In early winter, Gretchen Rose wasn’t sure about the fate of her job at Yale Medical Group’s Center for Sleep Medicine in New Haven. And six months later, when she stood as a witness before the Department of Public Health at Gateway Community College on June 18, she was still in the dark.
“Hi. My name is Gretchen Rose, and I hereby adopt my pre-filed testimony,” she said to the hearing officer. “And I’m going to read it anyway, so everyone can hear.”
Rose worked at the Yale Medical Group sleep center for 15 years, until she was laid off last December after its closing. The center cited decreased demand for its services, in part due to home sleep study technologies. She and her coworkers were assured that their clinic was not being purchased by the Yale-New Haven Hospital as part of a merger. But she wasn’t so certain.
“The [Group] denied that Yale-New Haven Hospital was taking control of the practice. They told us that it was not happening, that they didn’t know where we were hearing that from,” she said. “It was denials everywhere.”
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In 2013, the prognosis for another sleep center — Gaylord Hospital Sleep Medicine in North Haven — was also grim. The 12-bed facility provided diagnosis and therapy to patients with sleep problems like sleep apnea and narcolepsy, but overnight patient visits decreased by 26 percent between 2011 and 2013, and in 2013, the sleep center took over $137,000 in losses. That figure was projected to hit $307,000 in 2016.
And so the Gaylord sleep center did what many failing businesses would do: It decided to shut down, a decision solidified in November 2013 when it filed a Certificate of Need application with the Department of Public Health’s Office of Health Care Access. Conveniently, Yale-New Haven Hospital’s North Haven Medical Center was located next door. So when Gaylord began planning to close its facility, Yale-New Haven Hospital, which didn’t have its own sleep center, stepped in to purchase it.
Meanwhile, Yale Medical Group also closed its Center for Sleep Medicine, a timing that raised suspicion of a hushed negotiation. While Rose and 10 other members of the UNITE HERE Local 34 labor union for Yale clerical and technical employees lost their jobs, their patients were able to access their old doctors.
“Our patients are still being seen by our doctors, but, during the closure time, it was very confusing as to who was going to see them, where they would get an overnight study, and, right now, it’s still confusing,” Rose said at the June 18 hearing. “Our patients are still calling and don’t know where to go. Phone numbers are not in service.”
Rose and other employees were wracked with uncertainty. Was the Yale Medical Group sleep center really closing as they were told, or was Yale-New Haven Hospital absorbing it in a hushed asset transfer, laying off workers and inconveniencing patients in the process?
If this were in fact the case, then Yale-New Haven Hospital would force Yale Medical Group patients and employees to commute to Gaylord’s old North Haven facility. Rehired employees would receive lower salaries and would lose the benefits and seniority from their Yale Medical Group jobs. And New Haven patients, many of whom are ethnic minorities with low-income backgrounds that heighten their chances of struggling with sleep problems, would need to travel to a location that previously drew only a quarter of its patients from New Haven.
And so Local 34 petitioned to have the June 18 public hearing before OHCA, at which the union would challenge Gaylord Hospital’s application for the Certificate of Need it required to close its sleep center. Local 34 hoped that OHCA would deny the application in order to prevent Yale-New Haven from absorbing the Gaylord facility.
The controversy even drew the attention of New Haven Mayor Toni Harp. She wrote to OHCA in support of Local 34, commenting on the difficulties that New Haven patients would face in having to commute to a North Haven sleep center facility.
“I encourage you not to grant this Certificate of Need as presented. Instead, I encourage you to require Yale-New Haven Hospital to file a Certificate of Need of its own for this practice and to bring its plans, policies and prices into the open as a result.”
But if this timing — Yale Medical Group’s decision to close its sleep center and Yale-New Haven’s interest in acquiring Gaylord’s struggling facility — is no more than a coincidence, then Local 34 stands to obstruct Gaylord Hospital’s attempt to close its failing sleep center, and jeopardize Yale-New Haven’s reputation.
When Melissa Dawkins-Doumbia worked at Yale Medical Group’s sleep center as a temporary employee last December, she believed that Yale-New Haven was taking over Yale Medical Group’s practice.
At the hearing before OHCA, she said, “I was instructed by management to tell patients, ‘Yale-New Haven Hospital will be opening up a sleep center. They will be taking over our practice. All of your charts and medical records will be switched over to the hospital.’”
“I’m just asking that you please call Yale-New Haven Hospital to the table, and, you know, there’s a lot of things going on, and we haven’t heard from them.”
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Yale-New Haven Hospital and Yale Medical Group tell a different story.
“We were surprised and disappointed that there was confusion regarding the acquisition of Gaylord,” said Vin Petrini, senior vice president of public relations at Yale-New Haven. There’s exhaustion in his tone when he affirms that Yale-New Haven’s interest in the Gaylord Sleep Center is fundamentally separate from the closing of Yale Medical Group’s facility.
Like Local 34, Petrini seems genuinely concerned for the well-being of the sleep center patients. The sleep center is “literally in the next parking lot over” from the North Haven campus of Yale-New Haven, he said. “We thought it would be convenient to have those resources there for patients.”
And on behalf of Yale Medical Group, Senior Communications Officer Karen Peart replied firmly to questions about the relationship between the sleep centers. She affirmed over email that Yale’s decision to close the New Haven facility was based only on the level of demand for its services.
This decrease in demand for sleep center services is a widespread problem, one all too familiar to Gaylord Hospital President and CEO George Kyriacou. Gaylord owned three other sleep centers in addition to its North Haven facility, and all four centers have seen a decline in activity over the past seven years. Gaylord has filed Certificate of Need requests to close all of the facilities — but the controversy with the Yale-New Haven acquisition has brought special attention to the North Haven site.
As Kyriacou saw it, the problem in the sleep center closings lay in the financial viability of sleep medicine centers as a whole. Home sleep study technologies give patients the opportunity to record diagnostic information as they sleep, which decreases the need for overnight stays in sleep center facilities.
In 2011, he said that this home sleep testing really began to catch on. Insurance companies now often mandate that patients take advantage of this new technology instead of paying extra for overnight sleep monitoring services at centers like the ones run by Gaylord and Yale Medical Group. And if insurance companies aren’t willing to pay for their services, then it follows that facilities like those operated by Gaylord and Yale Medical Group would predict lethal cuts to their bottom lines.
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On Monday, OHCA did approve Gaylord Hospital’s request for a Certificate of Need. There are 400 pages of records and correspondence regarding the application in OHCA’s public records, but the approval comes as a succinct 11-page file providing evidence that the North Haven sleep center was quickly becoming a financial leech on Gaylord Hospital.
OHCA echoed Kyriacou’s concerns in their approval — the North Haven facility was experiencing such a decrease in revenue, in part due to the rise of home sleep testing, that keeping the overnight facility open was no longer cost-effective.
But, likely to the dismay of Local 34, OHCA only briefly addressed the controversy surrounding Yale-New Haven’s plans to takeover Gaylord’s North Haven sleep center. OHCA is responsible only for approving the closing of Gaylord, not for what happens to the facility afterwards. And so the order’s acknowledgement of Local 34’s conflict with Yale-New Haven is brief:
“It is important to note that UNITE HERE raised the issue of YNHH purchasing the assets of the Sleep Center in the future. While this purchase is not currently under OHCA’s jurisdiction, it does confirm that YNHH will continue to offer sleep services at the North Haven location subsequent to its purchase. Therefore, there will be no effective changes to the provision of sleep services at the North Haven location other than the name of the provider.”
It’s not quite an endorsement of Yale-New Haven’s planned purchase of the Gaylord facility. But if OHCA intended to support Local 34’s efforts to halt the acquisition, whatever its nature, it’s just passed up its chance.
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In March, Local 34 interviewed some of its laid-off workers and sent transcripts to OHCA, hoping to secure June’s public hearing in discussion of Gaylord’s Certificate of Need application. Melissa Mason, Legislative Liaison for UNITE HERE, interviewed Geraldine Haddon, a fellow Local 34 member who had worked at Yale Medical Group’s sleep center before it closed.
As awareness spread that their jobs were in jeopardy, employees found themselves struggling to fit the pieces together. And, as members of Local 34 fear, they may never complete the puzzle. Mason asked Haddon about the order in which she and her co-workers uncovered news of the closing.
“Some of the doctors I talk to, I really don’t think they had a clue. And other people that I work with felt completely different, that they knew all along. It’s really hard to say which,” Haddon said. “The whole thing comes down to they were playing with patients, they were playing with their employees’ lives. And that never should have happened.”
Contact Theresa Steinmeyer at
theresa.steinmeyer@yale.edu .