Letter: A failure of leadership at New Hampshire Hospital

Sunday, August 13, 2017
A failure of leadership at New Hampshire Hospital

New Hampshire Hospital lies in a state of stagnation. On acute care units, bed turnover has fallen abysmally, with lengths of stay measured in months beyond the point of clinical stabilization.

Lawmakers have proposed adding hospital beds to ease the backlog of patients stranded in general hospital emergency rooms awaiting emergency admission to New Hampshire Hospital. However, common sense dictates that existing beds be freed up first.

I believe that this and other problems at New Hampshire Hospital are largely attributable to a failure of leadership. Such failure played a central role in the loss of a dozen physicians and nurse practitioners amidst the Dartmouth-Hitchcock contract dispute last year. Since then, politicization of hospital administration has intensified. Influenced by political pressures and fears of criticism by the mental health community, the press and the state government, hospital leadership has pursued restrictive and overly risk-aversive measures that only compound the gridlock. Dumping of patients by general hospitals, the community and the mental health system due to failed housing is increasingly tolerated. Refusal of psychiatrically unnecessary admissions by New Hampshire Hospital physicians is not infrequently overridden by medical administration.

Under an unwritten “two midnight” rule imposed by the medical director, same- or next-day discharges deemed clinically appropriate by the attending psychiatrist are countermanded. Physicians and social workers are micromanaged and decisions about discharge planning are made by committees of nonclinicians. Unrealistic housing plans result in some of the lengthiest hospital stays. Long-term civil commitment, a time-consuming process meant by law to apply to the most dangerous patients, are often sought for the sake of convenience of patient management.

A recalibration of hospital leadership is overdue. Politics must be subordinated to a truly patient-centered approach, one that upholds the doctor-patient relationship and respects patients’ right to the least restrictive care. Lastly, the public deserves more transparency and improved overall communication from New Hampshire Hospital administration.




(The writer is on the staff at New Hampshire Hospital and the Dartmouth-Hitchcock Clinic, but is not currently on active clinical assignment. He worked full time at New Hampshire Hospital on an acute admissions unit from 2006 to 2013.)