On Sunday, September 14, staff, practitioners and patients of the non-profit Pathways to Wellness complementary care center at 35 West Newton Street were surprised by an e-mail from Pathways president and board chairman Devan Dewey that the center was closing its doors on that date due to ongoing financial struggles. Founded in 1989 as the AIDS Care Project, Pahtways offered holistic, alternative therapies such as acupuncture, massage and Chinese herbal medicine, with an innovative Share the Care payment model in which insured or self-paying patients helped finance sliding-scale and free care for disabled, low-income, veteran and HIV/AIDS patients. Since the closing, Pathways staff and practitioners have continued to work together to maintain treatment for their patients and to find new venues for their services. Beth Sommers, Pathways's former Director of Research and Education, chairperson of the American Public Health Association and a licensed acupuncturist, elaborated on the closure in a telephone interview. "The staff is all heartbroken," she said. Nevertheless, the former colleagues continue to collaborate to guide patients to new venues for care. "There is a phoenix coming out of all these ashes and that phoenix is the restoration of acupuncture services. The clinical staff of Pathways is very committed to their patients' health and wellness," Sommers said. "Ever since Pathways closed, the staff has really come together to brainstorm about restoring services and there hasn't been any recrimination or pointing fingers. It's been very constructive. I think all of our staff efforts are geared to restoring services and some really wonderful advances have been made." Board chairman Devan Dewey is impressed with the staff's efforts to provide continuity of care. "It is a huge credit to the leagacy that Pathways has built," he said.

Sommers described three factors that were instrumental in forcing the shuttering of the clinic. "One was that we moved from the South End Community Health Center (SECHC) to a new space. We wanted to stay in the neighborhood and we work on a number of projects with SECHC," she noted. "The expense of the move turned out to be much more than we could actually afford." Pathways had been headquartered on the third floor of SECHC at 1601 Washington Street since 2006, and started looking for a new space in 2012. When Pathways arranged to move to a storefront space at the corner of West Newton and Washington Streets, hopes were high that the increased visibility would bring in more patients and in particular, more full-pay patients. However, the new space needed extensive renovation to meet Pathways's needs, and the renovations ran beyond the original schedule and budget.

Pathways opened at its new location in December, 2013, but was beset by challenges from the start. In addition to the cost overruns, severe weather and snow worked against the center, forcing it to close for approximately three weeks and resulting in significant lost revenues. Another major blow came when a computer system problem at Neighborhood Health Plan (NHP) caused claims from Pathways to be automatically denied for about three months. Sommers recalled, "Because insurance is always a little behind, we didn't realize it until a little later down the line. When NHP investigated its own system, it realized it was rejecting Pathways and some other centers automatically. Eventually NHP reimbursed us for those claims." She continued, "Those three elements really resulted in a trifecta of factors. If any one of those had happened we might have overcome it, but the fact that we were hit with all three was just too much. Our executive director had some family problems and could only work part-time and she had to leave in April. We had an interim person who was only there two days a week and because we didn't really had someone at the helm it created more challenges." The center sent out a distress signal in June in the form of an e-mail asking for an emergency infusion of cash to keep its doors open. Pathways also launched a crowdfunding campaign on GoFundMe in June, but it only netted a fraction of its $200,000 goal.

While Pathways's financial troubles were known to employees, Sommers expressed disappointment in the center's end. "We got an e-mail on a Sunday afternoon with no notice from the board of directors. We felt that we had been betrayed and that hundreds of clients were betrayed. The staff and I felt they had extremely poor financial management, lack of planning and that the closing was handled really poorly. When the board first closed Pathways, they announced it in the Boston Business Journal. Those were the interests that the board represented. I'm not going to say anymore," she said. Robert Johnson, president and CEO of SECHC, commented, "for us and for the area, the closing of Pathways was a major blow. For over 20 years, they were doing very good work and we referred a lot of people there." He added, "They were serving a very neeedy population and insurance wasn't always avalable to cover them. Grants are very hard to get. Without a steady cash flow, it's tough to make it." Board chairman Dewey shed some light on Pathways's difficulties since moving. "I think everybody was disappointed in the short time table for closing. We really had no option. We ran out of funding kind of unexpectedly and we simply couldn't keep the clinic open. We did a last minute effort with our major donors to try to come up with the funds." He went on, "We have been in a very tough spot since the move. We had a lot of losses from weather closures and cost over-runs. We had been in a very tight cash crunch from the first of the year. The cash crunch happened in a matter of weeks. For nine months we've been surviving week to week. We were very optimistic about the move when the board decided to go forward with move in August 2013. We knew it was going to be tight but we thought it would work. The number of thtings that went wrong between December and March was far beyond what we ever would have exxpected and we just coudln't recover. We were trying to fight the battle for the funding and not cause people to lose hope, so we didn't tell the staff about every single thing that happened."

Sommers detailed the initial steps the practitioners took to direct patients to providers. "Because we were given the closing information with no time to make treatment plans or plan with patients, we made lists that are taped to the door and we got them translated into Spanish. Some of the staff members have private practices or work in a clinic in the South End and Back Bay. Michael McGrath is at South End Acupuncture." She added, "Our joke has been that now that we aren't working we are working harder than ever to get services restored." As is the case with many mainstream physicians and practitioners, patients have developed personal bonds with their Pathways practitioners and have expressed concern for them in light of the closing. Sommers explained, "In treating patients since the closing, patients have been very concerned about me losing a job."

Looking to the future, Sommers talked about programs already in place at Pathways's satellite locations and laid out potential plans for new programs and partnerships. Sommers said, "We have three hospital-based programs at Massachusetts General Hospital, Tufts New England Medical Center and at Cambridge Hospital. I am at two of the hospitals and I hope to work with the AIDS care program at Boston Medical Center (BMC), although that is still in the development stage. I have a little private practice as well, but I am really dedicated to the idea of public health and making services accessible. We are really interested in getting the acupuncture services integrated in health centers and hospitals." She added, "Because of my involvement in public health, the two people who run the integrated medicine program at BMC contacted me about a potential space they were offering for the AIDS care program. We are working on integrating the services into a bigger, multi-disciplinary setting." She added, "We had a very lively home care program. We partnered with NHP and Commonwealth Care Alliance and others to provide acupuncture and shiatsu massage to homebound patients. In fact, the home visit program is being helped out by New England School of Acupuncture."

While the abruptness of Pathways's closing saddens Sommers, she seems buoyed by future prospects for the continuation of the center's services and by her colleagues' efforts to shepherd their patients to ongoing care. "We definitely need some healing as a community after this. It's been horrible personally and spiritually, but I am so grateful for the collective efforts of the Pathways staff. I've never heard of anything like this before."