Frisbie Hospital plans to send baby deliveries to Portsmouth. State AG says not so fast.

ROCHESTER — Frisbie Memorial Hospital is facing a review by the New Hampshire attorney general's office over a decision to discontinue labor and delivery services, sending patients instead to Portsmouth Regional Hospital, which is under the same ownership.

Attorney General John Formella said Frisbie, which informed the state attorney general last month it plans to stop delivering babies, had agreed in February 2020 to continue labor and delivery services for at least five years after it was acquired by HCA Healthcare for $67 million.

The agreement states the hospital would have to "show proof of extreme financial loss/disadvantage" in order to justify discontinuing labor and delivery services. The attorney general's office is not satisfied that proof has been provided by Frisbie.

In a July 29 letter from Joseph Sowell III, senior vice president of FMH Health Services, Frisbee cited a decline in labor and delivery services that has "challenged the clinical competency and staffing outcomes of the department, resulting in financial losses." Instead it proposed to partner with Portsmouth Regional Hospital to continue the services.

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In response, the AG's office stated it has concerns about this decision and planned to begin a review. A response letter from the attorney general states the office is particularly concerned over whether Frisbie received federal CARES Act money and had already begun transferring labor and delivery patients to Portsmouth. The letter also said Frisbie's basis for showing a financial loss was lacking details.

Frisbie's response

Frisbie Memorial Hospital spokesperson Ellen Miller said Monday the hospital has not ended labor and delivery service yet and is awaiting the attorney general's review.

She also provided a statement from the hospital.

"Due to our area’s aging population and years of declining births, and faced with the challenges of operating a low birth rate center, we have made the difficult decision to close the birthing center and transition to a new program which will provide our patients with all pre- and post-natal care at FMH and labor and delivery at area hospitals," the statement reads in part.

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The statement from the hospital echoed the attorney general's office in noting the hospital sent a July 29 letter about the decision to discontinue labor and delivery to the Greater Rochester Community Health Foundation "as required by the asset purchase agreement" from 2020 when the hospital was sold.

"We are working closely with the Foundation to ensure compliance with the terms of the (asset purchase agreement)," the statement reads. "Additionally, in an effort for full transparency, we notified the attorney general of our intentions and will work with his office to address concerns and ensure continuity of care for all of our Frisbie (obstetrics) patients. We remain committed to women’s health in Rochester and will partner with local OBGYN providers to offer pre- and post-natal care for women in the current birthing center space, and will continue offering all gynecological surgery at FMH."

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The statement adds, "We are proud of our dedicated team and their successes in ensuring exceptional birthing experiences for our moms and families. It is a privilege to provide obstetrical care to this community. We look forward to continuing to serve the communities’ needs for many years to come."

Seacoast hospital acquisitions

The attorney general's review of hospital acquisitions is pivotal in the process. It has both approved and rejected mergers of Seacoast hospitals in recent years.

In 2019, the attorney general opposed a sale of Exeter Hospital to Mass General, which would have put the local hospital under the same ownership as Wentworth-Douglass Hospital in Dover. Exeter tried to fight the decision, but Mass General later ended its pursuit of the deal. This year, Beth Israel Lahey has reached a deal to acquire Exeter Hospital.

The sale of Frisbie was finalized in March 2020 after it was approved by the attorney general, allowing the Rochester hospital to be sold to the same ownership as Portsmouth Regional Hospital and Parkland Medical Center in Derry. HCA states it owns more than 180 hospitals and 2,000 health-care facilities in the United States and the United Kingdom.

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Focus of attorney general's review of Frisbie

The attorney general's office points to a 2020 asset purchase agreement, which defined "extreme" financial issues as a "contingency" that could allow for the hospital to stop labor and delivery services.

The attorney general's director of charitable trusts will review the hospital's compliance, "exploring whether (Frisbie Memorial Hospital) made a good faith effort to avoid the contingency that led to the decision to close labor and delivery services" well before five years expired, the attorney general stated.

The attorney general's announcement states it learned about Frisbie Memorial Hospital's plan to end labor and delivery services July 29. That is when the hospital forwarded a letter it had sent to the Greater Rochester Community Health Foundation to the director of charitable trusts in the AG's office.

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The attorney general's office, citing documents filed with the state, stated, "since the sale of the assets of Frisbie Memorial Hospital and its affiliates in March 2020, the Frisbie boards have been meeting to plan for the future management of the proceeds resulting from the sale as well as the other Frisbie assets, which are required to be used for charitable purposes for the benefit of local residents. The boards have recently approved a plan for The Frisbie Foundation to be renamed the Greater Rochester Community Health Foundation."

The Greater Rochester Community Health Foundation became a supporting organization of the New Hampshire Charitable Foundation, which is a statewide community foundation incorporated in 1962, according to the attorney general.