Marisa Peryer
In 2015, Yale-New Haven Hospital and city community health centers Cornell Scott-Hill Health and Fair Haven Community Health Care first started planning to consolidate primary care at a Long Wharf facility. The New Haven Primary Care Consortium will aim to provide patients with high-quality, coordinated care, according to the Hospital press release.
The plans, however, have drawn sharp criticism from the medical community and local advocates, including seven interviewed by the News, who say that the Long Wharf location will not be accessible to low-income, disabled and elderly patients under the current proposal. Because Long Wharf is in a remote part of the city, away from most neighborhoods, these groups may have difficulties accessing care. They also argue that the three providers have not adequately solicited feedback from the New Haven community — specifically the tens of thousands of patients that the move will affect — even though planning for consortium has spanned several years and is currently awaiting approval from the state.
In a recent effort to halt approval of the proposed consortium, three groups — the New Haven Legal Assistance Association, the Connecticut Cross-Disability Lifespan Alliance and the Connecticut Legal Rights Project — joined the city’s Department of Services for Persons with Disabilities to condemn current transportation plans in a joint letter sent to Connecticut’s Office of Health Strategy on Friday.
“Apart from all of the other access issues presented by the proposal, with essentially no countervailing benefits for low income primary care patients, it would be ill-advised to approve this application while so many pieces of the applicants’ critical transportation plans are still only theoretical or inadequate on their face,” the letter reads.
YNHH Senior Vice President for Operations Cynthia Sparer was not available for comment and representatives from Cornell Scott-Hill Health and Fair Haven could not be reached for comment over the weekend.
According to the New Haven Independent, the consortium plans to offer a variety of services at its location at Long Wharf, including radiology and behavioral health care. In addition to these services, the three providers will use the same electronic medical records system.
The consortium has the potential to innovate care administered to patients, but advocates are concerned that it could make primary care inaccessible for thousands of patients across the Elm City.
On Jan. 3, the project’s planners sent a response to the state elaborating on its solution to the transportation question. The consortium plans to use Uber, with rides controlled and coordinated by the center’s staff. Yale-New Haven stated that there is no anticipated cap to the Ubers, and the program would be supplemented by already existing health care ride services such as Veyo, a state program that operates in the city.
But Michelle Duprey, director of the city’s Department of Services for Persons with Disabilities, and other signatories on the letter sent to the state’s Office of Health Strategy claim that Uber is an ineffective primary means to transport those who most need specialized care — the elderly and disabled. Uber, Duprey told the News, is likely unwilling to accommodate disabled patients and has faced lawsuits — unrelated to the consortium — brought by disability rights advocates across the nation.
“[The proposal] probably came from people who don’t use wheelchairs,” said Duprey, who told the News she had not been contacted or consulted on the consortium. “Knowing what I know about Uber … I can’t imagine that there is any market where [using Uber to transport patients] would be hugely successful.”
Sheldon Toubman, staff attorney with the New Haven Legal Assistance Association and another signatory to the letter sent to the state, shared Duprey’s concerns on transportation. He told the News he is skeptical of the claim that the center will be able to coordinate rides — no smart phones required on the patients end — and, even then, he sees gaps in the plan, which depend on a specialized Uber plan, uberASSIST.
“UberASSIST doesn’t exist in Connecticut,” Toubman said. “It’s a proposal.”
Even if uberASSIST were implemented on time, the system would only be up to standard to those with foldable or collapsible wheelchairs or scooters, according to Toubman. Ubers would be unable to accommodate those with nonfolding aids, in addition to any patients who cannot transfer themselves from a wheelchair into a car without assistance.
In interviews with the News, Chair of Connecticut Health Policy Project Ellen Andrews as well as a Yale-New Haven primary care provider — who wished to remain unnamed for fear of retaliation by their employer but whose patients will be directly affected by the move — both said that it is unclear whether the Hospital fully understands how the consortium will affect patients who cannot drive.
Others, including Lizzy Fitzsousa MED ’21 as well as another Yale-New Haven primary care doctor and an internal medicine resident who both wished to remain anonymous, fearing retaliation from the Hospital, questioned the effectiveness of the proposed transportation plans to Long Wharf.
“[Transportation] was a very early concern, and it’s a little disturbing, frankly, that Yale-New Haven did not see that and apparently didn’t even consider this a problem.” Andrews told the News. “They’ve been playing catch up all along, and the [administration] clearly does not understand the lives of their patients.”
Last summer, the Hospital issued a transportation survey to patients, gauging how many drove to clinic. They found that two-thirds of their patients drove to clinic, and Senior Vice President of Operations Cynthia Sparer noted that parking fees posed a significant burden to patients. Sparer said at a public hearing that the consortium would offer roughly 250 free parking spots.
In an interview with the News, Sparer lauded the survey and said the survey “illustrated some very important points,” such as the burdensome parking fees. But of the seven questions listed on the survey — including how did you get here today, how will you get home today, have you ever missed a medical visit because of transportation costs and what neighborhood are you coming from — none of them asked patients about their primary care provider moving to Long Wharf, or how this would affect their ability to access their provider.
“It’s the one third that we’re worried about. It’s the people who walk, who take the bus, who got dropped off,” one of the primary care doctors told the News.
One of the primary care doctors and the internal medicine resident told the News that they were both unsure how the survey data could be extrapolated to understand patient transportation to Long Wharf, as this was not explicitly asked on the survey.
Of the four members of the Board of Alders contacted by the News, none claimed that they were engaged by the project’s planners on the issue of transportation solutions. Ward 21 Alder Steve Winter ’11 told the News that Cornell Scott Hill Health asked for feedback at one of the ward’s management team meetings.
But Ward 6 Alder Dolores Colón, whose ward will include the new proposed facility in Long Wharf, was aware of the plans to consolidate but not told the specifics. Two other alders, Ward 1 Alder Hacibey Catalbasoglu ’19 and Ward 8 Alder Aaron Greenberg GRD ’19 said they had not been engaged by any officials on the consolidation.
Michael Schaffer, the Yale-New Haven Hospital administration’s representative on the hospitals Patient Family Advisory Council, said that the Hospital had communicated with Alders, including Colón, about the consolidation. He did not clarify how many Alders had been interviewed.
“This process likely would lead to a higher quality, better product end result if patients and the community had been more effectively involved in the process,” one of the primary care doctors interviewed by the News said.
When asked if patient engagement with plans for the consortium has been adequate, the doctor responded, “Not at all. No.”
The Yale-New Haven Hospital opened in 1826, according to their website.
Marisa Peryer | marisa.peryer@yale.edu
Angela Xiao | angela.xiao@yale.edu
Correction, Feb. 3: A previous version of this article implied that Cornell Scott-Hill Health would close if plans for the consortium are approved. In fact, Cornell Scott-Hill Health will remain open.