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The Organizational Review Committee, a body created last spring to seek $14 million in savings for the fiscal year beginning in July 2010, issued a report earlier this month that included recommendations to discontinue overnight inpatient care at Health Services. Members of the ORC's Student Services team, which made the recommendation, said students will not lose access to any important medical aid if the measure is approved by the Corporation — the University's top governing body — at its meeting later this month.

The Student Services team was charged with finding $500,000 in savings, either through "identifying budget reductions" or through new sources of revenue, said team leader Margaret Klawunn, vice president for campus life and student services.

Klawunn would not say how much money the University could save by dropping inpatient care.

"It was a huge portion of our cuts," said Chelsea Waite '11, one of the student representatives on the team, though she said she did not know the exact figure.

According to Klawunn, the team was not allowed to raise fees, so they had to look for cuts that would not "reduce the quality of student experience," Klawunn said.

Klawunn also said an external consultant examined Health Services in 2007 and recommended that Brown close the inpatient clinic in order to save money and reduce liabilities. When students spend the night at Health Services, one nurse cares for all of the patients, none of whom are deemed ill enough to warrant treatment from a doctor, she said.

But at the time, Brown's finances were more stable and it was not necessary to immediately cut the program, she said.

Instead, the University decided to begin reducing inpatient care, and since September the unit has been closed Monday through Thursday nights.

Sarah Rutherford '12, another member of the ORC's Student Services team, said she supported eliminating the program because Health Services had reported to the committee that the reductions in inpatient care this fall had not left students without access to good health care. 

"The most convincing factor for me was that they'd already closed it Monday through Thursday, and they didn't feel like that had factored in," she said.

Most people using inpatient care could just as safely spend the night in their rooms, she added. "My impression is that if Health Services were seriously concerned with a student, they would send them to the hospital anyway," she said.

The ability to stay overnight at Health Services is "a convenience service," Waite said.

"A part of me definitely realizes that the convenience of having Health Services right here with beds if you don't want to stay in your room is really nice," Waite said, adding that the overnight care provided students with the assurance and supervision they might receive from parents at home. But it is "not cost-effective."

"The staff at Inpatient Services is not trained to do a lot of what people would need," she said. "It's a huge liability to have people staying overnight when they're not in a hospital."
Brown's infirmary-style overnight care is "an outmoded model," Klawunn said. The ORC report detailed several existing alternative services — including physicians, psychotherapists and nurses on call, expanded Health Services hours on evenings and weekends and a new overnight nursing triage service — that will continue to serve students if the team's recommendation is approved by the Corporation.

Emergency Medical Services First Responder Connor Barnhart '13 said he thought the proposed cuts might negatively impact students' ability to seek out care and could perhaps make them more reluctant to call EMS.

"Generally we only respond to E.R. emergencies, but very often we'll forward people to Health Services if we don't think it warrants an E.R. visit," Barnhart said of the patients he sees through EMS. Because hospital visits are so expensive, EMS prefers not to send people to the emergency room, he said. Without Health Services available at night, he predicted more students would need to go the hospital.

Currently, students are responsible for financing their own hospital care, which means that students on their parents' insurance generally need to inform their parents of hospital care. Under Rhode Island law, EMS cannot bring dangerously inebriated students to Health Services, but must send them to the hospital even when University inpatient care is available, Klawunn said.

But students can currently bypass EMS and instead walk their friends to Health Services on Friday, Saturday and Sunday nights if they worry their friends have consumed too much alcohol, Klawunn said. Although inpatient caregivers will send students to the hospital if they need intensive treatment, under current guidelines some less-critical students are able to stay the night and avoid the cost of a hospital visit and the parental notification it usually entails, she said.

Costs for hospital visits vary widely by procedure and insurance, but the Brown University Student Health Insurance Plan demands a $100 co-payment for emergency room visits, according to its Web site. There is no such cost associated with Health Services.

Most colleges and universities have dropped inpatient health care services and depend mainly on area hospitals to care for students at night, Rutherford said.

"All of our peers have shifted to a different model, and they did that for a reason," she said.




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