When Exeter Health Resources finalized its merger with Beth Israel Lahey Health in 2023, the case for consolidation was the case big systems always make: scale, efficiency, capital investment, and a promise to maintain — even expand — the local services patients had relied on for generations. Three years in, residents who packed Exeter’s historic town hall last week say the experience on the ground has been something else: a string of service cuts, a community scrambling for answers, and a hospital that no longer feels like the local institution it was before the deal closed.
The April 29 hearing was held by the state’s Health Care Consumer Protection Advisory Commission, led by Attorney General John Formella, which has been collecting community feedback since the merger. What they heard was, by any measure, not the success story Exeter Health Resources sold to regulators in 2023.
The Cuts Residents Described
Speakers at the hearing recounted a 2024 stretch in which several long-standing service lines were trimmed or eliminated outright. Pediatric dental care. Neurology. Podiatry. The advanced life support paramedic intercept service. Each of those lines anchored a different piece of community care, and each disappeared in close succession.
The neurology cut may have hit hardest. Executive Councilor Janet Stevens told the commission that the Rockingham County Nursing Home was “panicked” when staff learned Exeter Hospital’s neurologist would no longer be available. The nursing home, Stevens said, feared having to transport hundreds of patients to Boston for care that had previously been provided locally. “Not an option,” she said.
The paramedic intercept service — the kind of unglamorous infrastructure that quietly underwrites emergency response across a region — was ultimately picked up by the Plaistow Fire Department after Exeter Health Resources provided a $2 million transitional grant. That arrangement kept service in place. It also underscored that an outside entity, not the hospital itself, ended up holding the bag for a piece of pre-merger functionality.
What Was Promised
The merger memorandum filed when the deal closed pledged that Beth Israel Lahey Health would “maintain and expand access to clinical services at Exeter Hospital, including a planned $375 million capital investment over 10 years.” That kind of commitment is meant to reassure regulators that a non-local owner will not strip a community asset for parts.
The capital investment may yet materialize. What residents pointed out at the hearing was that the operating-side commitments — keeping the doctors, the service lines, the paramedic intercept — eroded faster than any new building could compensate for.
The CEO’s Admission
Beth Israel Lahey Health’s leadership did not arrive at the hearing in defense mode. The Portsmouth Herald, which originally reported on the meeting and whose work was republished by NHPR through the Granite State News Collaborative, captured the system’s CEO acknowledging openly: “We’ve made mistakes.” That admission — rare from a hospital chief executive sitting before a state oversight body — is itself the most telling piece of the story.
It is also a vindication of the commission’s existence. The Health Care Consumer Protection Advisory Commission was created precisely so that the consequences of large healthcare transactions would not have to be inferred from press releases. Instead, residents get to deliver them in person.
Why This Matters Beyond Exeter
The Exeter story is not unique. New Hampshire — like most of New England — has watched the consolidation wave of the last decade absorb community hospitals into larger regional and multistate systems. The promise has consistently been continuity of care plus the financial stability that scale provides. The lived experience, often, has been service-line decisions made farther from the patient and harder to reverse.
That tension is now sitting in front of the state in concrete form. The commission’s findings will feed into how New Hampshire scrutinizes the next merger application, what conditions get attached, and how aggressively the Attorney General’s office monitors compliance after a deal closes. The conversation also runs alongside the broader stress on the state’s healthcare system as a whole — and the federal and state push to shore up rural healthcare access through programs like GO-NORTH.
For Exeter residents, the immediate question is more practical: which services will come back, on what timeline, and with what enforceable commitment. The CEO’s apology was the right opening line. The follow-through is the rest of the story.
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