of people treated per day in those inpatient units dropped from 22 to less than 1.
The cuts illustrated in these reports were corroborated by hospital employees who testified at an October 2021 public hearing before OHS. The hearing concerned an application from ECHN to make Rockville a satellite hospital of Manchester.
Glen Maloney, a Rockville mechanic for 23 years and union president of AFT Local 5121, told state officials that several of the hospital’s units “have remained closed for over a year, their equipment removed, services to the public curtailed, and employees displaced.”
“The gift shop was also closed. Apparently no visitors justify no gift shop. I thought all hospitals had a gift shop. Perhaps RGH is no longer considered a hospital,” Maloney said during the hearing.
Deidre Gifford, executive director of OHS, said the agency doesn’t have sufficient capacity to conduct all necessary compliance investigations.
“We have not had at OHS a lot of resources to do investigations and compliance type of work,” said Gifford. She noted that the agency recognized this as a need and is currently in the process of hiring an attorney who will work on compliance. The agency also has received funding to hire additional staff to support its approval processes.
ECHN spokesperson Nina Kruse did not respond to multiple rounds of detailed questions about the current status of services. Instead, she provided a general statement about ECHN’s compliance with state reporting requirements and the health system’s role during the pandemic.
“ECHN works closely with all state agencies to ensure access to information and that the operations of our organization comply with the requirements of regulatory agencies,” Kruse said in the emailed statement.
Prospect Medical Holdings did not respond to a request for comment.
Prospect comes to Connecticut
When Prospect bought ECHN in 2016, it promised to bring its philosophy of “higher value” and “better care” to Connecticut. The company pledged to invest $75 million in capital improvements to the health system in its first five years. ECHN did not confirm whether Prospect made the investment.
At the time, ECHN was struggling, according to testimony by Peter Karl, its former president and CEO, during a March 2016 public hearing.
The hospitals were facing mounting challenges — increased pension and other debt, tax liabilities, reductions in federal and state reimbursement, and aging facilities. The system had eliminated 200 jobs over the previous two years.
“I can’t express enough the dire situation we are in at this point in time,” Karl testified.
Hospital staff and community members alike supported the acquisition, hopeful that Prospect ownership would stabilize the health system.
For the first several years, Ellis, who was president of the local nurses union at the time, said new management signaled Rockville wasn’t a priority by shifting some services, like ambulatory care, to Manchester Memorial.
But the real trouble began with the start of the pandemic.
On March 14, 2020, Gov. Ned Lamont issued an executive order allowing hospitals to circumvent the typical approval process for terminating or adding services, known as a certificate of need, in order to temporarily increase capacity for COVID patients.
On March 24, ECHN executives filed for permission to suspend surgeries under the waiver, which the state granted the following day, according to a letter from then-OHS director Victoria Veltri to Deborah Weymouth, ECHN’s CEO.
“Closing these rooms will enable RGH to better utilize the existing space to manage the expected surge of patients needing treatment of the COVID-19 virus by making available (21) additional beds for this purpose,” Weymouth wrote in a proposal submitted to the state.
But reports submitted to OHS show ECHN took the cuts further.
The utilization and financial performance documents, required by the state, confirm the hospital shut down its entire medical/surgical unit, which includes the surgical services that Rockville got permission to stop, but also features inpatient medical care, like overnight monitoring after a car accident, that the hospital did not receive permission to stop. The hospital also stopped taking patients in its intensive care unit, which it never received permission to do.
The reports show the state was aware of these changes because it asked a series of follow-up questions.
In a September 2020 financial document, Rockville reported a 35% drop in total gross patient revenue over the previous year. The hospital included an explanation for the steep change: “Decrease in volume related to COVID. Closed inpatient units.”
In a document that includes follow-up questions from the state and responses from the hospital, the state asked which inpatient units had closed and whether the closures were temporary or permanent.
“All inpatient units (i.e. Med/Surg) were temporarily closed due to COVID,” reads a response by Nicholas Jamieson, a controller at ECHN.
In the same document, Rockville reported the number of patient discharges decreased dramatically. The number of patients in the hospital’s medical/surgical and intensive care units had plunged by 54% and 59%, respectively. The state, again, asked for an explanation.
“Rockville med/surg inpatient units were closed in March 2020 as a result of COVID-19. All ECHN inpatients were cared for at Manchester Memorial Hospital from March 2020 through September 2020,” Jamieson reported to the state.
COVID subsides, but cuts continue
In annual filings the following year, Rockville again reported no inpatient activity at the hospital.
In a September 2021 annual utilization report, Rockville Hospital recorded zero patient discharges for the previous 12 months in both its medical surgical and intensive care units. Accompanying correspondence between OHS and Rockville show the state again asked the hospital to explain.
“Due to COVID, RGH has no IP volume during FY 2021,” stated Lori Czapla, an ECHN financial analyst. The following year, in a September 2022 filing, Czapla reported that inpatient admissions at Rockville resumed again in April 2022 but didn’t specify which units opened back up.
Tina Kumar Hyde, a spokesperson with OHS, said the waiver obtained by Rockville in March 2020 only applied to surgical services and expired on July 21, 2021, at which point all services should have resumed.
In February 2022, OHS issued Rockville a $118,000 fine for “willfully [failing] to seek certificate of need approval prior to terminating Surgical and Procedural Services.” The state’s notice of civil penalty did not note the suspension of any other inpatient services.
Prospect appealed the penalty and, in June 2023, OHS waived it, along with the fines it had issued to two other hospitals for the same reason.
In the case of Rockville, OHS hearing officer Daniel Csuka found that, while the hospital had terminated services, there wasn’t substantial evidence proving the company had “willfully” terminated them. Weymouth, ECHN’s CEO, said on multiple occasions to OHS she was under the impression the waiver expired in February 2022, not July 1, 2021, and Csuka determined that OHS’s guidance on when services must resume had been unclear.
Kruse, the ECHN spokesperson, said the ruling proved the hospital did not violate any regulations.
“Transparency and adherence to regulations have been ECHN’s cornerstone, evidenced by all pertinent documents … and the civil penalty hearing concluding with a 'no penalty' ruling,” said Kruse.
Department of Public Health spokesperson Chris Boyle said DPH has a limited role when it comes to hospital compliance. The agency conducted two visits to Rockville between October 2020 and April 2022 and found “no violations of the Public Health Code.”
Elizabeth Benton, a spokesperson with the Attorney General’s office, confirmed that the AG has an ongoing investigation regarding Prospect Medical Holdings’ financial practices but said she could not comment further.
Records submitted by Rockville to the state for fiscal years 2020 and 2021 show the hospital provided COVID-related outpatient services, like testing, but did not treat a single COVID patient overnight at the hospital, despite obtaining the waiver to close its surgical services for this purpose.
The hospital received $7.4 million in COVID relief funding from the federal government, according to a database published by the federal Department of Health and Human Services. It received an additional $1.8 million from the state, according to the Office of Policy and Management, or OPM, the state’s budget office.
The hospital’s acceptance of relief funding, despite not providing inpatient care for COVID patients, does not constitute a misuse of funds, said spokespeople for both OHS and OPM.
ECHN did not directly answer questions about how it used the COVID relief funding or what services it offered at Rockville hospital during the pandemic. Instead, it issued a statement lauding the health system’s work.
“We proudly convey that Eastern Connecticut Health Network (ECHN), incorporating Manchester Memorial and Rockville General Hospitals, stood as beacons of hope and resilience during unprecedented challenging times,” hospital officials said. “Navigating an unparalleled and ever-changing medical crisis, we acted to respond to federal and state orders, disseminated information to the community and our patients on safety behaviors, hand hygiene, and vaccinations, enhancing community well-being.”
What’s happening at Rockville today?
Even among hospital physicians and union leadership, there is confusion over which services technically reopened following the pandemic.
Today, the hospital continues to operate its emergency department, as well as outpatient services like blood work, X-rays, lab tests and colonoscopies that don’t require an overnight stay, according to multiple employees.
Rockville also provides inpatient psychiatric services. But those are technically a part of Manchester Memorial through a lease agreement, even though they’re physically located at Rockville, said John Brady, vice president of AFT CT, a union whose members include Rockville employees.
Hospital officials told the state that inpatient services resumed in April 2022, but, according to multiple employees, several key services did not return. Inpatient surgical services never came back, and the intensive care unit, or ICU, never reopened in its pre-pandemic state.
Instead of reopening the intensive care unit, the hospital opened a progressive care unit, or PCU, which can’t handle the same complexity of care, according to Brady and Ellis. A PCU treats patients in need of critical care, but, unlike an ICU, a PCU can’t handle those needing intubation or around-the-clock cardiac monitoring. ICU-level patients now get transported to Manchester for care, according to employees and state Sen. Saud Anwar, D-South Windsor, a physician who is affiliated with Manchester Hospital.
Kumar Hyde, the OHS spokesperson, confirmed that changing an ICU to a PCU requires state approval and that Prospect has not applied for permission. Gifford said the agency has not been notified that the hospital made this change. ECHN did not answer repeated questions about the status of its ICU.
Kumar Hyde also said that Rockville represented to OHS that all surgical services that were paused during COVID-19 had been restarted by May 2022.
After the August security breach, even the inpatient services that managed to survive the pandemic suffered. According to Boyle, the DPH spokesperson, the agency conducted surveys at Rockville in August and September in response to the cyberattack. Rockville officials reported in the surveys that the hospital had only one inpatient unit, no ICU and no inpatient surgical services.
Brady said the progressive care unit never reopened after the breach.
Brown and Rep. Tammy Nuccio, R-Tolland, who both represent Vernon, said a significant share of the town’s families live paycheck to paycheck. According to a 2020 report by the United Way of Connecticut, more than 40% of Vernon households qualify as “ALICE” — asset limited, income constrained, and employed.
“Rockville Hospital used to be an amazing hospital that really cared about the community and took care of the residents,” said Nuccio, who was born at Rockville, just like her mother, aunts, uncles, and two of her three children. She even volunteered there as a candy striper.
“It's so predatory, and it's so bad for the residents there,” added Nuccio. “We're taking services from people who are vulnerable [for] the profitability of a company that isn't even in Connecticut.”
A familiar pattern
Prospect owns 16 hospitals across the country, according to its website. Since acquiring the three Connecticut hospitals, the company has garnered a reputation for draining resources from its facilities while raking in profits for executives and investors, according to published news reports.
In 2018, Prospect took out a $1.1 billion loan and used the funds to pay its executives and shareholders a $457 million dividend, CBS News reported. Prospect CEO Sam Lee took home roughly $90 million from the transaction.
To repay the loan, Prospect sold the land and buildings from hospitals it owns in Connecticut, California and Pennsylvania to a real estate investment trust for $1.4 billion, then leased back those hospitals from the trust. In Pennsylvania, the lease-back agreement meant one health care system was on the hook for $35 million a year in rent, CBS reported.
Private equity firm Leonard Green & Partners owned a majority share of Prospect for over 10 years but sold its stake in 2021. Members of congress said that, by the time it exited, the firm paid itself roughly $658 million in fees and dividends from the hospital chain.
Over the last several years, Prospect has also been closing hospitals.
In 2019, the company shuttered Nix Medical Center, based in downtown San Antonio, Texas, citing “a decline in community demand for its acute care services.” Prospect said the closure wouldn’t impact access to care because there were several other health care facilities within a 10-mile radius, including five hospitals.
In 2016, the same year Prospect acquired Waterbury and ECHN, it also bought Pennsylvania-based Crozer Health. At the time, the four-hospital system was struggling financially, and Prospect promised to “dramatically increase … service to the community.”
Today, two of the four hospitals — Springfield and Delaware County Memorial — have stopped providing care, setting off a media frenzy and broad criticism from the local community.
“Springfield Hospital is the first hospital that was temporarily closed during the Omicron variant outbreak and then never reopened. Delaware County Memorial Hospital is the larger hospital, which was closed down essentially unit by unit and then forced to shut down by the state due to staffing levels,” said Monica Taylor, chair of the Delaware County Council, in an interview with The Connecticut Mirror.
In April 2020, Crozer shut down all the units at Springfield Hospital, except for its ER, due to “significant” drops in patients. In January 2022, the company announced that it was going to temporarily close the emergency department due to staffing shortages but that it hoped to resume services “as soon as it is safely possible.”
In the first few months of 2022, Crozer shut down the maternity, intensive care, and surgical units at Delaware County Memorial. In November, the Pennsylvania Department of Health suspended admissions at the hospital because of “serious violations.”
“The state health department had to act and have them closed down, which is what Prospect was hoping for,” said Taylor.
In February 2022, Delaware-based ChristianaCare signed a letter of intent to acquire the Crozer hospitals from Prospect, but the deal fell through in August after months of negotiations. In a joint statement, the companies cited the changing economic landscape.
What’s next for Rockville?
The fate of Rockville, as well as Manchester Memorial and Waterbury Hospitals, hinges on the outcome of the Yale acquisition.
“Everybody’s got these hopes that Yale will come along,” said Maloney, the mechanic at Rockville who told the state what was going on at the hospital two years ago.
Yale New Haven Health last year announced an agreement to acquire all three of Prospect’s Connecticut hospitals for $435 million. Completion of the sale and a certificate of need are still pending.
Several weeks ago, Yale executives requested, among other terms, $80 million in state funding over five years and a reduced purchase price in order to move forward.
Negotiations between state officials and executives from Yale and Prospect broke down earlier this month after the state sought to keep the talks private. But they resumed days later, when the parties agreed to confidentiality.
“OHS has provided the applicants with a draft settlement agreement, and the applicants have agreed to confidential settlement negotiations,” Kumar Hyde said. “OHS is unable to comment any further at this time.”
So far, Lamont has said he sees no reason for the taxpayers to chip in. However, he’d like to see the deal go through and said it’s up to Yale and Prospect if they want to renegotiate the purchase price.
“That's Prospect-New Haven seeing if they can reach an agreement. And that'd be a good solution for all if they can,” Lamont said after an Oct. 18 press conference.
Longtime employees have their own hopes for the hospital.
“I was angry at first, but now I'm just tired and frustrated. But I'm not a quitter, and I'm not going to stop until they do what they're supposed to do,” said Ellis. “I would like to see Rockville reopen in its pre-pandemic state, because I feel like the community needs and deserves to have that.”
Maloney said these days, he’s embarrassed to wear his “Eastern Connecticut Health Network” T-shirt around town because of what people might think about the health system.
“They read about our company in the papers, and it's not good stuff,” he said. “Our name is going down the drain.”
This story was originally published by CT Mirror on Oct. 29, 2023.