Limited Review Application
State of New York Department of Health
Office of Primary Care and Health Systems Management
Project to be Proposed/Applicant Information
This application is for those projects subject to a limited review pursuant to 10 NYCRR 710.1(c)(5)-(7). Please check the appropriate
box(es) reflective of the project being proposed by your facility (NOTE – Some projects may involve requisite “Construction”. If so,
and total project costs are below designated thresholds, then both boxes must be checked and necessary LRA Schedules submitted).
Please read the LRA Instructions to ensure submission of an appropriate and complete application:
Minor Construction – Minor construction project with total project costs of up to $15,000,000 for general hospitals and up to
$6,000,000 for all other facilities, if not relating to clinical space – check “Non-Clinical” box below).
Necessary LRA Schedules: Cover Sheet, 2, 3, 4, 5, and 6.
Equipment – Project related to the acquisition, relocation, installation or modification of certain medical equipment, with total
project costs of up to $15,000,000 for general hospitals and up to $6,000,000 for all other facilities. (NOT necessary for “1-
for-1” replacement of existing equipment without construction, pursuant to Chapter 174 of the Laws of 2011 amending Article
28 of the Public Health law to eliminate limited review and CON review for one for one equipment replacement)
Necessary LRA Schedules: Cover Sheet, 2, 3, 4, and 5.
Service Delivery – Project to decertify a facility's beds/services; add services which involve a total project cost up to
$15,000,000 for general hospitals and up to $6,000,000 for all other facilities; or convert beds within approved categories. (If
construction associated, also check “Construction” above.)
Necessary LRA Schedules: Cover Sheet, 2, 6, 7, 8, 10, and 12. *If proposing to decertify beds within a nursing home,
provide a description of the proposed alternative use of the space including a detailed sketch (unless the decertification is
being accomplished by eliminating beds in multiple-bedded rooms). If proposing to convert beds within approved categories,
an LRA Schedule 6 and all supporting documentation are required to confirm appropriate space for the new use.
Cardiac Services – Project by an appropriately certified facility to add electrophysiology (EP) services; or add, upgrade or
replace a cardiac catheterization laboratory or equipment. (If construction associated, also check “Construction” above.)
Necessary LRA Schedules: Cover Sheet, 2, 7, 8, 10, and 12.
Relocation of Extension Clinic – Project to relocate an extension clinic within the same service area which involve a total
project cost up to $15,000,000 for general hospitals and up to $6,000,000 for all other facilities. (If construction associated,
also check “Construction” above.)
Necessary LRA Schedules: Cover Sheet, 2, 3, 4, 5, 6 and 7. Also include a Closure Plan for vacating extension clinic.
Part-Time Clinic – Project to operate, change services offered, change hours of operation or relocate a part-time clinic site
– for applicants already certified for “part-time clinic”. (If construction associated, also check “Construction” above.)
Necessary LRA Schedules: Cover Sheet, 2, 8, 10, 11, and 12.
OPERATING CERTIFICATE NO.
CERTIFIED OPERATOR
TYPE OF FACILITY
4102002H
Samaritan Hospital of Troy NY Inc
Hospital
OPERATOR ADDRESS – STREET & NUMBER
PFI
NAME AND TITLE OF CONTACT PERSON
2215 Burdett Avenue
756
Ted McCarthy, Director of Business Development
CITY
COUNTY
ZIP
STREET AND NUMBER
Troy
Rensselaer
12180
315 S. Manning Blvd
PROJECT SITE ADDRESS – STREET & NUMBER
PFI
CITY
STATE
ZIP
2215 Burdett Avenue
756
Albany
NY
12208
CITY
COUNTY
ZIP
TELEPHONE NUMBER
FAX NUMBER
Troy
Rensselaer
12180
5185258792
TOTAL PROJECT COST: $ CONTACT E-MAIL: ted.mccarthy@trinity-health.org
(Rev 09/2019)
LRA Cover Sheet
Application Documents
07/17/2023 4:41 PM
Application Number:
Facility Name:
Decertify all 15 Maternity beds and close the maternity unit
231352
Project Description:
Samaritan Hospital
NYSE-CON Project Application
Document Type Description DateFilename
LRA Cover Sheet lra_cover_sheet - Samaritan Maternity
060123.doc
06/14/2023LRA Cover Sheet
Schedule LRA 7 Proposed Operating
Budget
TM EDITS_SAM Women's
Closure_schedule_lra_7.docx
06/19/2023LRA 7
Schedule LRA 7 Attachment LRA 7 Attachment_Burdett Revenue
File.xlsx
06/19/2023Burdett Revenue File
Schedule LRA 8 Staffing SAM Women's
Closure_schedule_lra_8.docx
06/19/2023LRA 8
Schedule LRA 10 Impact on Operating
Certificate
schedule_lra_10.doc 06/19/2023LRA 10 - Sites Tab
Schedule LRA 12 Assurances SAM Women's
Closure_schedule_lra_12.pdf
06/14/2023LRA 12
Public Comment 231352 Public Comment Wright.docx 07/13/2023From Project Management:
Public Comment 231352 Public Comment Elected
Officials.pdf
07/05/2023From Project Management:
Submitted By: Mccarthy, Theodore
Submitted Date: 06/20/2023
1Page 1 of
07/17/2023 4:45 PM
NYSE-CON Project Summary
Application Number:
Project Description:
Facility Name:
231352
Samaritan Hospital
Decertify all 15 Maternity beds and close the maternity unit
General Information
Review Level:
Total Project Cost:
Application Type:
Project Status:
Application - Limited Review - Service Delivery
Received
Limited
$0.00
Acknowledgement Date:
Initial Review Date:
Received Date:
Project Status Date:
06/20/2023
06/26/2023
06/20/2023
Main Site Information
County:
Physical Address:
Facility Type:
7562215 Burdett Avenue
Troy, NY 12180
Hospital
Facility ID:
Samaritan HospitalFacility Name:
RENSSELAER Region: Northeast
2215 Burdett Avenue
Troy, NY 12180
4102002H
Current Operator County:
Samaritan Hospital of Troy NY Inc
Operating Certificate #:
Current Operator:
Contact Information
(518) 525-8792 315 S. Manning Boulevard
Albany, NY 12208
Director of Business Development
Email:
Title:
Phone:
Ted McCarthy
Address:
Fax:
Name:
Alternate Contact Information
[email protected]Name: Ted McCarthy Email:
1Page 1 of
Applicant View
SAM - IP Burdett
Grouping
Days Discharges
Commercial Fee for Service 1,322 682
Medicare Fee For Service 5 2
Medicare Managed Care 3 2
Medicaid Fee For Service 147 89
Medicaid Managed Care 1,429 801
Private Pay 61 38
Other 75 35
Grand Total 3,044 1,649
FY23YTDMay Annualized
LRA 7 Attachment
JOHN T. McDONALD III, RPh
Assemblymember 108
th
District
THE ASSEMBLY
STATE OF NEW YORK
ALBANY
CHAIR
Governmental Operations
COMMITTEES
Alcoholism and Drug Abuse
Higher Education
Health
Ways and Means
June 28, 2023
Dr. James V. McDonald
New York State Health Department Commissioner
New York State Department of Health
Corning Tower
Empire State Plaza,
Albany, NY 12237
RE: Project # 231352 Samaritan Hospital Burdett Birth Center
Dear Commissioner McDonald:
As elected officials at the city, county and state level that represent Rensselaer County as well as Albany County, we
collectively wish to share our strong opposition to the proposal submitted on June 20
th
by Trinity Health to permanently
close the 15 bed Maternity Ward at the Burdett Birth Center (BBC) at Samaritan Hospital in Troy, NY.
BBC is the only birth center located in Rensselaer County which serves patients not only in Rensselaer County but also
Columbia, Washington, and Albany County. Trinity Health, located in Livonia, MI, serves as the corporate headquarters
that oversees St Peter’s Health Partners (SPHP) which includes Samaritan Hospital in Troy, St. Peters Hospital in Albany,
St. Joseph’s Hospital in Syracuse, and many other health practices, health facilities and long-term care facilities throughout
the state of New York as well as many other entities throughout the country.
According to our conversations with Trinity, they were encouraged by the NYS DOH to notify elected officials of the
proposed change to close BBC. Accordingly, only some, but not many of the relevant elected officials, were notified on
June
13, 2023, only 24 hours prior to public notice. Since that time the many members of the community have been
understandably concerned and alarmed regarding this sudden news, as are the elected officials who serve these communities.
On June 26
th
, Trinity Health met with the elected officials below as well as a representative from the Governor’s office to
hear directly from Trinity on how this decision, without public or elected official input, came about. The reasons were varied
but focused on staffing, payer mix, and finances. We are all aware of the challenges that hospitals faced during the
pandemic and post pandemic. We are also aware that various lines of business that were once profitable to hospitals have
transferred to alternative options such as ambulatory surgery centers which have also met with community acceptance. We
realize that this has impacted the overall financial health of the facilities and that is not lost on any of us. That is a symptom
of a larger health care issue that requires a broader approach by government at the federal and state level.
During the discussion, we asked for specific examples of economic hardship. We share this as one example of the frustration
we are experiencing as we asked about reimbursement for a traditional delivery, without complications. We were advised
they are reimbursed $2,925 for a Medicaid Delivery, which cost BBC $3,300. However, we have been separately advised
that most Managed Care plans pay $3,400 on average, which covers the cost of services and allows for the 3% margin that
Trinity shoots for across all lines of care.
When asked about public engagement we received a muted response that we felt did not encourage broad public meetings
but isolated meetings. We collectively find this distressing as it indicates to us that they are not willing to defend their
decision and explain to the public why they are reneging on their commitment from 2011 to maintain maternity services in
Rensselaer County when the creation of SPHP first came to be.
When asked about transportation for those individuals in labor, we were advised that there would be a reliance on the
normal Medicaid transportation system, which we know is not geared towards emergency response. Both the City of Troy
Mayor and Rensselaer County Executive stressed that the EMS system is already overstressed in the county and that relying
on local EMS was a major concern.
There were many other questions and discussions shared by all on the call, which it is not productive to discuss in a letter in
great detail; however, there are several questions that we would like answered as this process moves forward. Specifically,
here is a sample list of questions asked but not answered that we find to be important to be reviewed and considered:
• What is the operating financial performance of each business unit of the Trinity Health System in New York State
for the last five years?
• What is the annual funding amount that Burdett, SPHP Albany and St. Joseph’s hospitals have paid to Trinity
Health for the last five years in management fees along with support and any capital fund contributions which may
have been required the past five years.
• What is the annual birth data for Burdett and SPHP Albany for the past five years? Of this figure what is the payer
mix, by payor, as well as the race of individuals who have delivered?
These are just a few of the questions we have asked for follow-up on, and we are still awaiting a copy of the presentation
they presented to us that has now been delayed by two days.
As it relates to financing, we stressed the following changes that are now in effect that can improve the financial health of
BBC:
• The recently passed New York State budget presented an increase of 7% reimbursement across the board for all
Medicaid claims for hospitals.
• The Federal Government has confirmed that the Capital Region will finally see by the end of this year a long
overdue in the Medicare Wage Increase which will mean Albany area hospitals will be reimbursed at 122% of the
national average, leading to an increase of reimbursement to Albany area hospitals by $192 million.
• As of July 1
st
, 2023, Medicaid redeterminations will be underway. It is expected that over 1,000 patients will fall off
the Medicaid rolls in the next year. This will mean patients will move to either commercial plans (which pay 60%
higher than Medicaid on average) or to the Essential Plan which is a low-income health plan for working families of
which there are plan options, based on income that either follow the Medicaid rate or the commercial plan rate. The
point here is that there is a reality that there may be a drop-off in payer mix for future births that needs to be
considered.
We have asked Trinity to reconsider their decision based on the new reimbursement opportunities that by their own words
will lead to sustainability in the next year.
We were surprised to hear the response from Trinity when we spoke of the unique and desired care by the midwives at
Burdett that this would not be an issue as they are using a health care transformation grant to build a new birthing unit in
Albany. To all of us this indicates that this decision was made not in the last six months but over the past two years. A
premeditated attempt to remove maternity care from Rensselaer County which is shameful considering the Capital Region
has also been known as the Tri-City area, inclusive of Albany, Troy, and Schenectady.
As you can see, we remain opposed to this proposed change. We are disappointed to find out that an amended Certificate of
Need (CON) has been submitted in an expedited manner with the expectation that discussion will focus on the closure plan.
This is totally unacceptable.
We request a meeting with you and your staff at the earliest opportunity to have further discussion. As community
representatives we deserve that opportunity to represent the concerns expressed by our communities and to also understand
the process moving forward and the public participation opportunities that will be presented.
In closing, we took a minute to review the Trinity website which speaks to their community values:
We actively engage with our communities and members to find what matters most to those we serve, and partner together
to develop solutions to improve the health and well-being of our communities, so that everyone can thrive and live their
best lives.
We agree with this statement and look forward to continued dialogue on this important facility and services in our
community.
Sincerely,
Hon. John T. McDonald III, RPh
Member of Assembly, 108
th
District
Hon. Jake Ashby
NYS Senator, 43
rd
District
Hon. Patricia Fahy
NYS Assemblymember, 109
th
District
Hon. Scott Bendett
NYS Assemblymember, 107
th
District
Cc: NYS Governor Kathy Hochul
NYS Attorney General Tish James
US Senator Charles Schumer
US Senator Kirsten Gillibrand
Congressman Paul Tonko
Congresswoman Elise Stefanik
Room 625 Legislative Office Building, Albany, New York 12248
PHONE: 518-455-4474 | FAX: 518-455-4727 |
EMAIL: mcdonaldj@nyassembly.gov
www.nyassembly.gov
Hon. Patrick Madden
City of Troy Mayor
Hon. Steve McLaughlin
Rensselaer County Executive
Ms. Mary Fran Wachunas
Rensselaer County Public Health Director
Rensselaer County Deputy County
Executive
From: Erin Wright
Sent: Wednesday, June 28, 2023 9:20 PM
To: Morley, John (HEALTH)
Subject: STOP the closure of the Burdett Birth Center
I am writing to ask that you do whatever is in your power to SAVE BURDETT BIRTH CENTER in Troy NY.
Burdett Birth Center provides essential Maternity Care to the community through a Midwife-led, OB collaborative
model of care. This model of care has statistically proven to produce the best outcomes for moms and babies.
I am deeply concerned about the negative effects this potential closure would have on the birthing people of
Rensselaer County and beyond.
If this egregious closure is allowed, it will leave the already-drastically-underserved city of Troy and the hundreds
of thousands of rural residents in the surrounding area without an acute maternity care facility. This will be a
disaster for public health and it’s yet another glaring example of how profit-driven healthcare is destroying
communities. This is not a Rensselaer County issue – it is a Capital Region and, truly, statewide and nationwide
issue of corporatization of healthcare at the cost of evidence-based, intervention-reducing and cesarean-reducing
maternity care.
BBC’s Cesarean Section rate is 15% entirely and 8.9% for the Midwife Group (Capital Region Midwifery).
Punishing Burdett Birth Center because they are practicing OB collaborative, midwifery-led care, which happens
to not produce the money from surgeries and procedures, is in direct opposition to New York State’s initiative to
improve care for underserved communities, of which Rensselaer, Albany and Troy are all included statistically.
While Burdett Birth Center is available to all members of the community, 51% of its patients are receiving
Medicaid and this closure will absolutely affect BIPOC and working class families negatively and
disproportionately.
I am urging you to do everything in your power to STOP THE CLOSURE of this vital birth center and protect the
people in our community.
Thank you.
Sincerely,
Erin Wright
Rensselaer, New York
Letter to New York State Department of Health Commissioner
James V. McDonald, M.D., M.P.H.
_________________________
RE: Burdett Birth Center (BBC)
Obstetrical Deliveries
December 21, 2023
1
Table of Contents
Letter to Commissioner McDonald
Overview
Care Transitions
Appendices:
Appendix A: NYS Dept. of Health Closure Checklist
Appendix B: Patient Notification Letter
Appendix C: List of Providers
Appendix D: St. Peter’s Health Partners Communication Plan
Appendix E: Health Equity Impact Assessment by Chartis
2
December 21, 2023
James V. McDonald, M.D., M.P.H.
NYS Department of Health
Corning Tower, Empire State Plaza
Albany, NY 12237
Dear Commissioner McDonald,
Samaritan Hospital, one of two acute care facilities that is part of St. Peter’s Health Partners
(SPHP), is a 257-bed community hospital in Troy, New York, with a rich history of serving Troy
and the Capital Region. In this Limited Review CON application, we seek approval of our
transition plan to close Samaritan’s 16-bed maternity unit.
From 2011 – 2020, the Samaritan Hospital maternity unit was a separate hospital, the Burdett
Care Center (later renamed Burdett Birth Center). It was formed in 2010 as part of the
agreement that created St. Peter’s Health Partners. The Burdett Birth Center has operated at a
loss since its inception due to declining births, a high Medicaid population coupled with low
Medicaid reimbursement rates, declining referrals, and exceptional expenses (especially high
malpractice expenses). In recognition of the financial fragility of Burdett Birth Center, NYS
Dept. of Health granted it only a three-year operating certificate renewal in 2016.
By 2019, Burdett Birth Center was nearly insolvent. To preserve maternity service in Troy,
Samaritan Hospital proposed acquiring Burdett Birth Center, absorbing its losses for the near
term, and trying to improve its finances. Burdett Birth Center merged with Samaritan in 2020,
right before the pandemic.
Unfortunately, in the wake of COVID-19, conditions have worsened. The factors mentioned
above – declining births, low Medicaid payments, and declining referrals, continue to strain the
Samaritan maternity service. In the recent past, Samaritan might have been able to continue to
absorb such losses to preserve the service. But Samaritan and the rest of the health system
operated by SPHP are experiencing significant post-COVID financial stress and can no longer
absorb maternity service losses of this magnitude.
To make matters worse, the severe healthcare worker shortage has significantly impacted the
maternity service. In 2023, Samaritan Hospital and its staff obstetricians had to redirect or
transfer expectant mothers to other hospitals due to insufficient staffing at a rate of
3
46/month. By comparison, in 2022, the number of mothers redirected or transferred was only
23/month. In short, the rate of cases moved from Samaritan Hospital has doubled.
After consultation with NYS DOH officials, SPHP and Samaritan leaders began communicating
with local leaders and interest groups to develop a closure plan that integrates and reflects the
information and guidance of such individuals and groups. We engaged The Chartis Group for
our Health Equity Impact Assessment, and we continue to engage stakeholders individually and
in meetings like the Town Hall we held on November 9, 2023. We were gratified that the event
enabled us to emphasize our strong commitment to the Troy and broader Rensselaer County
communities, and it appeared to allay some of the anxiety over the closure. The closure plan
integrates stakeholders’ feedback and addresses the factors listed in the recent health equity
impact assessment legislation. Our completed health equity impact assessment has been added to
this application.
In closing, it should be noted that the Capital Region is fortunate to have several options for
individuals who expect to deliver a baby, including St. Peter’s Hospital, Albany Medical Center
Hospital, and Bellevue Birth Center (part of Ellis Hospital). SPHP and Samaritan Hospital will
continue providing prenatal, postnatal, and gynecological care in Troy, along with several other
providers.
Samaritan Hospital and St. Peter’s Health Partners have given much thought and planning to
provide and continue comprehensive services to women of all ages in Albany and Rensselaer
Counties, and we appreciate your assistance in moving this plan forward. I can be reached at the
phone number below should you have questions. We look forward to working with the
Department on this transition.
Sincerely,
Kim Baker
SVP, Hospital Operations
(518) 525-1491
Overview and Rational to Discontinue
Obstetrical Deliveries at
Burdett Birth Center
Our experience with the Burdett Birth Center, along with the impact of numerous market forces,
informed Samaritan Hospital’s and SPHP’s decision to transition birthing services to St. Peter’s
Hospital, and close the maternity unit at Samaritan Hospital:
Burdett Birth Center History:
The Burdett Birth Center, initially known as the Burdett Care Center, was established as a
hospital operator by the Public Health and Health Planning Council (PHHPC) in 2011. The
transaction forming Burdett Birth Center allowed for the affiliation of Northeast Health with St.
Peter’s Health Care Services and Seton Health System, creating the new health system St. Peter’s
Health Partners (SPHP). Burdett was organized as a separate not-for-profit corporation with its
own board of directors and no corporate relationship with Samaritan Hospital, SPHP, or SPHP’s
parent, Catholic Health East (later Trinity Health Corporation). To help launch the new
maternity hospital, Samaritan provided it with $5 Million in start-up funds in a trust. It also
conveyed the physical space of its maternity unit to Burdett as a condominium unit with a no-
interest mortgage. Burdett also contracted with Samaritan Hospital to provide an array of
administrative services at cost.
The initial operating certificate was for only five years because, from the outset, the New York
State Department of Health (DOH) had questions about financial sustainability. Since its
inception, Burdett has operated at a loss due to declining births, low Medicaid reimbursement
rates for a high Medicaid population, declining referrals, and exceptional expenses (especially
high malpractice expenses). In recognition of the poor financial trend of Burdett Birth Center,
DOH granted it only a three-year operating certificate renewal in 2016.
By 2019, Burdett Birth Center faced insolvency. They were never able to break even, failed
financially despite SPHP writing off the lease and expense payments that were owed, and the
BBC Board was unable to find a sustainable solution to the problem. To preserve maternity
service in Troy, Samaritan Hospital proposed acquiring Burdett Birth Center, absorbing its losses
for the near term, and trying to improve its finances. With DOH and PHHPC approval, Burdett
Birth Center merged with Samaritan in 2020, right before the COVID-19 pandemic.
5
Staffing:
The effects of the COVID-19 pandemic on the nationwide healthcare workforce are well-
documented, and SPHP and Samaritan Hospital are not immune. We are contending with a
global healthcare workforce shortage. Staffing shortages and burnout have tested our limits, but
we remain steadfast. The transition of birthing services to St. Peter’s Hospital is a strategic move
to help our health system navigate the storm, ensuring optimal patient experiences and
sustainable care.
Samaritan Hospital’s maternity unit is generally staffed with 30 full-time colleagues and 15 part-
time/ per diem roles, but it has faced increasingly significant challenges to consistently providing
an optimal patient experience post-COVID. The unit has also been without a manager since
December 2022. From January 2021 to August 2023, 31 staff members left Burdett to work in
another hospital area, and 37 left the organization altogether. One of its three obstetricians also
resigned, and we have not been able to successfully recruit a full complement of physicians to
support Samaritan OBGYN services for many years. The maternity unit has consistently had to
rely on internal and external agency nurses to provide care. The January 2024 staff schedule is
nearly complete, but February and beyond require situational planning. Short and long-term
birthing strategy plans have been created for when the unit cannot sustain core staffing for 75%
of the pay period (2 weeks).
When BBC cannot sustain core for 75% of a pay period scheduled c-sections, versions, and
inductions would be scheduled at St. Peter’s Hospital. Providers would evaluate each patient
with awareness of current staffing/capacity and direct their patient where to proceed for
evaluation. Patients arriving without contacting their provider would be assessed, and an
appropriate care plan would be implemented, including safe redirect or transfer. BBC will
continue to handle surges in volume/acuity as they have, managing case by case with the Charge
RN and OB provider determining where the patient should be directed. When they can no longer
consider case by case due to staffing, all patients will be re-routed to St. Peter’s Hospital, and
Samaritan providers will remain the attending of record. All patients, including those in
ambulances, will be diverted to St. Peter’s Hospital, and the OB provider will determine if s/he
can remain the attending of record or if the St. Peter’s OB service needs to assume care of the
patient.
In 2022, faced with significant recruitment and retention challenges, SPHP’s dedicated
anesthesia group was forced to consolidate its providers into serving St. Peter’s Hospital only,
because of recruitment and retention problems the group was experiencing. SPHP responded by
forming its own employed anesthesia group. Staffing of that new group has been extremely
difficult, as has staffing of other clinical positions. While emergent Cesarean sections can be
performed at Samaritan, Troy obstetricians and their patients have most often chosen to have
non-emergent Cesarean sections performed at St. Peter’s Hospital, because of more dependable
anesthesia staffing. Also, because of limited OB physicians and anesthesia available for in-
6
hospital coverage overnight, patients desiring a Trial of Labor After C-section (TOLAC) have
had to have their deliveries moved to St. Peter’s.
Hospital Transfers and Other Redirecting of Care:
Nurse vacancies frequently necessitate transferring laboring mothers to another hospital.
Ambulance crews are also informed of the situation and divert OB patients to St. Peter’s. At
times, the Samaritan unit is at capacity based on the staff on duty, requiring the OB providers to
redirect patients to St. Peter’s Hospital. Scheduled procedures (c-sections and inductions) are
also reviewed and either re-scheduled to another day at Samaritan or moved to St. Peter’s
Hospital. In 2023, Samaritan needed to transfer laboring mothers or otherwise redirect care to
other hospitals because of staffing shortfalls at a rate of about 46 per month, double the rate in
2022. This is not best practice for patient care, and it is not what expectant mothers want.
Reduction of these transfers and redirected cases will improve patient experience and reduce the
use of emergency transport resources, which are already strained.
By consolidating maternity services at St. Peter’s Hospital, the possibility that the expectant
mother would need to be transferred to another hospital due to staffing challenges is mitigated. It
will also reduce the need to transfer a newborn who needs NICU services. Delivering at St.
Peter’s Hospital increases the likelihood that both mother and newborn can remain in the same
facility, should there be a need for an additional level of care or services.
Equitable Options for Women:
While deliveries will cease being performed at Samaritan Hospital, we will maintain all other
prenatal, postnatal, emergency, and pediatric services currently being provided in the City of
Troy and Rensselaer County. Samaritan will continue to operate ob-gyn and midwife practices at
their present locations; there is no need to find a new provider or practice. Patients will continue
to receive care without interruption.
We are committed to securing accessibility to safe care for all who seek it - especially the most
vulnerable members of our community. We will establish a safe delivery plan for all patients
entering our care and address transportation for those needing it during their first prenatal
visit. Transportation is more specifically addressed later in this document.
We appreciate the concerns regarding this decision's effect on people of color and underserved
communities, as documented in the health equity impact assessment and expressed at various
forums and in the media. Addressing health equity is an integral part of SPHP’s mission and
strategy, and this closure plan is intended to mitigate any adverse effects.
7
St. Peter’s Health Partners has a long history of excellence in caring for the health needs of all
women in the Capital Region. While birthing services shift, all other essential services in Troy
and Rensselaer County remain. We prioritize accessibility to safe care, addressing concerns
about the impact on underserved communities. Health equity is a cornerstone of our mission.
Birth Rate and Delivery Trend:
Births in the Capital Region have steadily decreased from 8,437 in 2013 to 8,081 in 2022. The
average birth rate is expected to decline by 5% in 5 years and 9% in 10 years. With this trend, the
Capital Region will have more maternity beds than needed.
Of birthing persons who reside in Rensselaer County, 75% give birth in Albany County.
Deliveries at Burdett Birth Center were 1,182 or 14% of the region’s market share in 2013 and
decreased to 881 or 10.9% in 2022.
The complexity of maternity cases continues to be impacted by societal factors, including the
later age of conception and the increased prevalence of obesity, diabetes, and hypertension
among the pregnant population. As a result, a larger portion of the dwindling number of
pregnancies are high-risk and require care in more sophisticated centers, like St. Peter’s Hospital
and Albany Medical Center. Combined with an overall decline in birth rate, these trends
accelerate the decline in the number of patients whose pregnancies are appropriate for delivery in
centers like Burdett.
Financial Losses and Health System Sustainability:
The financial viability of Burdett was a concern for more than a decade, and we made every
attempt to ensure its survivability — including writing off debt, absorbing losses, and deferring
collections owed to Samaritan. Since the merger of Burdett into Samaritan, financial problems
have been further compounded by staffing shortages, low utilization, and declining birth rates
that mirror those occurring nationwide during the pandemic. In fiscal year 2023, the operating
losses incurred through the operation of the Samaritan Hospital maternity services unit, including
staff, supplies, providers, anesthesia, and fixed costs, totaled $2.7 million.
The challenges faced by the health system operated by SPHP are much more significant than
those presented by financial losses on this one service. SPHP has been forced to take other cost-
cutting measures too, including consolidating some physician practice locations and
discontinuing some higher-cost, lower-reimbursement hospital procedures.
We recognize that DOH is well aware of the macroenvironmental forces affecting healthcare
providers in New York State, which have a significant impact on the decisions our health system
must make. These forces include:
8
• The inexorable shift of inpatient care to outpatient care, which has obvious health and
societal benefits, erodes the financial bedrock of many not-for-profit health systems, like
SPHP.
• The costly race for technological advancement and the need for rapid investment to avoid
obsolescence.
• Competition from private equity start-ups, which seek disruption of the healthcare
marketplace and the pursuit of profit but which do not always work for the long-term
healthcare needs of our communities. Health systems like SPHP must remain the safety
net for the poor and underserved.
• The growing percentage of our patient population covered by government payers like
Medicare and Medicaid fail to cover our costs, necessitating more drastic cost-cutting
efforts.
The Decision:
Samaritan Hospital’s Board of Directors’ decision to propose the closure of the Burdett Birth
Center was difficult and not made lightly. A formal discernment process preceded the Board’s
approval. The discernment was conducted by a group of 15 participants, including various
operational, financial, human resources, and mission leaders, plus one of our independent Board
members, with two meetings held over a month. In reviewing the closure proposal, the central
question focused on how the proposal aligned with SPHP’s mission and core values. Various
concerns were raised, not unlike those raised by many community members, such as how Troy
citizens would access delivery services and maintain the presence of our obstetrical and midwife
providers in Troy. Subject to the taking of various measures intended to maintain access,
discernment participants determined that approval of the proposal was consistent with the values
and mission of Samaritan Hospital and SPHP and would help to preserve other services. This
discernment was reported to the Board, and it helped to inform the Board’s decision.
9
Care Transitions
Since we announced our proposal to consolidate the maternity unit at Samaritan into St. Peter’s
Hospital in June, we have continually communicated our position to leaders, residents,
community groups, and media outlets across the region through numerous individual, group, and
community-wide meetings. We understand and appreciate all the concerns raised by internal and
external stakeholders and continue to be mindful of the effects of changes in the healthcare
system on the communities we serve. That is why, even though it was not initially required, we
proactively agreed to perform a health equity impact assessment and, following the guidance of
the DOH, engaged the services of an independent, external agency with a health equity focus to
complete the assessment. Information about stakeholder meetings held from June through
November 2023 is available upon request.
St. Peter’s leaders hear and respect people’s concerns about the anticipated issues and barriers to
services they believe the closure will bring about and have been, and will continue, working to
mitigate those circumstances. We recognize that closure will mean many things for many people,
including a different commute to the birthing center of their choice, transportation challenges,
and concern about and confidence in their continuity of care after closure. While deliveries will
cease being performed at Samaritan Hospital, we will maintain all other prenatal, postnatal,
emergency, and pediatric services currently provided in the City of Troy and Rensselaer County.
Samaritan will continue to operate ob-gyn and midwife practices at their present locations.
Our obstetrical and midwife providers in Troy will advise their patients that they perform their
deliveries at St. Peter’s Hospital, and patients will have the option to seek other providers if they
prefer to have their delivery at Albany Medical Center or Bellevue Woman’s Center. St. Peter’s
Hospital has room and will be able to accommodate the Samaritan expectant women, offering a
collaborative multidisciplinary doula/midwife/ob-gyn model of care and a full range of maternity
services. At Samaritan Hospital, there has always been the possibility that mother and baby will
become separated in the immediate postpartum period if the baby requires a higher level of care.
This possibility is significantly reduced at St. Peter’s, with the availability of its neonatal
intensive care unit near the maternity unit, which is better for mother and baby.
We understand that transportation can be challenging for birthing persons in the City of Troy
who are in labor. Of course, transportation to Samaritan Hospital is presently a challenge for
some laboring mothers, too. Nonetheless, what may have been a 5-minute or 10-minute drive to
Samaritan Hospital may become a drive of more than 20 minutes to St. Peter’s Hospital or an
alternate facility. Individuals will develop their birth plan with their OB provider on the first visit
and determine where the birth will take place. If they choose to deliver at St. Peter’s Hospital,
they will have the same unique choices, including midwives, offered at Samaritan and can
arrange a maternity unit tour. Samaritan OB patients are encouraged to enroll in prenatal classes
and will be referred for doula support and the Healthy Families and MOMS Programs. Their
10
transportation needs are also assessed and considered for their birth plan. Each plan will include
arrangements for transportation to deliver for those who need it.
Samaritan/St. Peter’s Health Partners will continue to provide 100% of the services to 100% of
the patients we’re currently serving. The only thing impacted by this decision is the delivery site;
all our patients will continue to receive care without interruption.
Since 2021, St. Peter’s Health Partners has participated in the NYS Dept. of Health Birth Equity
Improvement Project and developed a close working relationship with BirthNet, a birth justice
organization in Albany, NY, whose mission is to eliminate the inequities in birth outcomes for
all childbearing people and to ensure that all birthing families receive respectful and supportive
maternity and infant care. With grant funding contracted from BirthNet, St. Peter’s successfully
piloted doula services at St. Peter’s Hospital’s birthing center. Additional grant funds were
awarded in July and November 2023 to support the creation of our SPHP doula program.
Doula care is an important yet underused resource in improving maternal health equity. Doulas
are certified, non-clinical healthcare personnel who provide physical, emotional, and
informational support not only during labor and delivery but also to pregnant and postpartum
mothers. Utilizing doulas amplifies the voice of Black, Indigenous, and People of Color (BIPOC)
birthing people by recruiting, training, and employing BIPOC individuals, ensuring that free
doula services are available to birthing people, especially those from marginalized communities
regardless of socio-economic status. They provide support by offering breathing techniques
during labor, empowering mothers to advocate for their healthcare preferences, facilitating
communication with providers, sharing guidance with mothers’ loved ones, and providing
breastfeeding assistance.
Robust evidence demonstrates the benefits of doula care for mothers and infants. For mothers,
doula care is associated with increased maternal engagement and higher satisfaction with care.
Additionally, babies whose mothers received doula services are less likely to have low five-
minute Apgar health scores at birth. Doulas are scheduled for shifts at the hospital's labor and
delivery unit and are assigned to patients as needed. If someone comes to the hospital without a
support person but would like assistance, a doula will be provided for them. Doulas will support
patients through vaginal birth, cesarean birth, or miscarriage in the hospital.
The Healthy Families Program of Rensselaer County, based at Samaritan Hospital, is a
nationally accredited, evidence-based, voluntary home visiting model designed to provide
services at no cost to families that begin prenatally, or at birth, through age five, when they are
most in need of and receptive to services. They use an infant mental health/relational
development approach that promotes parent-child attachment to achieve their mission of
preventing child abuse, neglect, and other adverse outcomes. Home visiting programs target
11
services to lower-income pregnant or new parents and their young child(ren). Depending on the
family's unique needs, they directly provide or connect families with parenting coaching, health,
mental health, or other services.
The St. Peter’s MOMS Program (Maternal Obstetric Mentoring Services), located within
Samaritan OB/GYN, strives to improve birth outcomes for OB patients by providing pregnancy
education, nutrition counseling, one-on-one childbirth, breastfeeding education, and prenatal and
postpartum support while addressing patients' social needs. MOMS is already aligned with our
goal of improving birth equity outcomes. With grant funding, doula services will also be
available to MOMS patients beginning in January 2024. Any pregnant person, regardless of age,
insurance, or immigration status, can participate, and there is no cost for MOMS services.
Transportation:
OB patients are encouraged to make transportation arrangements as part of their birth plan when
necessary. In emergent situations, when the birthing person calls 911, Troy Fire Dept. and/or
Mohawk Ambulance currently bring them to Samaritan Hospital, and there is concern that
bringing the pregnant person to Albany or Schenectady hospitals will increase both time and
mileage and keep ambulances waiting in the ambulance bay area for up to 2.5 hours. After the
Burdett closure, if transported to Samaritan emergency departments (Albany or Troy campuses),
the birthing person will be taken as a priority patient and brought to a room immediately, and if
brought to St. Peter’s Hospital, will be directly admitted to maternity. The ambulance will not be
held in the bay and will be released back to their home base.
Samaritan emergency department providers at both the Troy and Albany Memorial campuses can
manage any laboring person who may present in the emergency department. Should a person
deliver in Samaritan’s emergency department and need to be transferred to St. Peter’s Hospital, it
would typically require two ambulances with mother and baby traveling separately. For a better
mother/baby experience and to cut down on the number of ambulances needed after Burdett’s
closure, St. Peter’s Health Partners has purchased Neonate Medical Wraps in various sizes for
both of Samaritan’s emergency departments (Troy and Albany Memorial campus). The tube-top
device securely holds the baby in a frog leg position against an adult chest without interfering
with adult transport seatbelt protection. Wrapped securely with skin-to-skin contact, baby’s
transport risks are significantly reduced, while the benefits include keeping baby warm, reducing
stress, providing access to food that is otherwise unavailable in an ambulance, and, of course,
increased physical safety.
SPHP recognizes that traveling to St. Peter’s or other hospitals for delivery could be a challenge
for some patients, and again, will be highly encouraged to arrange ahead of time.
12
There are three delivery centers within a reasonable distance of Samaritan Hospital:
St. Peter’s Hospital (22 minutes/15 miles away)
Bellevue Woman’s Center (21 minutes/13 miles away)
Albany Medical Center (18 minutes/11 miles away)
SPHP currently screens for transportation access across the system and is exploring ways to
expand that further. St. Peter’s Health Partners held discussions with several companies for
patient transportation options/assistance, including Troy Fire Department, Mohawk Ambulance,
Roundtrip, Ambulanz, Tech Valley, Uber, and Lyft.
St. Peter’s Health Partners is seeking to contract with Roundtrip for non-emergent patient
transportation assistance needed, including birthing persons. Roundtrip is a transportation
solution that leverages end-to-end integrations to route rides to the appropriate transportation
company simply and efficiently. It accesses any vehicle type (Lyft, Uber, taxi, medical car,
wheelchair van, BLS, ALS, SCT/CCT, etc.) and works with any payor type (facility, rider,
Medicare, Medicaid, private insurance).
Tech Valley has also agreed to be a non-emergent patient transportation option, from planned to
urgent care appointments, and is available 24/7/365 with advanced notice. St. Peters Health
Partners already utilizes Medicaid transportation services and has had a contract with Lyft for
some time.
Lodging for high-risk patients:
Lodging at the Ronald McDonald House and St. Peter’s Hospital’s Becky’s House can be
coordinated for high-risk expectant mothers who must be close to St. Peter’s or Albany Medical
Center Hospitals as they prepare to deliver. Samaritan OB providers, St. Peter’s Care
Coordinators (C3), and social workers will share the list of high-risk patients with the labor and
delivery supervisor and can make those arrangements as needed. Ronald McDonald House is 1.6
miles from St. Peter’s and 0.4 miles from Albany Medical Center. Becky’s House is 0.25 miles
from St. Peter’s Hospital and 1.7 miles from Albany Medical Center Hospital. Transportation
will be arranged to those 2 locations for lodging if necessary.
Staffing:
St. Peter’s Hospital can absorb all deliveries now performed at Samaritan Hospital. St. Peter’s
will offer all the patient-centered services Samaritan does as well as the benefits of 24/7 in-house
newborn care, neonatal intensive care unit, 24/7 in-house obstetrical care, 24/7 in-house
anesthesia care, and a fully staffed and stocked blood bank. All Samaritan OB providers have
privileges at St. Peter’s Hospital. Samaritan emergency department providers at both the Troy
and Albany Memorial campuses can manage any laboring mothers who may present in the
13
emergency department. Staff have been and continue to be provided with additional education,
simulations, and drills for competencies.
By bringing the highly trained staff at Samaritan to St. Peter's maternity, we can tap into the
expertise of midwives and other birthing caregivers whom the community has grown to rely on
and trust during their birthing journey. These birth models in a centralized location will further
enhance a program long recognized for its excellence. In 2023, St. Peter’s Hospital was
recognized as a “Best Hospital for Maternity Care” by U.S. News & World Report, the only
hospital in the Capital Region to receive the designation. This is a direct result of our highly
skilled and compassionate doctors, midwives, physician assistants, nurse practitioners, nurses,
and other colleagues, and our dedication to creating a space where women and their families
know they are valued, they are heard, and they will be cared for today and well into the future.
St. Peter’s Birthing Center Capacity:
We have been examining and revising our surge capacity planning for St. Peter’s Hospital
units. We are fortunate to have cross-trained staff caring for laboring patients or post-partum
couplets. We also have a level 3 NICU at SPH for infants needing a higher level of care,
minimizing the separation of the family. The flexibility of our nursing colleagues and creative
staffing strategies have allowed us to utilize space across the division better and enhance the
progression of care, specifically in our 39-bed maternity unit.
In addition to the available space, we have acquired five additional patient beds on the same
hospital floor as the rest of the division. The SPH Labor & Delivery unit is undergoing a
beautification project, requiring the closure of the rooms being renovated. We obtained five extra
bed spaces to serve as swing spaces during the renovation to anticipate that impact. Those rooms
will be permanently added to our unit footprint and become our triage area. These additional
rooms and the better utilization of space across the division increase our capacity to care for the
new volume. This new surge plan will support us to care for 12 births daily. The St. Peter’s
Hospital Birthing Center renovation project is being completed in phases, with an anticipated
completion date of October 2024.
15
Burdett Birth Center and St. Peter’s Hospital Model and Plan for an Integrated
Maternity Service
Given the background and overview of the rationale for Burdett Birth Center (BBC) to
transition obstetrical deliveries to St. Peter’s Hospital (SPH), the Executive Team at St.
Peter’s Health Partners and SPH's obstetrical department has been developing a
sustainable model and plan to support OB/GYN care for birthing people in the
surrounding Capital Region communities and beyond. The plan for maternity care is to
provide prenatal and postnatal care at Samaritan Obstetrical Offices, while the actual
labor and delivery will be performed at SPH. St. Peter's Health Partners will continue
providing the Maternal Fetal Medicine (MFM) Program for high-risk expectant patients.
The following is the model with a detailed plan that Burdett Birthing Center and St. Peter’s
Hospital have developed to transition Samaritan maternity services to St. Peter’s Hospital.
Model Overview
Pre- and postnatal care will remain at Samaritan OB clinics provided by the same
experienced team of midwives and obstetricians with whom women have built
relationships over the years. Dr. Ken Baker will remain the Chief of OB/GYN for St.
Peter’s Health Partners. He will continue to ensure the coordination of care for patients
and provide oversight for prenatal and postnatal care for pregnant women at BBC and
the labor and delivery at SPH. Dr. Ryan Cuff oversees the SPHP Maternal Fetal
Medicine (MFM) Program.
The following comprehensive information and processes will be provided to expectant
mothers and providers to ensure the success of the model:
Prenatal
•
Prenatal care will include the following education topics provided during routine
office visits by SAM OB licensed midwives and physicians. For more in-depth
and specific information, clients will continue to be referred to SPHP prenatal
class offerings for:
o
Childbirth
Education
o
Breastfeeding care and support groups
o
Infant care
o
Sibling classes
o
Trial of Labor after a C-section
o
C-section
16
•
The SAM OB providers, along with the expectant person, will make a birth plan
for delivery by the 24
th
week of pregnancy.
If a patient plans to deliver in a location
other than St. Peter’s Hospital the SAM OB provider
will assist the patient in locating
an obstetrical provider/practice so that care can be transitioned to that provider and
place of delivery.
•
SAM OB providers are always available when questions arise regarding labor or other
physical concerns during pregnancy for current patients but also for those who arrive at
the Samaritan Hospital emergency department and do not have an OB provider of record.
This includes after-hours and on weekends. The SAM OB physicians will continue to
provide consultative services for SAM Midwife practice.
•
A Social Worker (SW) can be consulted via SAM OB offices to assist clients in
navigating
their birth plans. The SW/Licensed Midwife/OB Physician will encourage
families to register online or coordinate with the Program Liaison at SPH t
o attend the
expectant parents' tour of the SPH obstetrical units.
•
A
Maternal Fetal Medicine
program will be offered on-site at the 400 Patroon Creek
Medical Office Building in Albany and one day per week at the Samaritan Medical
Office Building. An MFM physician will be available to provide high-risk care and
will have the capability to access the electronic medical record. High-risk patient
needs will be shared with the Labor and Delivery supervisor in the patient’s last
trimester.
•
As an option, clients with a history of high-risk or precipitous deliveries could meet the
criteria
to stay at the Ronald McDonald House or SPHP-affiliated Becky’s House at 39
weeks or greater to ensure proximity to the SPH labor and delivery unit. The SW/SPH
Clinical Care Coordinator (C3) will assist with arrangements if requested. This will
require the provider's medical indication.
•
Clients determined to need a scheduled procedure (c-section, induction, external
cephalic version, or D&C) will continue to follow current scheduling practices at
SPH (pre-admission testing).
•
Should patient care need to be transferred to the SPH OB service provider, the
electronic medical record is also available to credentialed providers.
Delivery
•
The patient will be instructed to go directly to SPH's labor and delivery unit when the
patient and SAM OB provider expect delivery.
•
The expectant mother can speak with her SAM OB provider about a planned
induction of labor if the patient is concerned about the distance to SPH.
•
The social worker or SPH C3 will assist clients with transportation issues in locating
resources to ensure a safe and timely trip to SPH.
•
The patient is instructed to call her SAM OB provider when she suspects she is in
17
labor. The SAM OB provider has a direct line to SPH's labor and delivery unit to
alert the unit of the patient's imminent arrival. The communication to SPH will also
provide continuity of care.
•
When the patient calls the SAM OB provider indicating an imminent delivery, the
patient will be advised to go to the nearest ED to be evaluated.
•
When the patient delivers in the ED, if medically stable, the mother and baby will be
transported by ambulance to SPH for further treatment and evaluation. Otherwise,
each may need separate transports.
Post-Partum
•
Once the baby is delivered at SPH, the newborn will be evaluated by a Community
Pediatrician who provides hospital coverage or by an SPH pediatric hospitalist. After
discharge, the baby is cared for by a community pediatrician practice as designated by
the parent.
•
Post-partum, the baby's records will be sent via secure fax to the indicated community
pediatric provider. Maternal records will remain accessible via the same electronic
health record as the pre-natal period.
•
The patients will be instructed that there is no reason for a return visit to SPH unless
there has been a complication associated with the delivery.
•
SPH nursing leadership will continue to complete patient rounds to inquire about
patient satisfaction with the integrated birth model and to obtain feedback to improve
the model. SAM OB providers will communicate any concerns or feedback they
receive regarding the patient’s experience.
Planning with the SAM Emergency Department (ED)
•
Katrina Kardos, MD, ED Lead Physician at SAM, and Ken Baker, MD, Chief of
SPHP OB/GYN, discussed a plan of action for patients who present to the ED and
are pregnant. The ED Physician has access to the SAM OB providers.
•
During office hours, SAM OB providers can perform a Non-Stress Test (NST). A
Biophysical Profile (BPP) can also be completed in the SAM Radiology Department
Ultrasound when ordered.
•
During off hours and weekend hours, SAM OB providers remain available for
consultation for patients without an OB provider or for their patients of record.
•
ED education plan:
o
ED providers and Nurse Team Leaders are receiving training in neonatal
resuscitation.
Drills/simulations to be completed.
o
Management of precipitous delivery
18
o
Observations of vaginal births taking place at Burdett Birth Center (requires
patient permission) as individually arranged prior to closure.
o
Management of OB hemorrhage scenarios
o
Management of hypertensive (HTN) emergencies of pregnancy
•
Patients who are less than 23 weeks pregnant, and presenting to the ED will be
evaluated and admitted to observation status and the rapid decision unit for short-
stay continuous monitoring. Patients requiring inpatient services who are 23 weeks
or greater will be transferred to SPH. Any patient requiring fetal monitoring will be
transferred to SPH when greater than 23 weeks gestation.
19
St. Peter’s Hospital Model for an Integrated Women's Health Service
Summary of Information and Processes
Action/Situation
When
Who is involved
What/Where
Develop Birth Plan
By 24
weeks of
pregnancy
Patient and SAM OB provider
Determine where the
birth will take place: at
SPH or other facilities of
the patient’s choice
Prenatal education
Encourage
patients to
enroll for
prenatal
classes and
tours during
3
rd
trimester
Patient, Social Worker, OB
office manager, SPH Program
Liaison, and/or SAM OB
providers.
SAM OB referral for Doula
support.
SAM OB offices refer to the
Healthy Families Program or
MOMS Program
Breastfeeding, Lamaze,
Crib notes (infant care),
Family & Friends CPR,
Trial of Labor after
Cesarian (TOLAC), C-
section.
Classes and tours require
registration. Financial
assistance is available.
Questions regarding
labor/delivery
Anytime
SAM OB providers
Contact the provider for
answers
Tour of SPH maternity
units
Posted
schedules
Program Liaison at SPH (518
525-1388)
Register online at
SPHP.com/maternity
Educators provide tours
of the L&D unit and PP
unit.
High-Risk Care
Upon
meeting
criteria
Obstetrician or licensed
midwife makes referral to
Maternal Fetal Medicine
Pt seen by Maternal Fetal
Medicine at 400 Patroon
Creek, in Troy office, or
at St. Peter’s Hospital
Concern about travel
with high-risk delivery
39 weeks
SAM OB Providers, Social
Work, SPH C3
Communicate high-risk list to
L&D supervisor
OB offices, Case
manager, and Social
Worker can coordinate a
stay at Ronald McDonald
House or Becky’s House
near SPH (transportation
options defined in the
birth plan)
Transportation issues to
SPH
For delivery
SAM OB provider office
manager, SW, SPH C3, SPHP
Community Benefits, Healthy
Families, MOMS Program
Transportation needs will
be assessed. (Car,
ambulance and/or other
transportation) Birth plan
will be taken into
consideration in planning
transportation.
Patient is in labor
Labor is
underway
Patient and SAM OB provider
Patient to call OB
provider and is advised to
go to SPH or other
planned hospital for birth
(Bellevue, AMCH)
20
SPHP Guidance for Providers and Specific Scenarios
*Please utilize SAM OB providers for patients presenting to SAM ED, who do not have an
OB attending of record. Patients presenting to AMH ED, contact SPH OB.
Scenario
Weekday
OFF-HOURS
SAM or AMH
ED
R/O pre-term labor
Evaluate in the
provider's office.
If preterm labor, transfer
SPH
If called, instruct
pt. to go to SPH
for eval
Basic evaluation
(eval). Pt. may
need education.
Abd pain- <24 weeks
Standard eval. at office
Observation (Obs) or
direct admission if
needed. If more
extensive eval needed,
consider ED workup
ED eval v.
morning appt with
OB provider
Standard eval
Pre-term labor
eval
Consult OB
provider of
record. *
Abd pain- >24 weeks
Eval at office
If to be admitted-
transfer to SPH
Instruct pt. to go to
SPH for an eval
Eval and consult
OB of record. *
May require
transfer to SPH
for complete eval
and treatment
Bleeding - 1
st
trimester
Eval in office
Complete blood work,
ultrasound, and exam.
After discussion
with patient, SAM
OB of record
provider my
recommend an
evaluation at SPH
Evaluate by use of
ultrasound, lab
work, and exam.
Consult with OB
provider of
record* and OB at
SPH. Transfer to
SPH as needed.
Bleeding - 2
nd
trimester
Eval in office
Complete blood work,
ultrasound, and exam.
After discussion
with patient, SAM
OB provider of
record * may
recommend an
evaluation at SPH
Evaluate by use of
ultrasound, lab
work and exam.
Consult with OB
provider of
record* and OB at
SPH. Transfer to
SPH as needed.
Bleeding – 3
rd
trimester
Evaluate.
SPH transfer if
warranted
Direct patient to
SPH
Evaluate and
stabilize.
Consult with OB
provider of record
*and OB at SPH.
Transfer to SPH
21
Scenario
Weekday
OFF-HOURS
SAM or AMH
ED
Hypertensive, headaches,
vision changes – 24
weeks
At Office: NST, Labs
Transfer to SPH if pre-
eclampsia
Recommend eval
at SPH
Evaluate and
stabilize.
Transfer to SPH if
pre-eclampsia.
Determine the
need for
magnesium &
initiate infusion.
Pyelonephritis
If need IV fluids &
antibiotics (ABX),
direct Obs admission.
If > 24 weeks needs
monitoring- transfer to
SPH
May direct the
patient to SPH for
Obs admission. If
> 24 weeks, pt
needs monitoring,
transfer to SPH
Eval pt. Consult
OB provider of
record* if needed.
Admit/Obs as
needed or transfer
to SPH if need
monitoring and is
>24 weeks
Dehydration/hyperemesis
Direct admit SAM or
SPH
Direct to SPH as
needed or eval in
office with
morning appt.
Eval in ED.
Consult OB
provider of
record* Transfer
to SPH as needed.
Premature contractions
Evaluate at office-
Non-
Stress Test (NST)/
Biophysical Profile
(BPP)
Transfer to SPH
Direct to SPH for
eval
Eval in ED.
Consult OB
provider of record
*. Transfer to
SPH as needed.
Decreased fetal
movement
Evaluate at office-
NST/BPP
Transfer to SPH
Direct to SPH for
eval
Will need SPH
eval.
Transfer to SPH
Coverage:
1. OB provider coverage: after office hours and weekends/holidays: provider group of
record should be contacted.
22
NEW YORK STATE DEPARTMENT OF HEALTH
CLOSURE PLAN REVIEW CHECKLIST
Appendix A
23
NEW YORK STATE DEPARTMENT OF HEALTH
Office of Health Systems Management
Division of Hospitals and Diagnostic & Treatment Centers
CLOSURE PLAN REVIEW CHECKLIST
Facility Identification
Facility/Provider
Operator: Samaritan Hospital of Troy NY Inc
Co
-Operator: St. Peter’s Health Partners
C0
-Operator: Trinity Health Corporation
Operator Class: Voluntary, Not for Profit
Facility ID (PFI)
756
Facility Address
2215 Burdett Avenue
Troy, NY 12180
Facility Telephone
518-271-3215 (Administration)
Operating Certificate #
4102002H
Closure Submission/Request
Anticipated Closure Date
June 30, 2024,
Related CON (if applicable)
Closure Request/Plan Submission
Date
December 19, 2023
Facility Contact for Closure
Name
Telephone
Email
Mailing Address
Maternity Unit at Samaritan Hospital
Kim Baker, President
(
518) 525-1491
Kim.Baker@sphp.com
St. Peter’s Health Partners
315 S. Manning Blvd, Albany NY 12208
Closure Justification/Reason
Financial restructure. Unable to sustain financial burden year-over-year.
•
Operation of the unit results in an operational loss of $2.7 million annually.
•
Agency RN staffing, anesthesia locum expense, and low Medicaid rates are key
sources of this loss, and these will continue to worsen.
•
Nurse vacancies frequently make it necessary to transfer laboring mothers to
another hospital.
•
The Capital Region currently offers three other hospitals with maternity
services. All have significant capacity; St Peter’s Hospital alone could absorb
the patients now delivering at Samaritan Hospital.
•
Women in Rensselaer County will be able to continue receiving prenatal,
postnatal, and gynecological care in that county, including in the city of Troy.
•
Samaritan colleagues can fill current vacancies systemwide.
•
The proposed closure offers an opportunity to repurpose the care setting to
deliver incremental volume and contribution margin to the health system.
•
Samaritan Emergency Dept. providers can manage laboring mothers who
present to the ED.
NYSDOH Review/Recommendation
Review Date
Reviewer
Regional Office Approval letter received (date):
Date: _______________________
Recommendation (Approve/Disapprove)
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Closure Plan Requirements
Describe the process to notify
patients of the facility closure (attach
Patient Notification Letter, if
applicable)
Corporate Communications will mail a letter to each active patient
notifying them of the site closure.
The Patient Notification Letter can be
found in Appendix
B, as well as the Communications Plan in Appendix D.
List of appropriate alternate
providers.
The list should show
name, address, services provided, the
distance from the facility closing,
etc.
The list of alternate providers can be found in Appendix C.
The plan to maintain and make
available to patients’ medical
records, care plans, medication
histories, etc.
The process for
patients and/or their health care
provider to obtain
copies of the
records should be disclosed in a
patient notification letter.
The physical location of the records
should be disclosed in the patient
notification letter.
Computerized / paper medical records and X-rays for each patient will be
available
upon request:
Samaritan Hospital
2215 Burdett Ave.
Burdett Avenue
Troy, NY 12180
Archival of paper medical records
is managed by:
Adirondack Record Management Inc.
45 Learned Street, Albany, N.Y. 12207
518-465-3376
The patient notification letter can be found in Appendix B.
Describe the process to notify the
community of the facility closure
(attach Community Notification
Letter, if applicable)
SPHP Marketing & Communications will update the Specialty Care
Directory made available at all site locations and online via:
SPHPMA.com.
Will notify all contracted vendors of site closure including supply and
laboratory vendors, insurance companies, and CMS.
Describe signage and other public
notification measures.
As part of the CON, the site sign at the Burdett Center location will be
modified to show
its closure. A sign will be posted on the door and any
applicable website links will redirect the public.
Describe the process to dispose of the
building and contents after closing.
1. Reconciliation of sites contents will be performed.
2.
Equipment to be disconnected via industry standards.
3.
Reallocation, decommission, and/or sale of equipment will occur.
4.
Materials management will appropriately dispose of surplus
supplies
Describe the process to dispose of
medications after closing.
All medications and biologics will be returned to the Pharmacy for disposal
or reuse upon unit closure.
Other
An internal Maternity Unit-Specific Checklist will be used to safely
transition patients and services
. The internal checklist is available upon
request.
Closure procedures, including disposal
and/or removal of equipment,
medications,
biologics, etc. will be completed according to SPHP policies,
which are available upon request.
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Patient Letter - Burdett Closure
Appendix B
26
27
Alternative Birthing Centers
Appendix C
28
Alternative Birthing Centers
St. Peter’s Hospital
315 S. Manning Blvd
Albany, NY 12208
Provides comprehensive maternity services; family-centered obstetrics program and midwifery
models of care; Level III NICU
Distance from Burdett Birth Center: 15 miles
Albany Medical Center Hospital
43 New Scotland Ave.
Albany, NY 12208
Provides comprehensive maternity services; family-centered model of care; Level IV Regional
Perinatal Care Center and Level IV NICU
Distance from Burdett Birth Center: 11 miles
Bellevue Woman’s Center – Ellis Medicine
2210 Troy-Schenectady Rd.
Niskayuna, NY 12309
Provides comprehensive maternity services; family-centered model of care; special needs
nursery.
Distance from Burdett Birth Center: 13 miles
Southern Vermont Medical Center
140 Hospital Dr., Suite 306
Bennington, VT 05201
Provides comprehensive maternity services; family-centered model of care.
Distance from Burdett Birth Center: 30 miles
Berkshire Health Systems
725 North St.
Pittsfield, MA 01201
Provides comprehensive maternity services; family-centered model of care.
Distance from Burdett Birth Center: 38 miles
Saratoga Hospital- William J. Hickey Women’s Health Services
211 Church Street
Saratoga Springs, NY 12886
Provides comprehensive maternity services; family-centered model of care.
Distance from Burdett Birth Center: 30 miles
29
Glens Falls Hospital – Joyce Stock Snuggery Childbirth Center
100 Park Street
Glens Falls, NY 12801
Provides comprehensive maternity services; family-centered model of care
Distance from Burdett Birth Center: 46miles
Optional Outpatient OBGYN/ Midwifery Locations
Capital Region Women’s Care
1. North Greenbush
101 Jordan Rd. Suite 200
Rensselaer, NY 12144
2. Delmar
250 Delaware Ave.
Delmar, NY 12054
3. Clifton Park
1783 Route 9 Suite 201
Clifton Park, NY 12065
Carenet OBGYN
1. Clifton Park
2 Chelsea Place
Clifton Park, NY 12065
2. Schenectady
2123 River Rd.
Schenectady, NY 12309
Heartspace Midwifery
1. The Ilium Building
406 Fulton St.
Troy, NY 12180
2. Saratoga
125 Highrock Ave. Suite D
Saratoga Springs, NY 12866
30
Local Care Midwifery
1. 35 Dearstyne Rd.
Troy, NY 12180
SPHP Outpatient OBGYN/ Midwifery locations and provider listing
31
Appendix D
Communication Plan
Maternity Unit Samaritan Hospital Intent to file Closure CON
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St. Peter’s Health Partners
Maternity Services at Samaritan Hospital
Communications Plan
HISTORY / BACKGROUND
2010
• The Burdett Care Center, located in the former Samaritan Hospital maternity unit, was
formed as a NYS Not-for-Profit Corporation with its own board of directors and with no
corporate relationship with Samaritan Hospital, St. Peter’s Health Partners, or St. Peter’s
Health Partners’ parent (Initially Catholic Health East; later Trinity Health Corporation).
• To help launch BBC, Samaritan provided it with $5 million in start-up funds via a trust.
It also conveyed the physical space of its maternity unit to Burdett as a condo unit under
a no-interest mortgage and contracted to provide an array of administrative services at
cost.
2011
• The newly named Burdett Birth Center (BBC) was established by the Public Health and
Health Planning Council (PHHPC). However, due to concerns about the financial
viability of the new hospital, the NYS Department of Health (DOH) took the unusual step
of issuing it only a 5-year operating certificate rather than the usual non-expiring
operating certificate.
• For nine years, BBC operated as an independent hospital, providing mostly maternity
services. From the start and continuously thereafter it lost money on operations due to
declining delivery volume, unfavorable payer mix, low Medicaid rates, fragile referral
sources and high malpractice costs.
2016
• The DOH renewed BBC’s operating certificate but, due to concerns about its financial
survivability, provided for only a three-year renewal.
• Samaritan Hospital tried in many ways to assist BBC in improving its financial situation.
Specifically, it repeatedly deferred collecting amounts owed by BBC to Samaritan under
the mortgage and administrative services agreement.
2019
• BBC faced financial insolvency. Samaritan, to preserve maternity services in Troy,
proposed that BBC merge into Samaritan. At that time, Samaritan had the operational
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margin and balance sheet to write off BBC’s debt, absorb projected Burdett losses, and
buy time for an attempted turnaround. The DOH and PHHPC approved that proposal.
2020
• On October 1, 2020, Burdett merged into Samaritan and became Samaritan's maternity
department. The department no longer offered tubal ligations and other services
prohibited by The Ethical and Religious Directives for Catholic Healthcare Services
(ERDs) but, per DOH direction, provides information to women on how to access such
services.
• As Samaritan pursued its plan to rescue BBC, the healthcare world changed drastically.
Covid and the related severe staffing shortage impacted the performance of the maternity
unit and undermined Samaritan Hospital and St. Peter’s Health Partners’ ability to absorb
its losses.
2022
• The losses incurred through operating the maternity services unit at Samaritan Hospital,
including providers, anesthesia, and fixed costs, totaled $2.3 million. Losses continue to
grow annually, compounded by staffing shortages, low utilization, and declining birth
rates.
2023
• The providers and staff of SPHP and Samaritan Hospital have worked for more than a
decade to maintain birthing services on Samaritan Hospital’s campus. Unfortunately, the
health system is no longer financially positioned to do so, and better staffing and more
comprehensive maternity and neonatology services can be provided at St. Peter’s
Hospital. Samaritan Hospital's BOD approved a provisional plan to close maternity
services at Samaritan Hospital while preserving prenatal care in Troy and absorbing
needed delivery services at St. Peter’s Hospital.
2024
• Closure date timing is under evaluation but will be sometime in the spring of 2024, no
later than June 30, 2024. This timing, which is reflected in our closure plan, will provide
additional time for:
o Further meetings with stakeholders.
o Completion of arrangements for transportation assistance and community
education.
o The orderly transition of staff and services; and
o Regulatory review and approval of the hospital’s certificate of need application
and closure plan.
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CURRENT SITUATION
Community Criticisms
Burdett is the only local facility offering women a full scope of options in maternity care.
Keeping these services will help close the gap in racial disparities that exist in maternity care.
Closing Burdett will create a maternity care desert in Rensselaer County and negatively impact
women of color.
Response to Criticisms
In this region, we have several hospitals where expecting mothers can deliver, including our St.
Peter’s Hospital in Albany, 14 miles from Troy. It also offers a Level 3 NICU. Indeed, 75% of
women in Rensselaer County who become pregnant already deliver outside the county. This
trend dates back decades and likely reflects a desire of most birthing mothers to be in a larger,
more sophisticated center.
We will continue to provide 100% of the services to 100% of our patients. The only thing
impacted by this decision is the delivery site, so all our patients will continue to receive care
without interruption. By maintaining prenatal and postnatal care in Troy, provided by our
employed OB/GYNs and midwives, while consolidating delivery services into St. Peter's
Hospital in Albany, we can continue to provide the same high level of compassionate care
expecting mothers deserve. All our Troy-based obstetricians and midwives have privileges at St.
Peter's Hospital, and they will continue to be part of the delivery plans (including doula services)
for our patients residing in Troy and Rensselaer County. Women will be able to be delivered by
the same providers caring for them today, be they physicians or midwives – none of that will
change.
We are committed to securing accessibility to safe care for all who seek it - especially the
community's most vulnerable members. We will establish a safe delivery plan for all patients
entering our care and address transportation for those needing it during their first prenatal visit.
As part of the Troy community since 2011, St. Peter’s Health Partners is deeply invested in
meeting its health needs. That is why, even though it was not initially required, we proactively
agreed to perform a health equity impact assessment and, following the guidance of the DOH,
engaged the services of an independent, external agency with a health equity focus to complete
the assessment. The results of this study were published on our public landing page and
submitted with our closure plan.
As a Catholic, not-for-profit healthcare organization, we operate for one purpose: to serve as a
transforming, healing presence within our community. We do this by:
35
• Reinvesting our financial resources back into the communities we serve by improving
healthcare services, buying new technologies, upgrading facilities, and ensuring that
comprehensive care is available to everyone — regardless of their ability to pay.
• Working to improve the health of our communities. Compassion is the foundation for all
that we do. Patients and their families are treated as people first, which means
compassion, dignity, and respect are at the core of any treatment program.
• Providing a range of special benefits to the community, such as programs to manage care
for persons with chronic diseases, health education and disease prevention initiatives,
outreach for the elderly, and care for persons experiencing poverty or uninsured.
St. Peter’s Health Partners has a long history of excellence in caring for the health needs of the
Troy community, regardless of their ability to pay.
We provide more than $32 million in community benefit to the City of Troy annually:
MOMS Program
Prescription Assistance Program
Soccer for Success (Boys and Girls Club)
Diabetes Prevention Program
The Butt Stops Here (Tobacco Cessation
Program)
Baby Cafes
Creating Healthy Schools and Communities
Grant
Healthy Families
PROS Program
Sexual Assault and Crime Victims Programs
Health Insurance Enrollment Assistance
Safety Net Health Centers
Troy High School Partnership
It Starts Here: COVID-19 Vaccination
Campaign
KEY MESSAGES / TALKING POINTS
• Samaritan Hospital continues to experience the same staffing shortages, low utilization,
and declining birth rates that prevail across the country in the wake of the pandemic.
• Secular trends (e.g., advanced age, prevalence of obesity) equate to a larger portion of the
dwindling number of pregnancies that are high-risk, necessitating care in a more
sophisticated center like St. Peter’s Hospital or Albany Medical Center.
• Our top priority is and always has been patient safety, and disproportionate staffing ratios
are detrimental to the quality of care we provide.
36
• Only delivery services are impacted by this decision. Patients do not need to find new
providers or new practices and can continue to receive the full spectrum of maternity care
services, including prenatal and postnatal care, from our Troy OB/GYNs and midwives.
• The first thing we are going to do is establish a safe plan of delivery for each patient
entering our care, including the provision of transportation for those who need it.
IMPORTANT FACTS
• There are three delivery centers within reasonable proximity to BBC: Albany Medical
Center (18 min), St. Peter’s Hospital (22 min) and Bellevue Hospital (21 min). St. Peter’s
Hospital alone has the capacity to perform all the deliveries presently done at BBC, and
all the Troy-based providers have privileges at St. Peter’s.
• 75% of pregnant women who reside in Rensselaer County already have their deliveries
outside of the county.
• This is not a case of a health system favoring a facility in a more affluent and less diverse
location. In fact, there is very little difference in the racial profile of patients delivering at
Samaritan Hospital as compared to St. Peter’s Hospital.
• Most cesarean sections performed at Samaritan Hospital are emergency procedures.
While scheduled C-sections are an option at Samaritan, most of them are performed at St.
Peter’s Hospital by the obstetrician from Samaritan with whom the expectant mother has
been receiving prenatal care.
• Samaritan emergency department providers can manage any laboring mothers who may
present in the ED.
• SPHP’s affiliation with Trinity Health is instrumental in navigating the complexities of
the modern healthcare landscape. However, our local leadership and boards have a
substantial voice, and retain much decision-making authority with respect to the services
we offer. The decision to close the maternity unit at Samaritan Hospital was made by the
hospital’s board of directors on the recommendation of the hospital’s local leadership –
by people who live in and understand this community.
• The Medicare Wage Index adjustment is not a windfall. It brought this region into parity
with other parts of the U.S. but brings us only part way toward ensuring we can continue
37
to provide safe, compassionate, appropriate care to the communities we serve, well into
the future.
EXECUTIVE SUMMARY
We understand the impact the BBC closure has on our colleagues and the communities we serve,
and we are committed to supporting them during this transition period. SPHP is proud of the
compassionate, high-quality care all our colleagues provide each day. The Samaritan Hospital
maternity unit is generally staffed with approximately 30 full-time colleagues and 15 part-time
and per diem roles. Our Human Resources staff is prepared to work with those interested
colleagues to identify opportunities for them within our system of care.
It’s important to remember that the great bulk of care provided to individuals bearing children is
delivered in the prenatal and postnatal setting. There will be no impact to prenatal or postnatal
OB/GYN or midwifery access in Rensselaer County. The robust, high-quality care our practices
provide will continue without interruption.
Samaritan OB/GYN and Capital Region Midwifery will remain open and continue to provide
their unique services to patients. SPHP colleagues at those practices, including doctors,
midwives, physician assistants, nurse practitioners, nurses, and support staff, are a vital
community resource, and they remain committed to providing patients the same services that are
offered today well into the future.
Patients will continue to have access to maternity and neonatal services, which are offered in
close proximity at several Capital Region hospitals, including St. Peter’s Hospital. SPHP
recognizes that traveling to St. Peter’s Hospital or other hospitals for delivery will be more
challenging for some patients. SPHP currently screens for transportation access across the
system and is looking at ways to expand that further. Transportation assistance for patients who
need it will be a key part of the plan moving forward.
SPHP’s goal is to provide the best experience, care, and outcomes possible for all our patients.
By consolidating maternity services at St. Peter’s Hospital, the possibility that the expectant
mother would need to be transferred to another hospital due to staffing challenges is mitigated. It
will also reduce the number of transfers for newborns who need NICU services. Delivering at St.
Peter’s Hospital increases the likelihood that both mother and newborn can remain in the same
facility should there be a need for an additional level of care or services.
If we continue to invest in services that drain financial resources and are impacted by declining
demand and staff shortages, it will hamper our ability to deliver the same level of community
benefits that are so important and necessary for our region. Our core value of Stewardship calls
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us to hold ourselves accountable for the human and financial resources entrusted to our care—
this sometimes means making difficult decisions to ensure the viability of our entire system so
we can continue to serve all our patients safely.
TARGET AUDIENCES
Internal
• Trinity Health Administration
• THNY Board of Directors
• St. Peter’s Health Partners
o SPHP Administration
o SPHPMA Board of Directors
o Directors and Managers
o Physicians/Providers/Affiliat
es
o Samaritan Maternity Services
Impacted Colleagues
o All SPHP Colleagues
• St. Joseph’s Health Administration
External
• Samaritan Maternity Services
patients and their families
• Referral Partners
• Government Officials (county and
state legislators, mayor)
• Leaders at Community
Organizations Serving Women /
Women’s Health
• Catholic Diocese / Bishop’s Office
• Media
• Vendors
• Impacted Providers/Hospital
Systems
• Community at large
COMMUNICATIONS TIMING
We are fully dedicated to being transparent and notifying the affected colleagues and patients in
a timely manner as soon as the DOH approves the closure plan. We will stress confidentiality to
stakeholders who are notified prior to the affected colleagues’ notification to prevent, as much as
possible, unintended disclosure before the official announcement.
Regardless of our efforts to be proactive and transparent, we should expect and be prepared for
an additional wave of objections from concerned stakeholders like the Save Burdett Birth Center
Coalition which includes leaders and members of Planned Parenthood, Mom Starts Here, YWCA
of the Capital Region, BirthNet, as well as birth doulas and midwives from Troy, NY and
beyond.
This communications plan is designed to further establish SPHP as a transparent, caring, and
compassionate source of truth for our stakeholders as we continue to work with community
groups and government officials to address areas of greatest concern.
