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Proposed NH Senate districts criticized as gerrymandered
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A Republican-backed proposal to set new boundary lines for N.H. Senate districts amounts to partisan gerrymandering, according to people who testified at a Senate committee hearing on Monday.

No witness supported the Republican plan, Senate Bill 240, which critics said was designed to benefit the GOP. The Senate Election Law and Municipal Affairs Committee will accept more redistricting proposals before reaching a decision.

Senate District 10, which takes in Keene and a large swath of Cheshire County, would be changed under the Republican proposal.

It is now a squat district in far southwestern New Hampshire, extending from the Vermont border on the west, to Harrisville on the east, Alstead in the north and Winchester in the south.

Under the plan, it would be extended generally to the east to take in the Hillsborough County towns of Hancock and Peterborough. Hinsdale and Winchester would be removed from the district, and added to District 9, currently represented by Sen. Denise Ricciardi, R-Bedford.

Sen. Jay Kahn, D-Keene, represents District 10. He said the proposal is aimed at consolidating Democrats within its boundaries so that other nearby districts now held by Republicans become even more friendly to the GOP.

“I think the Senate districts proposed in Senate Bill 240 are not in the best interest for Cheshire County,” he told the committee.

The best approach would be to draw compact districts of common interests where municipalities share affiliation by county, school district and commerce centers, he said.

Instead, the bill sets up districts by political party sentiment, Kahn said.

The Democratic minority on the committee also submitted a redistricting plan, which basically preserves the existing Senate District 10.

Much of the discussion before the committee seemed to be critical of the Republican plan and in favor of a bipartisan effort to draw a new map.

Kahn asked the committee to work together to draw up a non-partisan plan. Republicans make up a majority of the committee as well as the full Senate and the House.

“Political parties need to come together and develop one Senate redistricting map, the way a non-partisan commission might have if that Democratic proposal had been signed into law by Gov. Sununu,” Kahn said.

In 2019, Republican Gov. Chris Sununu vetoed a bipartisan bill to create an independent commission to come up with the best way to redraw lawmakers’ districts.

Ten years ago, when Republicans were also in the majority, there were again public concerns about gerrymandering. One often-cited example from that process was the Executive Council District 2, which includes Keene and extends east all the way across the state to Somersworth.

It’s been called the “dragon district” or the “salamander district,” because of its geographic length. Critics say it was designed to be packed with Democratic voters, so the other four districts on the council could be controlled by Republicans.

Councilor Cinde Warmington, who represents District 2, is the only Democrat now on the Executive Council.

Sen. Ruth Ward, R-Stoddard, represents Senate District 8, which takes in Langdon and Acworth on the west, Grantham on the north, and Weare and Francestown on the southeast.

She said in an interview Tuesday that it’s hard to take politics out of the redistricting process, since the law says the Legislature shall be in charge of it.

“If you could find a group not politically motivated to do it, that would be nice, but I don’t know if that would be possible,” Ward said. “I would go with the plan that the Republicans came up with. I don’t think it is perfect, but I would go with it.”

New districts are drawn up every 10 years based on updated population figures. Each of the state’s 24 Senate districts is required to have about the same number of people.

In New Hampshire, redistricting is done by the state Legislature and is subject to veto from the governor. Like other bills, both the House and the Senate participate in the process.


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At an N.H. Senate hearing on Monday, no witnesses supported the Republican proposal to redraw district lines, shown here, which critics said w…


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‘A real turning point’: Mobile crisis units offer new tool in mental health treatment

For years, getting help during a mental health emergency usually began with two options, neither ideal and both often harmful: A call to police or a trip to the emergency room, where someone could wait hours, days, even weeks for care.

So-called “emergency room boarding” has led to upward of 30 children and often as many adults waiting for an inpatient bed, lawsuits, and a state Supreme Court order.

As of this month, there’s a new option that mental health advocates have been asking for at least a decade: a 24/7 phone line answered by trained mental health staff and, for those who need more, a mobile crisis response team that goes to them.

The hope is that a quicker response to the community will spare people emergency room waits and provide them the appropriate level of care, which can often be immediate stabilization and a next-day appointment with a counselor. Staff from Health and Human Services have said they expect call center staff will resolve 80 percent of cases without dispatching a crisis response team.

“Families tell us all the time, we wish we had another option because we went to the emergency department and we had to wait four or five hours,” said Dennis Walker, vice president of emergency services at the Seacoast Mental Health Center. “We had to tell our story three different times. We had to get labs. We had to do all those things, and it’s just so exhausting. To be able to bring crisis care directly to somebody’s home or wherever they might be, I think that’s what’s so exciting about this.”

The Rapid Response Access Point, more commonly referred to as mobile crisis response, began Jan. 1 with surprisingly little publicity by the state or the company contracted to run it. In fact, community mental health centers said their two biggest challenges are hiring enough staff and making sure the public knows how to access the new service.

The company did not return messages and has shared little information about the program on its website, including the telephone number or nh988.com web address, though those kinds of details — as well as overall marketing — are required under the terms of the contract.

The Seacoast Mental Health Center began spreading the word to local police departments and doctors offices this summer. “I will say there’s so much more that we need to do to promote this to teach people about the model,” Walker said. “And a lot of that’s going to come from what we do but also how the state promotes it as well.”

Run by Beacon Health Options of Boston, the 24-hour phone and text line — 1-833-710-6477 — will be staffed by masters-level clinicians, intake workers, and peer support specialists who have lived experience with mental health or substance use disorders, according to its $9.2 million contract with the state.

Those in need can also reach help via a chat option at nh988.com. The phone and text line will be replaced with 988, the new national suicide prevention hotline, when it goes live in July.

In addition to helping people in their moment of crisis, Beacon’s staff are expected to follow up with callers to ensure they received the help they needed, according to the contract.

Currently, help for a mental health crisis largely depends on geography.

While the state’s 10-year mental health plan includes a statewide mobile crisis response, until this month, only three of the state’s 10 community mental health centers offered it: Manchester, Concord and Nashua — and they didn’t respond outside their regions. Elsewhere, law enforcement and school officials were often the first to respond to a crisis.

“If it was a family member, or if it was a police officer or the school, nine times out of 10, if they couldn’t get us, they would send the person to the hospital,” said Bill Metcalfe, director of mobile crisis at West Central Behavioral Health, which has offices in Lebanon, Claremont and Newport. “There’s no other option. And in a lot of these cases, to be honest, a lot of times we were able to discharge people just with a good safety plan in place.”

Now, all 10 of the state’s community mental health centers will have a crisis response team thanks to a $52.4 million state contract.

West Central Behavioral Health will have two teams, each with about 11 people, to cover the Upper Valley and Sullivan County. (All teams will also be allowed to respond to other sites within an hour’s drive.) Metcalfe said he’s filled the jobs for the team based in Claremont but still needs to fill about six spots for the one in Lebanon.

Previously, Metcalfe said a team of four people tried to handle phone calls, walk-ins, and calls to the hospital. So few people made it challenging to help everyone in crisis. “The idea of having a child wait in the ER for 13 or 14 days to get a bed, it really hurts you. It was heartbreaking,” he said.

Ken Norton, executive director of NAMI NH, said mobile crisis response in other states has successfully diverted people from emergency rooms to more appropriate care — and more.

“Nationally, from data where mobile crisis is happening, it reduces the number of hospitalizations as well as arrests, and likely also reduces injuries and negative events toward first responders and the individual in crisis,” said Ken Norton, executive director of NAMI NH. “I think that this is a real turning point for us as a state.”

The arrival of statewide mobile crisis response will not eliminate law enforcement’s role in mental health calls, said leaders of the community mental health centers. Nor do they want it to, given that so many departments have embraced mental health response training for officers. NAMI NH this week began the latest round of its 40-hour Crisis Intervention Team training. But their role will change.

“At the end of the day, they’re not mental health clinicians,” Walker said. “I think this kind of system change allows us to see what the police have been up against, which are some very, very difficult situations, and be able to team up with them. Oftentimes that means that the police can leave us there and move on to other situations in the community knowing that that person that we’re working with is safe and being helped.”

Maggie Pritchard, CEO of Lakes Region Mental Health, said she has long worked closely with the Laconia police and gets a call when they respond to a mental health crisis. The new statewide crisis line will transfer all calls to community mental health centers to the new number, a change she hopes will not eliminate that partnership with the police.

“I think some in the (police department) are anxiously waiting to see how it’s going to play out,” she said. “They are very used to calling us. Putting someone in the middle is just a different way of being.”


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For 2nd straight week, Cheshire Medical hits all-time high for COVID test positivity rate
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Although Cheshire Medical Center has seen a slight dip in COVID-19 inpatients as of Tuesday, the Keene hospital has broken its own record for the second straight week for the highest proportion of positive tests to date.

The Dartmouth-Hitchcock Health affiliate reported a positivity rate of 27.6 percent during the week ending Jan. 6, compared to the week before when it was 23.5 percent, according to the latest data available from the hospital.

These rates are considered extremely high. Before the current COVID-19 surge, which began right after Thanksgiving, the hospital’s highest test positivity rate had been in September, at 11.3 percent.

Dr. Aalok Khole, an infectious-disease physician at the hospital, added that Cheshire Medical’s rate will likely continue to climb, as cases related to holiday gatherings are expected to continue to come in within the next week.

“I don’t think we would hit the peak and trend down as of yet,” he said.

However, Cheshire Medical has been given a bit of relief with a lower count of COVID-19 inpatients than in recent weeks.

As of Tuesday afternoon, President and CEO Dr. Don Caruso said Cheshire Medical had 22 COVID-19 inpatients, down from the hospital’s all-time high of 29 at the end of last week, but that number is still difficult for the hospital to manage.

Six of those inpatients Tuesday are in the ICU — half of last week’s total — with five of them on ventilators.

Cheshire Medical also no longer has an influx of recovering COVID-19 patients — those who are no longer infectious but still require hospitalization to recover from the virus. The hospital had an additional 16 patients who fell under that category last week, but as of Tuesday had only two.

These patients further strain Cheshire Medical Center’s resources, an experience common to hospitals across the state. Data as of Tuesday from the N.H. Hospital Association show that in addition to at least 415 infectious COVID-19 patients, Granite State hospitals were treating another 126 patients recovering from the virus.

Even so, Cheshire Medical — like hospitals statewide — remains at capacity with its current staffing levels.

Lower patient numbers have “some level of impact” on the staff, Caruso said, “but they’re still very busy.”

Cheshire Medical continues to urge people to practice COVID-19 safety measures, such as wearing a mask in public, staying home when sick and washing hands frequently, especially as New Hampshire continues to see high case numbers.

Those who haven’t done so are also encouraged to get a COVID-19 vaccine and booster shot, as it’s the best way to protect yourself and others from the viral disease, according to health experts.

To schedule a COVID-19 vaccine or booster appointment, visit vaccines.nh.gov or call 2-1-1.


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Cheshire Medical: A variety of factors prevent hospital from offering monoclonal antibodies
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As Cheshire Medical Center continues to deal with the Monadnock Region’s ongoing surge in COVID-19 cases, some have wondered why the Keene hospital doesn’t offer monoclonal antibody treatment for outpatients, which has helped halt progress of the disease.

Dr. Aalok Khole, an infectious-disease physician at the Dartmouth-Hitchcock Health affiliate, said the decision made in the fall was based on the capabilities of the hospitals within the health system, as well as ongoing staffing constraints.

Cheshire Medical and Dartmouth-Hitchcock Medical Center in Lebanon are the only two hospitals within the 10-hospital Dartmouth-Hitchcock system with ICUs able to take care of the increasing numbers of seriously ill COVID-19 inpatients seen statewide, according to Khole.

Because of this, he said the system decided to send its COVID-19 inpatients primarily to one of those two hospitals, while Alice Peck Day Hospital in Lebanon agreed to serve as the system’s site for outpatients to receive the labor-intensive monoclonal antibody treatment.

Khole said Cheshire Medical had the treatment available for a short time in Keene last year.

“We had a clinic up and running in the summer of 2021 but delta had not come to the fore yet and hence we never ended up using it ...,” Khole said. “D-HH as a system began to discuss operationalizing this in September 2021 and [Alice Peck Day] went live with the clinic in the first week of October.”

Monadnock Community Hospital in Peterborough, which is not part of the Dartmouth-Hitchcock system, is the only local hospital to offer the treatment.

Monoclonal antibodies (mAb), used on outpatients, are laboratory-produced molecules that act as substitute antibodies that can restore, enhance or mimic the immune system’s attack on cells.

This means mAb treatment — which has received emergency-use authorization from the Food and Drug Administration — can block the virus from entering cells in the body and limit the amount of virus within the body, leading to milder symptoms and a decreased risk of hospitalization.

The goal of this treatment is to prevent people with COVID who are at high risk of getting very sick from needing hospitalization, such as those with underlying medical conditions. Adults and children at risk with mild-to-moderate COVID-19 are able to receive this treatment following a positive test result.

Khole said offering mAb — which is typically administered intravenously — involves a lot of logistics.

When someone tests positive for COVID-19, staff needs to determine whether they can be treated as an outpatient or if their illness is severe enough to require hospitalization. Once it’s determined someone can be an outpatient, they then need to be assessed to see if they have an increased risk for developing a severe illness, and, if so, to see if they meet other criteria for mAb.

“Then comes the piece about operationalizing a clinic, which needs to have a space, dedicated staff and necessary infection prevention-related input to administer these drugs, coupled with the monitoring time ... ,” Khole said. “So trying to do all of this at a time when things were surging, it was more of a logistical decision.”

Monadnock Community Hospital in Peterborough — which does not have an ICU — offers the treatment to a limited number of its patients, according to Chief Medical Officer Dr. Daniel Perli.

“Situations are reviewed by the primary care provider on a case-by-case basis. Availability of monoclonal infusions are limited, based on supplies that come from the state ... ,” he said in an email. “We highly recommend that all eligible patients be vaccinated and boosted to prevent serious illness from Covid-19.”

The hospital did not clarify after multiple requests from The Sentinel why they are able to offer the treatment.

However, the N.H. Hospital Association said there are a variety of reasons why a hospital may or may not provide mAb treatment.

“[I]t could be related to bandwidth, clinical resources, pooling resources to provide monoclonal antibody treatments across a health system, or that some new monoclonal antibody treatments being considered [have] scarce resources and not widely available, making the hospitals’ ability to provide the monoclonal antibody treatments unsustainable,” the association said in a statement to The Sentinel.

In the coming weeks, Khole said Cheshire Medical may be able to offer mAb after all, as well as COVID-19 treatment pills — another option for outpatients — recently given emergency authorization by federal officials, but nothing is set in stone yet.

He explained that, given the rising demand for treatment as COVID-19 community transmission continues to climb, the hospital felt offering mAb would best serve the community.

“The logistics and operations of the whole process are extremely complex but we have an extremely dedicated and driven workgroup trying to figure this out,” Khole said.

“A lot of work is going on on those fronts,” he said, “but no real final decisions or directions yet.”


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