The independent watchdog keeping an eye on care at Steward Health Care hospitals here urged the state, the company, and its lenders and creditors "to take action to lessen the devastation" that the looming closure of Nashoba Valley Medical Center in Ayer "is having, and will continue have," on people who live in the central Massachusetts region.

Suzanne Koenig, a health care management consultant, asked in a supplemental report filed in U.S. Bankruptcy Court that state government, Steward and its creditors to keep Nashoba Valley's emergency department open for an additional 30 days, or at least provide funding so an ambulance could be stationed outside the closed emergency room for at least a week after closure.

"Nashoba is a community fixture that has provided healthcare to residents for over fifty years. It is the sole emergency department (“ED”) within a thirty-minute radius in a community with limited paramedics and emergency medical services (“EMS”) personnel and no public transportation," Koenig, who is also a senior living facility owner, wrote in her report.

She said the closure of Nashoba Valley will turn a five-minute trip to an emergency department into a half-hour drive, effectively taking EMS workers out of service for an additional 45 minutes during the return trip. She said area EMS providers have staffed the area "for short trips for emergency care," counting on access to Nashoba Valley's ER.

"In addition to limiting the availability of EMS personnel, the EDs in other communities are not staffed or equipped to absorb the former Nashoba patients. This toxic combination of delayed EMS response times and overtaxed EDs will lead to dire results for patients needing emergency care," she wrote.

Steward said last month that it did not get any satisfactory bids for Nashoba Valley or Carney Hospital in Dorchester, and announced that the two facilities would close by the end of August. The hospital is slated to be shut down for good at 7 a.m. on Aug. 31, Koenig said.

She asked that the parties who have financial and political stakes in the messy Steward saga find a way to keep the ER open for an extra month, or to post an ambulance there after closure so anyone who rushes there expecting care can at least be stabilized and transported elsewhere.

"I am cognizant of the myriad of issues in these cases and the various stakeholders’ desires to maximize their recoveries. Notwithstanding, the Nashoba closure is devastating to the community and the patients who rely on this hospital and the ED. The patient population served by Nashoba played no role in the decisions that ultimately lead to the closure of Nashoba," she said.

"While the Ombudsman is hopeful that the Commonwealth arrives at a solution to reopen the hospital in the coming months, the Ombudsman requests that all parties carefully consider the inevitable outcomes of this expedited closure on the most vulnerable of the community and come together to provide for a basic level of interim services while the affected community adjusts to the closure of Nashoba."