Closure Of Dartmouth-Hitchcock Reproductive Clinic Displaces Upper Valley Patients

May 26, 2017

At the end of May, Dartmouth-Hitchcock Medical Center will be closing a program that treats a wide range of women's reproductive hormonal and infertility issues. And that has left a lot of women in the Upper Valley angry.

Of late, 50-year-old Sisyphus Bradford feels like she's been living up to her namesake.

“Yes, I am pushing a large rock up a hill with Dartmouth-Hitchcock," Bradford joked recently in the Vermont Law School library, where she is pursuing a law degree.

Bradford has a small tumor next to her pituitary gland. When her hormones fluctuate, she gets debilitating headaches. She gets hormonal treatment to help manage the tumor.

Since moving to Vermont, she's received treatment at her local health care facility, Dartmouth-Hitchcock Medical Center's Reproductive Endocrinology and Infertility program.

But when she says went to the hospital for her May appointment, they told her that her doctor at Dartmouth-Hitchcock would no longer be able to see her.

“The appointment schedule[r] gives me a piece of paper and says, ‘Well, you can transfer your records to UVM and you can call and make an appointment there.' That was it,” Bradford recalls, with palpable shock still echoing in her voice.

Sisyphus Bradford is worried about the future of her health care after Dartmouth-Hitchcock Medical Center announced it would be closing its Reproductive Endocrinology and Infertility program.
Credit Rebecca Sananes / VPR

Now, Bradford and 123 other women will either have to go to Burlington for treatment at the University Of Vermont Medical Center or Colchester at Northeastern Reproductive Medicine. Others will have to make the trip to Boston.  A Dartmouth-Hitchcock spokesperson added that patients have been referred to programs in Bedford, New Hampshire, and Springfield, Massachusetts as well.

But, as Bradford points out, the closure could affect far more women who may need care in the future.

The Center for Disease Control reports that in the U.S., about 10 percent of women experience issues getting pregnant, suffer from Polycystic Ovarian Syndrome or experience uterine fibroids.

"You've got lots of people leaving the state, but you're not even protecting the ones that are here who want to have babies." — Sisyphus Bradford, a former patient at the Dartmouth-Hitchcock program

And those are just a few of the many health concerns that were being addressed by the program at Dartmouth-Hitchcock.

To Bradford, there is an even larger principle at stake.

“It’s part of this systemic problem with sexism where a pre-existing condition is being a woman,” she said. “In politics here in Vermont, they're talking demographics: OK, you've got lots of people leaving the state, but you're not even protecting the ones that are here who want to have babies.”

One of the alternatives for patients who previously received treatment at Dartmouth-Hitchcock is the University of Vermont Medical Center, nearly 100 miles away in Burlington, Vt.
Credit Taylor Dobbs / VPR

Even though Dartmouth-Hitchcock is in New Hampshire, Vermont tax dollars go toward its funding.

Which is why Stacy Dion, a veteran working in White River Junction, was able to receive fertility treatment. She says if she had not had a regionally located IVF clinic, she doesn't think she would have been able to have conceived her daughter.

“These programs take two, three, five, sometimes seven visits a [menstrual] cycle — once a month — and they're two hours [sessions] each,” Dion explains, over the phone, periodically talking to her chattering 3-year-old, who had just woken up from a nap. “For me, with the length of time it took me to get pregnant, I would not have been able to sustain that schedule.”

Dr. Edward Merrens, the chief clinical officer at Dartmouth-Hitchcock, says the program is being disbanded because because of  "the inability to maintain the clinical resources."

"This wasn't a program that was losing money. In fact, this was a program that makes money." — Dr. Edward Merrens, Dartmouth-Hitchcock chief clinical officer

“This wasn't a program that was losing money. In fact, this was a program that makes money,” said Merrens. “Ours was basically a decision that was, could we continue a high level of care and coordination that we needed to do seven days a week across our system?”

Dartmouth-Hitchcock has not responded further to the women's concerns.

Dr. Paul Manganiello started the Reproductive Endocrinology and Infertility Program and ran it until five years ago. He is disappointed to hear the program is closing.

“Basically, reproductive endocrinology — we're involved in the care of women from infertility, so from conception to the grave – it covers the entire life spectrum of women's health,” he says. “It's part of the whole package. It is women's health.”

"We're involved in the care of women from infertility, so from conception to the grave, it covers the entire life spectrum of women's health." — Dr. Paul Manganiello, founder of Dartmouth-Hitchcock's Reproductive Endocrinology and Infertility program

Dartmouth-Hitchcock is also an academic hospital, so Manganiello says the closure impacts their ability to train a future generation of doctors in women's health.

“We have residents [at Dartmouth-Hitchcock], and if a resident is going to be looking at a program, they're going to be wanting to go to a program that has representation in all of the sub-specialties,” Manganiello says. “And if they don't, I think they would probably reconsider where they're going.”

Officials at the University of Vermont say between 30 and 50 of the former Dartmouth-Hitchcock patients have already been seen by their staff within the past two weeks. The facility is increasing clinic days and added overtime for nurses to absorb the additional need.

The Dartmouth-Hitchcock Reproductive Endocrinology and Infertility program is slated to close on Wednesday, May 31.

Correction 12:00 p.m. Tuesday May 30, 2017: This article has been corrected to reflect that a quote was mis-attributed to Dr. Edward Merrens. Previously, we incorrectly stated that there had been "infighting between doctors and nurses". We regret the error.

Update 1:36 p.m. Thursday June 1, 2017: This post has been updated to include Northeastern Reproductive Medicine in Colchester as an additional Vermont resource for fertility treatments.