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For more than two years, GraniteOne Health, the parent company of Monadnock Community Hospital in Peterborough, and Dartmouth Health have been working on a merger.

Monadnock Community Hospital President and CEO Cindy McGuire said the merger was approved by the Federal Trade Commission in April 2021 and was positively received in a series of public hearings last October. She said there were concerns about competitiveness, but “I felt like we had come to some good agreements.”

However, concerns about competitiveness doomed the plan to failure as state attorney general John Formella said he would not approve the deal because it violated a clause in the state constitution that requires “free and fair competition in commerce and industry.” hospitals said they could not accept the restrictions placed on them by the Attorney General’s Office.

The failed merger has left MCH working on what comes next.

“We are very strong,” McGuire said. “We are strong financially. We are clinically strong.”

However, the Monadnock Community Hospital is facing challenges, including a shortage of staff. If the hospital were fully staffed, McGuire said it would have about 525 employees. In the past, he would have had about 20 open positions, but now he has 80-85 short positions. Traveling workers and contractors made up some of the difference, but they cost more.

“We would rather pay it to our own employees,” McGuire said. “It puts a lot of pressure on the organization. We can’t just pass the price increase on to the patient.”

Due to lack of staff, there were days when the hospital limited the number of patients in its inpatient department. MCH has six beds in the maternity ward that are not closed and 19 beds for surgical patients, which it has had to close three or four days over the past two weeks. This situation is not unique to the hospital, according to Laura Gingras, MCH vice president of philanthropy and public relations.

“It’s a daily situation,” McGuire said. “Every day we evaluate, based on our staffing, how many patients we can accept.”

Recruitment has been on the rise as the hospital has added Advanced Practice Registered Nurses (APRNs) in recent months Michelle Brumacheem at Monadnock Behavioral Health Services, APRN Tiffany Gaudet at Behavioral Health Services, Dr. Miri Makebish at Monadnock Regional Pediatrics, APRN Sara Neal in pain management with Monadnock Orthopedic Associates and Physician Assistant Thomas Quinn with Monadnock Orthopedic Associates.

In the next few months, MCH will add an ARPN and a surgeon to Monadnock Orthopedic Associates, a physician to Monadnock Regional Pediatrics, two physicians to Monadnock Internal Medicine, and a physician to Antrim Medical Group.

McGuire said Dr. Daniel Purley, who was named Chief Medical Officer in April 2021, has done a great job recruiting.

“It’s been a pretty good year,” she said.

Most recruits are new graduates and will be mentored by existing primary care providers, McGuire said. She said the idea of ​​MCH being part of a larger system is attractive, but now that the merger is complete, MCH will be working with Dartmouth Health to tie them together academically.

“New graduates, it’s nice to have that connection,” she said.

Even without the merger, MCH and Dartmouth Health maintain a longstanding relationship, including Dartmouth Health staffing the MCH Cancer Center. The hospital also receives telemedicine services from Dartmouth Hitchcock.

“We can have that kind of relationship,” McGuire said. “There would just be a lot less inefficiency if we were all in the same (system).”

One area where the failed merger has hurt MCH is information technology, as McGuire said smaller hospitals are struggling with infrastructure and MCH is severely understaffed in this area. The hospital has separate systems for inpatient and outpatient care, and with the merger, MCH would become part of the Dartmouth Hitchcock system for all operations.

“We’ll have to look around there,” McGuire said.

Going forward, McGuire said the priority for Monadnock Community Hospital will be how to retain and care for staff, including determining what work will look like, in person or remotely.

“Right now our main focus is on our workforce,” McGuire said, adding that MCH is also trying to find employee housing and would like to work with a community group to do so.

The hospital turns 100 this June and enjoys a lot of support from the board of trustees and the community, McGuire said.

“It’s great to know that we have the support of the community,” she said. “For a hospital and a community of this size, we have a huge level of support.”

McGuire said the failure of the merger was disappointing: “But we’re not going to stop. We’re going to look into the future and see what the best options are.”

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