BBJ: Group opposing Boston Children's $1B expansion faults state oversight 

By Jessica Bartlett  – Reporter, Boston Business Journal

Sep 10, 2018, 6:12am

Opponents of a $1 billion expansion at Boston Children’s Hospital say the state’s Department of Public Health is refusing to enforce a key condition it initially imposed on the project, a decision that could have broader ramifications in the Massachusetts health care market.

The state in 2016 approved the hospital's plan to construct an 11-story building, despite objections that the project would involve the demolition of the beloved Prouty Garden on the site. The DPH imposed a number of conditions as part of its approval, including that Children's demonstrate that the 77 new beds would be filled primarily by out-of-state patients — not those who would otherwise go to competing and less expensive hospitals in Massachusetts. In theory, if DPH found that Children's failed to demonstrate this, it could refuse to license the beds, potentially throwing the project into doubt.

But opponent group Friends of the Prouty Garden argued in a letter to the state last month that the hospital has not been providing assessments of its patient mix in annual filings with the state. The group has previously filed several lawsuits seeking to halt the project.

In a response on Aug. 29, the DPH acknowledged that it plans to wait until the project is completed before analyzing whether the hospital does indeed need the increased capacity.

“The reports provided to DPH prior to project completion are necessary to establish a baseline understanding of BCH’s current patient mix, but until the project has been completed, the Department has no need to determine whether there has been a material change in patient mix in order to determine the impact of the construction and increased capacity,” the DPH wrote in its letter.

In a separate statement to the Business Journal on Friday, a DPH spokesperson said the department "has determined that the data reported by the hospital to date is sufficient at this time.”

Jim McManus, a spokesperson for Friends of the Prouty Garden, said in an email that the decision defeats the purpose of the state’s oversight process, which was put in place to protect competing hospitals that might otherwise see their volume whittled away by Children’s.

“BCH told the department that the international patient population would grow by 260 percent from 2012-2022,” McManus said. “If international patients don't show up, as we said all along, then BCH will have no alternative than to attract patients from competitors, raising health care costs.”

Boston Children's Hospital showcases $1B expansion plans

Here are renderings of the 11-story clinical building that received final state approval in 2016.

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In fact, according to its annual financial filings, the hospital's net patient service revenue from international patients remained relatively stable in 2016 after ticking up for several years, only increasing $180,000 from 2015 to 2016, to $409.8 million. That compares to a massive jump seen in years prior; in 2013, net patient service revenue from international patients was just $190.4 million.

Children’s did not respond to a request for comment.

The decision is concerning to health care expert Paul Hattis, a professor at Tufts University School of Medicine. He said the state’s decision to delay oversight of the Children’s project could mean that the hospital may ultimately go after more Massachusetts patients. A larger Children’s would be able to enact higher prices from insurers, and would also destabilize competing providers.

“I think it’s hard once you’ve permitted a hospital to open the beds and borne expense to do that and trained staff," Hattis said. "It’s hard to say we see those beds won’t be occupied by out of state patients, take them out of service."

Hattis added that the state’s decision to delay enforcement of its condition boded ominously for the DPH's oversight more broadly, especially as the state reviews the proposed mega-merger between Beth Israel Deaconess Medical Center and Lahey Health.

While the Health Policy Commission, the state’s health care watchdog, has anticipated that the Children’s project could raise health care prices by between $8.5 million and $18.1 million annually, it said the Beth Israel-Lahey merger could raise health care prices by $168 million to $251 million.

“We had this huge transaction in front of us now that we don’t know what’s going to happen,” Hattis said. “The Health Policy Commission is going to issue a final report and if it goes forward with conditions, this Children’s letter makes me worried about the ability of the agency to follow up on whatever conditions it writes.”

Boston Children's Hospital Opens Rooftop Garden Promised After Demolition Of Prouty Garden

Boston Children's Hospital officially opened a new rooftop garden Tuesday.

The garden is one of several new green spaces the hospital promised when it demolished a beloved healing garden to make way for a new building.

The 8,000-square-foot garden, on top of the 11-story main hospital building, offers expansive views. There's a small sloped lawn in the middle and hard surfaces around it to allow for wheelchairs. Plant beds border the space, and there's a smattering of brightly colored seats and small tables.

Among those visiting the garden Tuesday was 11-year-old Diane Langguth, of Hull, who recently underwent a liver transplant. As she moved about the garden with her parents, Langguth said she liked the fresh air and little breezes. She climbed the tiny grassy slope to look at a statue of a frog.

Several statues from Prouty Garden, including a life-sized nurse and child, and several animal sculptures once selected by the garden's benefactor, Olive Prouty, have been transplanted to the new space.

April Cohen, of Winthrop, sat with her 9-year-old son, Josh, who is fighting cancer. She said while it was very hot on the rooftop on this day, she and her son were happy to be outside.

Another mother walked by pushing her child in a wheelchair. A group of nurses sat at one of the tables holding a meeting. One of them, cardiac nurse Toni Imprescia, said while she will always miss Prouty Garden, she appreciates the new outdoor space.

Boston Children's Hospital President and CEO Sandra Fenwick told a small crowd gathered for a ribbon cutting that the rooftop garden is meant to be a sanctuary, "an oasis of peace, safely within Boston Children's but apart from the stresses of hospital life."

A small patch of greenery with a slight slope sits in the middle of the hospital's new rooftop garden. (Courtesy Boston Children's Hospital)

The demolition of the half-acre, ground-level Prouty Garden began in December 2016. Hospital officials chose the site as the location of a new $1.5 billion building, to be completed in 2021. The building will feature a neonatal intensive care unit to replace the existing one, which hospital officials call outdated. The new facility will also have a pediatric heart center and operating rooms. And it will allow the hospital to offer all private patient rooms, instead of having many that are double-bedded.

Gus Murby is one of the thousands of people who opposed the elimination of Prouty Garden, which was bestowed to the hospital in the 1956 and featured a 65-foot dawn redwood tree. Murby spent time in Prouty Garden with his teenage son when his son was being treated for leukemia. He took his son outside to the garden to die in 2007.

Murby hasn't seen the hospital rooftop garden in person yet, but after viewing pictures of it, said in an email that it doesn't appear the garden "even comes close to qualifying as a healing garden. It may turn out to be a well received outdoor dining area, though."

A statement on the Save Prouty Garden website reads, "... while it's wonderful that there is now a neatly manicured space for people to sit and eat lunch, enjoying nice views of Boston, there remains a massive and critical hole for a healing garden at BCH."

The hospital also plans a new 14,000-square-foot ground-level garden and some smaller indoor "winter gardens."

Children’s Hospital opens new rooftop oasis to help fill void of beloved Prouty Garden

By Priyanka Dayal McCluskey, Globe StaffMay 13, 2018

More than a year after demolishing the beloved Prouty Garden to make room for a new tower, Boston Children’s Hospital is opening a new green space — a rooftop refuge for sick children, their families, and the staff who spend days and nights caring for them.

The 8,000-square-foot space is 11 stories up, on the hospital’s main building on Longwood Avenue. There are scattered reminders of the Prouty here — sculptures of a nurse and child, a fox, a frog — but this modern garden is not likely to be mistaken for its predecessor.

A floor of pavers and wood surrounds a lush grassy knoll. Young perennials and grasses are planted in perfect rows.

There are no squirrels or bunnies or other critters here, as there were in the Prouty Garden. And there are no big trees.

But the new garden, which officially opens to patients Monday, offers sweeping views of the city skyline. From some angles, when clouds aren’t obscuring the view, children may be able to see a sliver of the harbor, and the ships rolling in and out.

Since the end of 2016, patients at Children’s Hospital have not had a place to go on campus to take a break from their medical treatment and feel the warmth of the sun.

“It’s beautiful, and I think it will be great for patients and families who are able to get out here and get some fresh air,’’ ICU nurse Elaine Feibelman said as she toured the space on a recent afternoon.

The rooftop garden is the first of several green spaces that hospital officials plan to open over the next several years as part of a $1 billion expansion and renovation of the campus slated to be complete in 2022. They plan to build another smaller rooftop garden, two indoor gardens, and a 14,000-square-foot, ground-level garden.

“That’s not a healing garden,” said Guy Murby, who fought against the demolition of Prouty Garden, “it’s kind of like a deck of a cruise ship where people can go out and have lunch.”

The biggest change to the campus will be the construction of an 11-story tower housing new patient rooms and operating rooms. Hospital officials say the new building will allow them to serve more patients and to offer more privacy to existing patients who now have to share rooms.

The tower will be on the site of the former Prouty Garden, a tranquil half-acre space cherished by many families and staff. Parents sought solace in the garden with their children when the children were sick or dying.

“The Prouty Garden will always live in all of our hearts as a special place,” said Judy Mahoney, a nurse manager who has worked at the hospital for 39 years. “It was really hard for us to move on from that. It was a little jewel in the middle of the city of Boston.”

But Mahoney, who works with infants and toddlers, said the new building is needed to help patients and their families. She said she tells parents: “If I could build that hospital faster, I would.”

Gus Murby, who was part of a group that fought the demolition of Prouty Garden, said he was disappointed after viewing pictures of the new rooftop garden. He called it “sterile” and “soulless.”

Murby visited the Prouty Garden with his son when the teenager was dying from leukemia in 2007. He is the lead plaintiff in an ongoing lawsuit that contends the hospital should not have been granted state approval to construct a new tower.

“That’s not a healing garden,” Murby said, “it’s kind of like a deck of a cruise ship where people can go out and have lunch.”

Lisa Hogarty, senior vice president of real estate planning and development at the hospital, said the rooftop garden was designed to withstand severe weather and to be welcoming for children, particularly kids in wheelchairs and those with compromised immune systems. The mulch, for example, is made from the shredded rubber of recycled car tires, which is safe for children with allergies.

There are bright-colored tables and chairs where visitors can sit in the sun, and more private benches in the shade.

“These gardens are meant to promote healing and health and offer respite for the patients and their families,” Hogarty said.

Nurses who got an early glimpse of the new garden said they were excited to have a place to take a break and to bring their young patients.

Nurses in the new rooftop garden. They’re excited to have a place to take a break and to bring their young patients.

Jessica Rinaldi/Globe Staff

“It does feel a little bit smaller [than the Prouty], but it’s still gorgeous,” said Michelle Audain, an ICU nurse.

Three-year-old Jake Moulton from Danvers, who was at the hospital recovering from tonsil surgery and other procedures, was the first patient to visit the garden. The boy climbed up on a bench to get a good view of the city and pointed excitedly to the buildings all around, as his parents followed with his IV bag.

“It’s a nice break from the hospital,” said his father, Steve Moulton, “that’s for sure.”

Children's Hospital, Prouty defenders agree: New garden is 'completely different'

When Boston Children’s Hospital demolished the beloved Prouty Garden to build a new inpatient building, executives promised that green space would return to the property.

On Monday, the first of five new gardens at the hospital opened to patients, as sick children were welcomed into a 8,000-square-foot space situated on top of the hospital’s main building on Longwood Avenue.

Hospital executives say the five gardens in total will be about 25 percent larger than the 23,000-square-foot Prouty Garden, which was demolished in preparation for Boston Children’s $636 million, 11-story new clinical building.

But executives aren’t claiming the hospital’s first foray into new green spaces is a replacement for the Prouty, which featured giant trees and natural wildlife as a secluded natural nook amongst the city’s tall buildings. The new garden is intended as a more modern space that overlooks the city and beyond.

“They are completely different,” said Lisa Hogarty, vice president of real estate planning and development at Boston Children’s. “It has incredible views of Boston, the types of plant material and the way the spaces have been designed are incredible and very thoughtful. I think it’s different. But the feedback we’ve been getting … when you come out of the elevator lobby and see the garden, there were gasps — and I’m not exaggerating — of delight.”

The other four planned gardens consist of a 14,000-square-foot Olive and Olivia Prouty Wishing Stone garden planned for land around the new building; a 3,700-square-foot rooftop garden on the top of the Hale Family Clinical Building; and two smaller, interior gardens in the Hale building totaling 3,500-square-feet.

Opponents of the project have fought to stall the construction and rebuild Prouty Garden, which was demolished starting in late 2016. In a blog post, the Friends of the Prouty Garden wrote that the new space lacked the immersive and serene quality of the old one.

“There are certain characteristics that every therapeutic healing garden must contain, and even rooftop gardens can have these features,” the Friends of the Prouty Garden group wrote on their website. “Things like: being serene, soothing and quiet in every sense. This garden has little shade, and visitors must content with sun, wind, and the noise of helicopters landing nearby.”

The group is still trying to stop the project, filing a suit in Massachusetts Appeals Court in February that appeals a Suffolk Superior Court dismissal of their case in which they sought to overturn the state’s approval of the project.

Despite the ongoing opposition, the hospital touts the first rooftop garden as a feat of engineering. Over 18 months, all the major building mechanical systems elsewhere on the roof were relocated, and a seven-foot high roof deck was built above the top of the building to allow for the necessary drainage.

The garden features shade sails adorned with patient artwork, and designers made the wood deck out of a Brazilian hardwood that grows back so quickly the material is considered sustainable. The mulch is made from recycled plastic, which is safe for immunocompromised children. The 12-foot glass panels offer 360-degree views of the city, and wheelchair-height binoculars let patients explore the city around the hospital.

“It’s hard to create these small niche spaces,” Hogarty said. “(This is available) for a family that wants to come up and have lunch, or a patient in the hospital or stretcher could come up and it creates nice enough privacy for the family to feel like the space is their own. At the centerpiece is a lovely grass mound.”

The new clinical building, which won't be completed until 2021 or 2022, will house the four other planned gardens. In the meantime, the hospital hopes the new rooftop garden acts as an ellipses to the Prouty — marking the beginning of change that will hopefully still be a restful place.

“The Prouty was what it was – a beautiful enclave,” Hogarty said. “But in this space the views are breathtaking. You can even see the cruise ships come into the harbor.”

 

Dr. T. Berry Brazelton, child care expert and pediatrician, dies at 99

By Joseph P. Kahn GLOBE CORRESPONDENT  MARCH 13, 2018

Trained in pediatrics and child psychiatry and endowed with an innate empathy for newborns and their often bewildered, guilt-ridden parents, T. Berry Brazelton devoted more than half a century to studying, nurturing, counseling, and advocating on behalf of young children and their families.

Through his clinical work, research papers, best-selling books, syndicated columns, television broadcasts, and popular lectures, Dr. Brazelton fundamentally changed the way pediatric care and child development are practiced and taught around the globe, from Boston’s renowned Children’s Hospital to remote corners of the Third World.

Retired from practice for many years yet continuing to publish and lecture well into his 90s, Dr. Brazelton, who held the title of clinical professor of pediatrics emeritus at Boston Children’s Hospital, died Tuesday morning at his Barnstable home at the age of 99, his daughter, Stina Brazelton confirmed. The cause of death wasn’t disclosed.

Brazelton described her father as brilliant, charismatic, and compelling. She said his mission in life was to help people.

“We loved him,” she said during a brief phone interview on Tuesday.

Working in the tradition of Dr. Benjamin Spock, another hugely popular advice-dispensing pediatrician, Dr. Brazelton combined rigorous science with personal charisma to become one of America’s most visible and celebrated child-care experts, his name appended to groundbreaking institutions and scientific methods, his smiling, calming countenance familiar to millions of baby boomers starting families in the post-Spock era.

“He revolutionized the way we think about families, particularly around the birth of a child,” said J. Kevin Nugent, a longtime colleague and friend who directs the Brazelton Institute in the Division of Developmental Medicine at Boston Children’s Hospital. “He affected so many people around the world.”

Dr. T. Berry Brazelton on the book cover for "Families: Crisis and Caring."

Dr. Brazelton’s focus on the overall health of babies and young children — their emotional well-being as well as their physical vitality — informed every aspect of his professional life. His ability to connect with them one-on-one, even at a preverbal level, was extraordinary, earning him the affectionate nickname “baby whisperer.”

“Whenever I’m with a newborn,” he once wrote, “I feel the magic in the way every baby plays a role in furthering the relationship with those who care for her and, as a result, her future.”

Among his most important contributions are the concept of anticipatory guidance for parents, a collaborative, dialogue-based approach now widely used in pediatric training, and his formulation of a neonatal behavioral assessment scale that bears his name. So, too, do an endowed chair in pediatrics and pair of programs affiliated with Children’s Hospital and Harvard Medical School: the Brazelton Institute, an education and research division of the hospital’s developmental medicine program, and the Brazelton Touchpoints Center, a training center made up of a network of doctors, nurses, educators, and other professionals dedicated to applying his teaching principles to parental education and public policy.

At Children’s, he founded and for many years directed the hospital’s first Child Development Unit, established in 1972. At Harvard, he started the first developmental pediatric fellowship program, another important piece of his legacy.

In addition to his pioneering clinical work, Dr. Brazelton wrote and lectured extensively for general audiences. As author or coauthor, he published more than 30 books and 200 scholarly papers while traveling widely as a kind of global ambassador for enlightened parenting and child-rearing.

His first book, “Infants and Mothers,” published in 1969, sold over 1 million copies and has been translated into two dozen languages. Other popular titles of his include “Doctor and Child” (1976), “Working and Caring” (1985), “What Every Baby Knows” (1987), “Toddlers and Parents: A Declaration of Independence” (1989), “Touchpoints: Your Child’s Emotional and Behavioral Development” (1992), and The Brazelton Way series, covering such topics as sleep, discipline, feeding, and toilet training. In 2013, he published “Learning to Listen: A Life Caring for Children,” a memoir written with the assistance of his daughter Christina.

Touchpoints, according to Dr. Brazelton and his colleague Dr. Jonathan Sparrow, are periods during the first years of life when children’s developmental spurts may cause “disruption in the family system.” His primary aim in writing “Touchpoints,” Dr. Brazelton asserted, was reassuring anxious parents that regressions are part of normal child development.

“Readers were grateful to have these normal hurdles predicted,” he noted, “because they could avoid a cycle of worry and guilt.”

“What Every Baby Knows” also became the title of a popular cable TV show hosted by Dr. Brazelton. Airing from 1983 to 1996, it won an Emmy award and made the affable baby doctor even more of a household name. Among his fans were Bill and Hillary Clinton, who invited Dr. Brazelton to a White House conference on children’s and parents’ issues. In 1988, Congress appointed Dr. Brazelton to the National Commission for Children. Fourteen years later, he was awarded a Presidential Citizens Medal for “exemplary deeds of service” to his country and fellow citizens.

Maria Trozzi, assistant professor of pediatrics at Boston University’s School of Medicine and director of the Good Grief Program at Boston Medical Center, trained under Dr. Brazelton as a pediatric fellow and traveled with him for nearly two decades on road trips with his National Seminar Series, an educational program for health professionals and parents.

“A hundred years from now, Berry will be credited as the father of developmental pediatrics,” Trozzi said. “There’s been nobody like him since,” she added. “His capacity to understand what parents were facing, not just their babies and young children, and to reach out and grab that parent emotionally — that was his magic.”

Thomas Berry Brazelton II was born in Waco, Texas, on May 10, 1918, where his father, Thomas Sr., a Princeton University graduate, ran a family lumber business. Their relationship was not a close one.

“I’m sure he loved me,” Dr. Brazelton later reflected, “but I never really knew him.” His father’s remoteness, he added, “fueled my ambitions” to better understand early father-child bonding.

Deepening this resolve was his mother’s own emotional distancing. Pauline Battle Brazelton doted on her younger son, Churchill, but not on young Berry, as he became known.

After attending boarding school in Virginia, he studied at Princeton and briefly contemplated a Broadway career. A talented singer and dancer, he had befriended, among others, actor Jimmy Stewart and director Joshua Logan before enrolling in medical school in Texas.

Dr. Brazelton transferred to Columbia University’s College of Physician and Surgeons and, after serving as shipboard physician on a Navy destroyer escort during World War II, completed internships at New York’s Roosevelt Hospital and Massachusetts General Hospital, settling in the Boston area, where he also did a training fellowship at Roxbury’s James Jackson Putnam Children’s Center.

It was during a residency at Children’s Hospital that Dr. Brazelton cultivated a lifelong interest in what he called the “total child.”

He also met Christina Lowell, a cousin of the poet Robert Lowell. After a brief courtship, the two were married in the fall of 1949. They had four children — Catherine (Kitty) Brazelton, of New York City, a musician and Bennington College professor; Christina, Pauline , and Thomas III — all of whom survive Dr. Brazelton,

In 1951, Dr. Brazelton opened a pediatric practice in Cambridge while beginning an instructorship at Harvard Medical School. As a child psychiatrist in training, he underwent two years of analysis himself. Along with Dr. Spock and Harvard psychologist Dr. Jerome Bruner, with whom he studied in the late 1960s, Dr. Brazelton counted among his friends and mentors Margaret Mead, the famed anthropologist.

Mead in particular helped spark Dr. Brazelton’s cross-cultural interest in babies and families, and in troublesome health issues like fetal alcohol syndrome. From Mexico, Guatemala, and Kenya, to China and Japan, he traveled widely in order to better understand different cultural approaches to childbirth and child-rearing, using those insights to inform his teaching and writing back home.

His influence ranged far and wide. At various times, Dr. Brazelton served in leadership roles with the Section on Child Development for the American Academy of Pediatricians, the Society for Research on Child Development, and the National Center for Clinical Infant Programs. He lobbied heavily for passage of the 1993 Family Leave Act. More than 180 Touchpoint teaching sites now exist in 33 states. He taught psychiatry and human development at Brown University, and his papers are archived at Harvard Medical School’s Center for the History of Medicine, housed at the Francis A. Countway Library of Medicine in Boston.

In a rare instance of his stirring public controversy, in 2009 Dr. Brazelton wrote a syndicated column suggesting that house cats could pose a health hazard to pregnant women and young babies. “Cat lovers may be upset with us,” he and his coauthor, Dr. Sparrow wrote, but, they warned, some cats could grow jealous of newborns stealing attention from them and “lie on (infants) to smother them.” Animal welfare advocates were outraged, denouncing the authors’ scenario as a long-discredited urban myth.

In his later years, Dr. Brazelton took up painting and gardening, among other hobbies.

His worldwide fame notwithstanding, Dr. Brazelton never lost his capacity to connect with young children and their parents on a profoundly human level. In his 2013 memoir, he recounted a 1992 trip to Croatia with UNICEF workers aiding Bosnian refugees in a genocide-plagued war zone. The trauma he witnessed was difficult to stomach, he recalled. Yet when a social worker wondered how he coped with emotional burn-out, Dr. Brazelton cheerfully replied, “I go see a newborn!”

He was duly taken to see an infant boy being cared for by his mother and grandmother. Dr. Brazelton asked for permission to play with the baby. “They were mesmerized when the baby turned to my voice, then chose his mother’s voice over mine,” he recalled. “His mother began to weep with joy. Without words, a new baby, once again, gave us all renewed courage and a feeling that the world might go on, in spite of the inhumanity of man to man.”

Brazelton leaves four children and multiple grandchildren, said his daughter, Stina.

Danny McDonald and Travis Andersen of Globe Staff contributed to this report. Joseph P. Kahn can be reached at josephpkahn@gmail.com.

The force of speaking truth to power

By Thomas Farragher GLOBE COLUMNIST  FEBRUARY 26, 2016

Anyone poring through a good reporter’s tip file would come to the same conclusion that I reached a long time ago. The ratio of wheat to chaff is about 1 to 25. And that’s being generous.

So when a good tip lands in your mailbox, your inbox, or your voice mail, you perk up and pay attention.

I thought I had one this week. It went like this: A longtime public servant in a small suburban town has unjustly landed in his boss’s crosshairs. The guy faces demotion or termination. Supporters are outraged.

“He is simply loved,’’ the tipster’s e-mail read. “He is a great, hard worker. He is always there to help anyone in need. . . . He is the best.’’

Great. Let’s talk turkey. But when I wrote back to get details, the tipster suddenly grew reluctant, insisting on anonymity and leaving me to my own devices. The public servant in question is constricted by legalisms and lawyers.

And so the tale of what might be a beloved figure being unfairly maligned — perhaps even persecuted — goes untold. At least for now.

There’s an old saying that — roughly paraphrased — goes like this: Bad things happen when good people remain silent. It turns out that courage is a rare commodity. That’s why it is so celebrated.

The courage to speak truth to power has been on my mind this week. There was an emotional hearing Thursday at the Harvard School of Public Health. State officials are examining Boston Children’s Hospital’s $1 billion expansion plan. Part of that plan includes the destruction of the Prouty Garden, an emerald oasis for sick children across six decades.

The hospital says it needs that space in order to better treat little kids. Garden supporters want the hospital to build somewhere else.

Amid the ensuing cacophony, there have been doctors willing to place their careers on the line to speak up to an administration that insists it has nowhere else to grow. It’s a phony argument and one of the most prominent pediatricians of the 20th century has said so.

He is Dr. T. Berry Brazelton, whose advice to America’s parents across multiple generations about how best to care for their babies has made him a national treasure.

He works at Children’s and wishes more doctors would raise their voices. “They don’t do it because they’re afraid,’’ Brazelton, 97, told me before Thursday’s hearing. “I’m so old they can’t do anything to me now.’’

Thank goodness for people like him.

And for people like Dennis Burke, the star orthopedic surgeon who had the courage to tell our Spotlight Team about his concerns over concurrent surgery — or double-booking — at Massachusetts General Hospital. Burke was fired for cooperating with the Globe but he left with his integrity fully intact.

And for people like Karen Jackson, a Milford probation officer, who was willing to tell us — at great personal risk — about the rigged hiring system at the state Probation Department that blocked her from getting a promotion she’d earned. A politically wired candidate got the job instead. A scandal erupted and senior probation officials were convicted in federal court.

They’re handing out the Academy Awards on Sunday night and the film “Spotlight” is up for a half-dozen of them. The movie is based on the Globe’s Pulitzer Prize-winning investigation of the clergy sexual abuse crisis that exploded in 2002.

In February of that year, I sat in the rectory of Our Lady of Sorrows Church in Sharon with a good and thoughtful priest, the Rev. Robert W. Bullock.

The pastor was an outspoken critic of how the Catholic Church’s hierarchy was handling the crisis — a moral scourge that had been whispered about for years.

“There is among us all some kind of varying degree of collective responsibility that we knew, or were aware at some level of our consciousness, that there was this disorder that was present,’’ Father Bullock, who died in 2004, told me. “And we were disinclined to make an issue out of it.’’

He said, with regret and candor, that priests were not accustomed to standing up to power, to taking risks, to having “the courage of our convictions.’’

Silence has its consequences. Courage of conviction is the precious raw material that makes all the difference.

Friends of the Prouty Garden appeal latest ruling in Boston Children's expansion

Opponents of Boston Children’s Hospital’s decision to construct a building on the site of a beloved garden have appealed a court ruling that allowed the project to move forward, the BBJ reports. 

The Friends of the Prouty Garden have filed a notice of appeal last month, challenging an October ruling in Suffolk Superior Court in favor of the hospital. The hospital demolished the garden in order to make space for an 11-story, 575,000-square-foot clinical building.

Read the full article by Max Stendahl, here.

Prouty Garden Supporters Weighing Options After Court Ruling

Prouty Garden lawsuit dismissed

November 3, 2017

By Emily Resnevic

Suffolk Superior Court Judge Sanders has granted the Department of Public Health (DPH) and Boston Children’s Hospital (BCH) motions to dismiss the Ten Taxpayer lawsuit challenging the state’s approval of BCH’s $1 billion expansion project.

Almost two years into this legal battle, Ten Taxpayer group is “disappointed without a doubt,” but exploring options to appeal the decision, according to Gus Murby, lead plaintiff of the Ten Taxpayer Group.

“We don’t think that we’ll be going away quietly,” Murby said.

BCH and DPH did not respond to requests for comment.

Ten Taxpayer Group is a group of individuals in the lawsuit, some of which are members of Friends of Prouty Garden who had advocated for saving the garden, which has since been demolished. The group is challenging Boston Children’s Hospital by alleging that BCH began construction of a new building before obtaining a Determination of Need (DoN), violating state law.

The DoN program, established by the legislature in 1971, promotes the availability and accessibility of cost effective and high quality health care services to Massachusetts’s citizens, according to DPH. It assists in controlling health care costs by eliminating duplication of expensive technologies, facilities, and services.

Murby said that the judge’s ruling has not been officially processed due to administrative reasons, but after the official ruling, the Ten Taxpayer group will have 30 days to make a decision about whether or not to appeal. They have not yet made a decision about whether or not they will do so, but are feeling motivated to keep on fighting and have several options to consider.

Murby said that he originally was motivated by the desire to preserve the garden because of his experiences there at a time when his son was being treated at BCH.

“If you’re facing a difficult diagnosis, being able to get out into the fresh air and away from the beeping machines has been clinically proven as a major benefit,” Murby said.

Murby also said that while the fight originally began to save the Prouty Garden, it has continued even after the destruction of the garden in order to challenge the legitimacy of the Determination of Need process and the state’s commitment to keeping healthcare costs low.

“We first started this battle for a range of reasons, most of which had to do with people’s personal connection with the garden,” Murby said. “The early push was to preserve the garden, which came down a year ago. The next logical place to look at was the DoN process, and we got drawn into that issue. We think this is a really bad project, not just because it eliminated the garden, but on economical gardens this thing is a dog, in our opinion. It’s based on faulty analysis and faulty administration of DoN process. For the past year, the issue we’ve been talking about is the issue of the impact that this will have on healthcare costs in Massachusetts – I’m a taxpayer, not simply someone who loved the garden.”

Murby said he was frustrated that the judge seemed to accept the argument from Children’s Hospital that the Ten Taxpayer group was only motivated by their desire to preserve the garden.

“Unsurprisingly, BCH suggested that the only reason we want to do this is to save the garden,” Murby said. “Unfortunately, the judge indicated that she accepted the argument that we were more motivated by the issue of the garden. She shouldn’t have accepted that, and I found it frustrating. We put so much effort into this.”

RELEASE: Prouty Garden Supporters Will Ask Court to Revoke State’s Approval of $1 Billion Boston Children’s Hospital Expansion

Amended lawsuit alleges that BCH’s violation of multiple regulations and the terms of its state-issued Determination of Need certificate warrant revoking the DoN and halting construction activities.

Plaintiffs say state public health officials have looked the other way while BCH has consistently flouted the law.

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Partners HealthCare cutting $600m in costs

By Priyanka Dayal McCluskey 

Partners HealthCare, the state’s largest hospital network, is planning to slash more than $600 million in costs over the next three years, its most significant initiative to become more efficient.

At more than $12 billion a year, Partners’ revenues surpass those of its competitors, but the company lost $108 million last year as its insurance arm and certain hospitals struggled. Executives say expenses are growing faster than revenues, threatening even renowned institutions such as Brigham and Women’s Hospital, which last month offered buyouts to 1,600 workers. Partners also owns Massachusetts General Hospital.

“This is an effort fundamentally to change not our values and our culture, but how we manage ourselves, how we focus on efficiency, the patient experience, the service we deliver, and try to be reflective of the pressures of being efficient,” Partners chief financial officer Peter K. Markell said in an interview. “We’re taking that seriously.”

Hospitals are under growing pressure from state and federal governments to control costs, a particular challenge for high-priced organizations like Partners, the most expensive health care system in the state.

The company started planning the cost-cutting initiative, dubbed Partners 2.0, with the help of consultants last year. The effort will target more than a dozen areas, including revenue collection, the supply chain, care delivery, and research.

Partners executives have not identified the steps they plan to take to contain costs but said the changes are scheduled to begin in the fiscal year that starts Oct. 1.

Markell said Partners may cut jobs, but he didn’t know how many. The Boston-based nonprofit organization owns 11 hospitals and employs about 73,000 people, making it Massachusetts’ largest private employer.

“We’ve basically taken different parts of the business and said... ‘How can we make it more efficient?,’ ” Markell said. “Then on the growth side, we’re looking at the region and national and international and saying ‘What are the best growth strategies for the future?’ ”

Partners is planning to acquire Care New England Health System of Providence, one of Rhode Island’s largest health care providers. In January, it completed an acquisition of Wentworth-Douglass Hospital in Dover, N.H., its first out-of-state deal.

Partners said Friday that it earned $24 million in the quarter that ended March 31, up from $21 million in the same quarter last year. Revenue in the quarter grew 8 percent to $3.3 billion.

Finances stabilized at Partners’ insurance business, Neighborhood Health Plan, which the company said was a result of the insurer’s restructuring plans. Neighborhood has predominantly served low-income families and individuals on Medicaid, but it is moving to shrink its share of members on Medicaid and expand into the more lucrative business of selling insurance to employers.

 

Prouty Garden advocates sue state over public record request

By: Jessica Bartlett

A group that's fighting the demolition of a beloved garden at Boston Children’s Hospital is suing the state, saying there may be a connection between the state's approval of the demolition last October and the hospital's participation in a new pilot program around the same time.

The lawsuit by the Friends of Prouty Garden in Suffolk Superior Court against Marylou Sudders, the secretary of the Executive Office of Health and Human Services, alleges the state refused to give petitioners documents it requested under the state’s Public Records Law.

It's the latest move in a longstanding dispute over the Prouty Garden, a half-acre plot of land at Boston Children’s Hospital that has already been demolished to make way for a $1 billion new clinical building.

According to Gregor McGregor, an attorney for the plaintiff who has also been a spokesperson for the group opposing Boston Children’s Hospital expansion, the group is seeking several documents related to the state’s communications around the Boston Children’s Hospital state approval — also called a Determination of Need, and communications relating to the state’s desire to have Boston Children’s Hospital join a pilot program for MassHealth to care for patients on a budget.

McGregor said the governor approved Children’s project at roughly the same time the hospital said it would participate in the pilot program. He reasons that there may be a connection.

“I’m not drawing inferences. I’m connecting the dots,” McGregor said. “That’s what this suit is about.”

The suit references meetings Gov. Charlie Baker had with Children’s CEO Sandra Fenwick, and also discussions he had with Sudders about that meeting.

Endowed in 1956 by a family, the garden had served as a healing space for children and their families. Advocates also say the ashes of at least two children who died in the hospital had been spread in the garden.

Despite opposition, and an ongoing court case against the project, the state’s Department of Public Health approved the expansion in October 2016. Demolition of the garden began in December.

Opponents appealed but still lost injunctions to stop demolition. McGregor said he’s still hopeful that the garden could be restored, or at the very least that the decision to approve the project would be rescinded.

“(My clients) want the integrity of (state’s approval process) upheld,” McGregor said. “They want the agency to review under its jurisdiction the project with no exceptions, and… this is designed to daylight how this went down. We’ll see what the facts lead to.”

MGH to help build Chinese hospital

By: Jessica Bartlett

Massachusetts General Hospital is helping build a hospital in Shanghai, China, the latest international work being done by Partners HealthCare hospitals.

Partners, the parent organization of MGH and Brigham and Women’s Hospital, already had a relationship with Jiahui International Hospital, signing a $3 million agreement along with the Brigham in 2015 to help develop a women’s health center of excellence, including development of obstetric, gynecology, and in-vitro fertilization programs.

MGH has been helping Jiahui in the space planning and architectural design of the new hospital, and have worked together since 2012 to transform oncology care.

The latest deal will add more Massachusetts medical expertise to the 300-bed Jiahui International Hospital, which is slated to open in October. According to the agreement, MGH will help develop the physical infrastructure of the hospital, operations and governance, as well as lend expertise in nursing, patient-care services and cancer care. In the future, MGH may provide second opinions to Jiahui patients remotely.

“As an academic medical center we relish the opportunity to share our experience gleaned from more than two centuries of providing top-notch patient care and leading-edge research,” Dr. Peter L. Slavin, Mass General’s president, said in a statement. “This relationship also affords us new learning to apply to our work in Massachusetts.”

Financial details were not disclosed, but a Partners HealthCare International official last year said Partners had received as much as $1.5 million a year to consult on construction of the Shangai hospital.

“Through this strategic collaboration with Mass General, we are bringing the concept of a world-class, patient-centered and top-quality healthcare to China,” said Dr. David Cook, chief clinical and operations officer of Jiahui Health and president of Jiahui International Hospital. “The goal is to highlight to the government, industry, patients, and the public that this concept can bring forth high quality, easy access and transparent costs.”

Partners is no stranger to undertaking work abroad. The international arm of the health care giant, Partners HealthCare International, has been collaborating with partners in several places in India for years, on both direct clinical care as well as a broad program around nursing education. Programs are also underway in Qatar working on quality improvement, physician leadership, disaster management. In Malta and the Ivory Coast, Partners is helping improve care at a number of hospitals.

At Jiahui, MGH will first focus on cancer care and research in constructing the new hospital before broadening its mission to include other illnesses and diseases. Mass General Cancer Center will help Jiahui launch a cancer center focused on breast, lung, gastrointestinal, lymphoma and myeloma treatment programs. The Nursing and Patient Care Services out of MGH will also help create training and educational programs for clinical staff.

GOP health plan would cost Mass. at least $1b, Baker says

By: Martin Finucan

The Republican plan to replace the Affordable Care Act would cost Massachusetts at least $1 billion in reduced federal aid, beginning in 2020, and even more in the future, according to Governor Charlie Baker.

Baker’s estimate came in a letter Tuesday to the state’s congressional delegation in which he shared his administration’s analysis of the effects of the controversial House GOP bill’s impact on the state.

“Overall, our analysis indicates that the [bill] would increasingly strain the fiscal resources necessary to support the Commonwealth’s continued commitment to universal health care coverage,” the Republican governor said.

Baker said that his administration estimated that the revenue hit would be at least $1 billion in 2020, $1.3 billion in 2021, and $1.5 billion in 2022, with an even higher impact in the following years. He said the numbers were developed after applying assumptions from the March 13 report on the bill’s impacts by the non-partisan Congressional Budget Office.

He also said there were other “key areas of concern” that “could further impact the Comonwealth’s budget.”

Congressional Republicans are hoping to ram through the new bill, titled the American Health Care Act, in a vote on Thursday. Some changes were announced late Monday to the bill to address concerns, including help for older Americans who could see major premium increases.

It wasn’t clear if the recent changes would affect the estimates developed by the Baker administration.

President Trump headed to Capitol Hill Tuesday to try to build support. A reporter asked him, as he entered a closed-door meeting with Republicans, if the bill would pass. Trump gave a thumbs-up sign and said, ‘‘I think so.’’

Failure to pass the bill would be a major setback to Trump. Success could give Republicans momentum to tackle other big issues. Even if it passes the House, though, the bill faces an uncertain fate in the Senate.

Massachusetts could also take a big hit under Trump’s budget plans. Trump released a budget blueprint last week.

Democratic US Senator Ed Markey estimated the state, under the Trump proposal, would lose nearly $1 billion in federal funding for research, clean energy, education, and social services programs.

Die-hard Prouty friends

The Friends of Prouty Garden just won’t quit. The group opposes Boston Children’s Hospital’s decision to demolish a beloved garden to make room for a $1 billion expansion, and is still trying to derail the project even though it was approved by the state and work is underway.

Lawyers for the group requested numerous public records, and they’ve uncovered an interesting tidbit: Governor Charlie Baker and Children’s chief executive Sandra Fenwick met in late August, while the Children’s project was under state review. Administration officials gave Baker a memo to brief him for the meeting, including three pages of details about the expansion. The memo noted that the project was in line for “anticipated” approval.

Gregor McGregor, a lawyer for the Prouty Garden supporters, said the meeting raises questions: Should the governor have met with Fenwick while the hospital’s project was under review? Was it appropriate for Baker and Fenwick to discuss the project?

The governor’s spokeswoman, Lizzy Guyton, said the meeting was arranged to discuss something far more dull: Medicaid reimbursement rates. (It’s not uncommon for the governor to talk to health care executives about such policy issues.) Guyton called the Friends’ concerns “completely baseless,” adding that “the approval process for the expansion of Boston Children’s Hospital was conducted thoroughly and transparently.”

Baker offered support for the hospital project when questioned by the Globe in October. A few days later, state health officials approved the project, with conditions.

Children’s spokesman Rob Graham said the hospital has adhered to all regulations around the approval process, and dismissed “any suggestion to the contrary.”

Children’s is pushing forward with its project. Opponents are still fighting their long-shot case against the hospital in court. — PRIYANKA DAYAL MCCLUSKEY

How Top CFOs Succeed In The Digital World

To explore how CFOs are transforming financial operations to drive success for their organizations, I held a roundtable on November 30, 2016 with industry leaders in technology, healthcare and transportation:

Mike Riccio, CFO and Treasurer, Panasonic Corporation of North America

Doug Vanderslice, SVP and CFO, Boston Children’s Hospital

Rick Short, EVP and CFO, Enterprise Holdings Inc.

Tom Fisher, Global Finance Transformation Practice Leader, IBM

Robert Reiss: What’s an important initiative your financial team is focusing on going forward?

Doug Vanderslice: We’ve undertaken a multi year initiative to upgrade all of our administrative infrastructure. Next in line is our human capital management systems. Health care delivery is a very people oriented service, so people are truly our most valuable asset and labor is our single largest cost. We have the opportunity to much better manage the core processes behind our employees but also to better understand how we’re deploying human resources and how we’re matching people with volume. This becomes extraordinarily important in managing affordability and capacity to reinvest.

Mike Riccio:  We’re now exploring ‘forward looking KPIs’. We’re pretty good at backward looking KPIs. So now we’ve picked a couple of our business groups and we’re working closely with them on some of the important business indicators either internal or external, that can help us be more predictive in terms of where their business is headed and what some of the gaps are, and we’re seeing financial results.

Rick Short: We have a decentralized organization that empowers employees to make local decisions to assist customers on the spot. These employees who interface with customers are providing invaluable feedback to their local management teams which then ends up being forwarded to the corporate office, so that we can use it to help enhance and grow other processes and systems to provide even better service in the future. It’s a collaborative process and since our culture is driven by change, it’s just a natural progression for us to meet the changing needs of the business with the use of technology.


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Reiss: What are you most excited in the digital world?

Riccio: The expansion of our business opportunities here in North America especially in automotive and avionics. 

Short: We’ve just created an innovation called “LaunchPad” which takes our employees away from the counter, so they can focus on the customer and what the customer wants wherever they want it.

Vanderslice:  Our ability to identify and treat patients or conditions that historically have not been treatable.

Reiss: What are you most fearful of in the digital world?

Short:  For probably most organizations, the most fearful thing is the cyber security issues that we all have to deal with every day.

Vanderslice:  I’m with Rick on cyber security. The other thing, though, that I’m fearful of is whether or not the significant capital investments we are currently making are going to be somehow rendered obsolete by new advances in care.

Riccio:  I too echo the cyber security concern, as well as, as we’re getting into fields that we have not traditionally played in, and just meeting the expectations of the market and also dealing with the new competition. 

Reiss: What one data point is most valuable in aligning with profitability?

Short It’s obvious for us: customer service. We want to know what our customers want and how we can satisfy that. We have a system in place where customers rate if they are completely satisfied with our service. We know a completely satisfied customer is three times more likely to rent from us again, and that is very significant from a long-term perspective.

Vanderslice:  I think it is treating as quickly and as effectively as possible at the right location, so as to manage the risk that health care systems are increasingly taking on as well as managing in a capacity constrained environment.

Riccio: For us it’s providing the solution for the customer but understanding then the business case and the return on investment because we are making new investments in these areas. So to me the metric that I look at is: Are we solving the customer’s problem and are we getting return on that investment?

Reiss: In healthcare, technology, transportation how is digital and innovation changing the competitive marketplace that you operate in today?

Short: Since we are such a customer-centric business we listen and our customers direct us on what kind of products and services they’d like to buy from us. And mobility is a key focus. From that, we have a total transportation solution model where you can “rent, buy or share” vehicles depending on your need.  And of course, we’ve had a lot of discussions with the auto manufacturers about the future of autonomous driving and accident avoidance.

Also, as a rental car company, we end up being an extended test drive for a lot of the auto manufacturers and their customers, because many people will be introduced to a new make and model of vehicle and its technology for the first time upon renting from us.  Another benefit to manufacturers is a program we call “Rate this Ride.”  Customers can rate the vehicle they are driving through an Enterprise Rent-A-Car or National Car Rental app or even by scanning a QR code, and the information is shared with the vehicle manufacturer. So it’s essentially a test-drive feedback session for our customer and eventually a manufacturer’s customer.


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Riccio: Top management has pretty much been remaking Panasonic, the Corporation, starting primarily here in North America. This transformation has us going from primarily a B-to-C box-sales-type business to a more B-to-B solutions type business. So the biggest transformation that we’re seeing that’s impacting us is how to provide solutions to customers. We are listening carefully to our customers, and each customer solution that we’re dealing with is quite unique, and the missing secret sauce in almost every case is data or software related, and we’ve been primarily a hardware manufacturer for most of our lives.

This has led us to make some strategic “niche” acquisitions. It’s changed us a lot because we were a company that traditionally did not make acquisitions. And then now we’re absorbing them into our organization so that we can have scalability going forward to provide solutions for other customers. This is true in almost every one of our groups: avionics, automotive, business-type computers. And, if you noticed, I didn’t mention the word “TV” because basically we’re not in the TV business now here in the US.

Vanderslice: Broadly in the healthcare industry the business model change is a shift from being volume driven to managing populations, being more value driven and looking at a hospital as more of a cost center. Also there’s a lot of non-traditional competitors that are starting to enter this space, particularly consumer-facing, including CVS and other drug stores entering into urgent care type settings. The tech companies are trying to find a variety of ways to play in the healthcare space. There’s a lot more biomonitoring and wearables that are available.

For Boston Children’s, and academic medical centers, the scientific advances have given us tremendous opportunities to treat conditions that were once untreatable and to identify conditions and treatments much more precisely with the use of genetic information, ‘precision medicine’ as it is now often called.

________________________________

In summary, Tom Fisher, Global Finance Transformation Practice Leader, IBM shared, “What we’ve found from our research with CFOs, are four themes which sum up the changing environment that CFOs need to adapt to: first is that competitive disruption – driven by technology innovation, virtualization and disintermediation - is real and accelerating every day; second that the CFO has become the most trusted advisor to the CEO and CMO on navigating business strategy and driving revenue growth; third is that order for CFOs to meet changing expectations, they need to transform financial operations by advancing from managing transactions and general ledgers to focusing on predictive and cognitive activities; fourth is that there’s a tangible payoff associated with reinventing Finance. For example, we see that analytically sophisticated companies have 55% higher revenue growth and 57% greater profitability and lower finance functional costs than their less analytically sophisticated peers  (Redefining performance - The CFO Point of View).”

The Many Health Benefits of Trees

By Lisa Esposito

Dec. 9, 2016

Heat-stroke protection, cleaner air, better breathing, sounder sleep, stress relief, disease prevention and defense from depression – trees and greenery offer a host of health advantages. Planting more trees beautifies urban neighborhoods while helping residents feel better. It's not just about city spaces, however. Even in highly wooded areas, tree loss is tied to a rise in disease and higher mortality. Below, experts make the case for investing in trees for health's sake.

Trees cool down neighborhoods. Trees in U.S. cities play an important role in keeping temperatures down, says Rob McDonald, lead scientist for global cities at the Nature Conservancy. "The average reduction is 2 to 4 degrees Fahrenheit in the summer," McDonald says. In a heat wave, he says, that can make the difference between people, particularly the elderly, staying healthy or risking heat stroke. Trees form a canopy that shades sidewalks and pavement to keep them from getting too hot.

Trees fight air pollution. Scientists refer to "particulate matter concentration" – most people call it air pollution. Large-leaved trees have more surface area for leaves to filter noxious particles from the air, McDonald says. In addition, he says, certain tree species, like elms, have a filtering advantage: "They have hairy leaves and do better at getting particles to stick to them – and if they're stuck to leaves, then we're not inhaling them."

Trees and greenery may boost lifespan. In a large study following nearly 110,000 women over eight years, published in April in Environmental Health Perspectives, Harvard researchers found that women living in the greenes t areas had a 12 percent lower non-accidental death rate than women surrounded by the least vegetation. While cause and effect wasn't determined, the strongest associations were for reduced death rates from respiratory illness and cancer.

Satellite imagery was used to determine seasonal greenness in the 250-meter radius (about 275 yards) surrounding each participant's address. Greenness, or vegetation, was not limited to trees, says study author Peter James, a research associate in epidemiology at the Harvard University School of Public Health and an instructor of medicine atBrigham and Women's Hospital and Harvard Medical School. "It really encompasses anything that undergoes photosynthesis," he says. "It would capture trees, it would capture grass, it would capture shrubs."

It's not just about parks versus pavement, James adds, or manicured lawns versus open spaces. "This could be street trees or landscaping; it could be a vacant lot that was overgrown by weeds."


Trees ease depression and stress. In the Harvard study, mental health was likely the key factor tying vegetation density to lower death risk, James says. Green environments tend to boost physical activity and social connection and dampen depression. That, plus nature's known stress-reduction effects, lead to better physical health. "We've already shown through other research that vegetation can help mitigate the effects of climate change," he says. "These findings suggest there's a co-benefit of vegetation to improve health."

Tree loss hurts health. "You don't know what you've got till it's gone," Joni Mitchell sang in "Big Yellow Taxi," as she mourned the sacrifice of trees to build parking lots. Tree loss isn't always man-made. A forest-infesting pest called the emerald ash borer is wreaking ongoing havoc in wooded areas. The spread of the tree-killing beetle gave U.S. Forest Service scientists and others the opportunity for a "natural experiment" to show the effect of environmental changes on public health. In the 15-state area and 17-year period covered, more than 15,000 additional deaths from cardiovascular conditions such asheart attack and stroke occurred. The study, published in 2015 in the American Journal of Preventive Medicine, also found more than 6,000 additional deaths related to lower-respiratory disease. Wealthier counties showed the most serious health effects from emerald ash borer infestations, which continue to spread in the U.S.

Trees reduce asthma's toll. A couple of years ago, strategically placed sensors measured nitrogen dioxide levels in nearly 150 Portland, Oregon, neighborhoods. Produced by vehicle emissions, industrial processes and other sources, nitrogen dioxide is a big part of smog and one of the six leading air pollutants identified by the Environmental Protection Agency. In the study, conducted by Portland State University, tree cover had a significant effect on nitrogen dioxide levels and residents' respiratory health by area, according to the study model. For instance, in higher-tree areas, young kids were estimated to have avoided missing more than 7,000 school days annually because of asthma attacks. Emergency room visits due to asthma were reduced yearly by an estimated 54 visits among all people. Similarly, over a year, hospital stays in older adults were reduced by an estimated 46 stays, according to the study in the November 2014 issue of the journal Environmental Pollution.

Trees support better sleep. In an extensive national study including more than 255,000 adults, researchers examined the effect of the natural environment on sleep. Proximity to oceanfront or bodies of water, ambient temperature, heat, humidity and light exposure were all factored into the study, published in the September 2015 issue of Preventive Medicine. Green space in itself helped protect men of all ages and older adults from insufficient sleep.

Time to replenish. In October, the Nature Conservancy released a report on the impact tree planting could have on health among 245 cities throughout the globe. If $4 was spent per resident in the hottest, most-polluted cities in need of tree cover, tens of thousands of lives could be saved, the report concluded. "We're hoping people will get motivated from this to plant another tree in their backyard or [encourage] their city governments to plant more trees along the street," McDonald says. (You can zoom in on this interactive map to see where your city stands.)

Older neighborhoods with beautiful oaks along the street are making way for newer subdivisions with fewer trees, McDonald says. While many U.S. cities were active in tree-planting right after World War II, he says, now those trees are now aging and dying out. "Trees provide a lot of benefits and they're healthy," he says. "So why don't we invest a little more in this resource?"

Demolition begins on BCH Prouty Garden

By Haley Fritz

Boston Children’s Hospital will soon replace the Prouty Garden, which is currently being demolished after the Massachusetts Public Health Council approved the hospital’s expansion project, according to BCH spokesperson Kristen Dattoli.

The new building will have a state-of-the-art clinical building that includes an updated neonatal intensive care unit and private rooms. However, Dattoli said some parts of the garden — such as statues, plants and other materials — will be preserved and incorporated into green spaces in the new building.

“A lot of thought has been put into the transfer of many items in the garden into the new green spaces,” Dattoli said.

The garden officially closed on Sunday, and demolition of the garden has already begun, according to the Save the Prouty Garden website.

In a Nov. 7 letter, BCH CEO and President Sandra Fenwick thanked stakeholders for the council’s approval, a decision that also included the improvement of BCH’s Longwood campus and new clinical facilities at Brookline Place.

“We would like to extend a special thanks to the Prouty family and our Greenspace Committee,” Fenwick wrote. “As we prepare to move into the future, the hardest decision of all was to say goodbye to a beloved part of our history. But thanks to your passion and dedication, the spirit of the Prouty Garden will be felt in ways both new and familiar across our entire campus.”

Gus Murby, a spokesperson for Friends of Prouty Garden, said his organization has been formally fighting the garden’s demolition since 2015. The cause is important to him because his son was treated at BCH as a teenager, he said.

“Any time you have a kid who’s cooped up in a hospital for weeks, if not months at a time, the opportunity to get out in and to get into the fresh air is a pretty big deal,” Murby said. “The hospital is a prison … for many people, the garden was a real important psychological escape.”

To combat the garden’s demolition, Friends of Prouty Garden launched a Change.org petition that acquired over 17,000 signatures, Murby said.

Friends of Prouty Garden then filed a civil lawsuit against BCH to protest the Department of Public Health’s failure to review its appeal regarding the demolition, according to Murby.

Friends of Prouty Garden appealed to a state judge on Nov. 23 to prevent the hospital from demolishing the garden until the lawsuit’s resolution, Murby said, but the judge denied the request.

“The garden … was an iconic facility that differentiated Children’s Hospital from any other hospital around,” Murby said. “[Now], you wouldn’t even know that you were near a garden.”

Michael Rich, a pediatrician at BCH and director of the Center on Media and Child Health, said that the demolition shows that BCH is off track as an institution, and that the garden’s demolition was purely a business decision.

“I’ve had patients that have asked to go there to die … so the fact that this administration is treating it as a vacant lot to be built on shows that they have some problems with our mission,” Rich said. “This is an expansion as well as a modernization, and it’s an expansion designed for optimizing profits, particularly from full-paying international patients.”

Several Boston residents expressed disapproval of the demolition of the Prouty Garden, as it has served as a green space and a relaxation area for patients and family members.

Amy Baker, 34, of East Boston, said the hospital should provide new green space if they demolish the garden.

“When families are going through something that’s stressful, you need something that’s not just a cold and clinical environment to be able to connect,” Baker said. “[But] I always think progress is good, as long as you understand the needs of the community before you do it.”

Mark Jones, 64, of the South End, said it is difficult for hospitals to decide between maintaining tranquil space and providing more services.

“The hospital industry in general in Boston certainly is a driver of the economy,” Jones said. “The capacity to support and treat more children is generally a good thing.”

Pamela Newman, 31, of South Boston, said the garden offered patients calmness and a place to escape the feeling of being in the hospital.

“It’s a shame that they had to tear down the garden and couldn’t build around it,” Newman said. “I’d want [a garden] if I was in there, or if my family was.”

Demolition begins at Prouty Garden

By Jeremy Fox

The demolition of a beloved garden at Boston Children’s Hospital has begun, frustrating many who fought for years to preserve the space.

A hospital spokesman said Sunday that Children’s has closed Prouty Garden and begun removing trees and plants to prepare the site for construction of a new clinical building.

Opponents of the demolition lamented the apparent removal one of the half-acre interior courtyard’s most distinctive features, an imposing 65-foot tree.

“It looks like they’ve completely taken down the dawn redwood tree, which for me is a symbol of the heart and soul of the hospital and what the hospital has been giving to the patients and families and staff,” said Anne Gamble, who started an online petition to save the space. “For me, it is personally devastating.”

Rob Graham, the hospital spokesman, said in a statement that the hospital’s planned expansion will improve care and the patient experience while honoring the garden.

“We have preserved statues, plants and other materials from Prouty Garden to use in the new gardens created as part of new clinical building and the renovated Longwood campus,” Graham said. “Among the new gardens includes the Anne and Olivia Prouty’s Wishingstone Garden, a 1/4 acre ground level outdoor garden.“

The garden was donated in 1956 by Worcester-born novelist and poet Olive Higgins Prouty, who lived most of her adult life in Brookline. Prouty hired the Olmsted Brothers design firm to create the courtyard in memory of her daughters Anne and Olivia, who died in childhood.

The garden is being demolished to create space for the 11-story clinical building, part of a planned $1 billion expansion of Children’s. Opponents, who brought a lawsuit in an attempt to block the teardown, have said the garden is a cherished space of recovery for the hospital’s patients.

“The significance of the healing power of the garden has been an integral part of the core values of the medical profession, as I’ve perceived it, at Children’s for decades,” said Gus Murby, lead plaintiff in the lawsuit.

The opponents sought an emergency injunction to halt demolition, but last month a Suffolk Superior Court judge denied their request.

Murby said he visited the hospital Thursday to donate blood and saw that signs for the garden had been removed. First-floor windows facing the courtyard were blocked.

“I don’t think they wanted anyone to see what they were doing behind the screens, to be honest with you,” he said.

Though the work has begun, Murby said the lawsuit will continue in hopes that it can be halted and the garden at least partially restored.

“It’s too late for the dawn redwood,” he said. “It’s not too late for the garden.”

Dr. Wendy Wornham, a pediatrician affiliated with Children’s, said the garden was a “unique space” and its razing was a great loss “for the community of health care providers and the families that come to the hospital for healing.”

“It was unique because it allowed a space for sick children, their families, and health care providers to step away from suffering and the incessant beeping of machines and pagers … and attempt to put this all into some sort of perspective,” Wornham said.

Mason W. Smith, a grandson of Prouty, said he was sad to see the garden go but accepted that nothing is permanent.

“I was asked if my grandmother said that the garden could never be changed, and my reply to that was that she might hope it wouldn’t change, but she also knew that stuff changed,” Smith said.

Smith said he was heartened to see that designs for the hospital expansion include several new green spaces.

“I guess my feeling is life moves on, and we have to deal with it, and lets keep as many of the attributes as we can as we move forward,” he said. “And I think that would be consistent with the grandmother I knew.”