Chris Sununu has one ask before he leaves the corner office: to see Dartmouth Health take over operations at Hampstead Hospital.

He knows it’s a unique proposition – the private hospital would lease the facility from the state, gaining full control over hiring and operations – but after months of negotiations, he’s convinced it’s the best model of care for New Hampshire’s most vulnerable kids.

In 2022, the state bought the psychiatric hospital and residential facility from private owners and offered the first state-run services for kids with the highest needs in New Hampshire. The last two years have been fraught, though, with changing leadership and limited capacity for services.

“We’ve been very passionate about making sure that we’re doing everything we possibly can to create the right systems,” he said. “Assuming we’re going to get it through, it would be just a jewel and a crown of what is really a reformed system.”

He’ll have to wait until later this month to see that wish come to fruition. Executive Council members tabled a contract for Mary Hitchcock Memorial Hospital – a branch of Dartmouth’s medical center – to take over operations at their Wednesday meeting, raising concerns on the oversight of the proposition and saying they need more time to understand the partnership agreement.

The hospital itself has 71 beds available for in-patient services, as well as a dozen beds in the psychiatric residential facility, called East Acres.

Both the hospital and residential facility have operated well below capacity since opening, leaving kids boarding in emergency rooms and utilizing out-of-state programs as they wait for in-state care.

Within the hospital, 36 beds are currently occupied, with 35 offline and six kids waiting, as of Dec. 3. Only six children have been admitted at a time to East Acres, as well, with the Executive Council approving a $3 million renovation to the facility to increase the capacity, last month.

Sununu’s confident the state will reach a consensus with the councilors, and they’ll approve the partnership at their Dec. 18 meeting, which will be his last before Governor-elect Kelly Ayotte takes office.

“I absolutely expected that they would want more time. It’s a bit different than what we’ve seen before,” he said. “So they should absolutely take more time. I think the contract is fantastic.”

Not all parties will be happy with the proposal, though. A petition from over 100 Hampstead Hospital employees is asking for them to remain as state employees, rather than be hired by Dartmouth.

The last two years have marked a “challenging season of many changes” according to Morissa Henn, the deputy commissioner of the Department of Health and Human Services.

She hopes Dartmouth will right the ship.

“We also owe it to the employees, to your point, to provide them with the certainty and stability they deserve. They have been through tremendous change,” said Henn. “Our commitment is that every employee has a great job at the end of the day.”

Employees have had four changes in leadership, which means changes to insurance plans and retirement packages. Another transition to a new employer with Dartmouth would lead to “some objective – if inconvenient – facts,” they stated in the petition, including a loss of state pension plans.

After the purchase, the state entered a contract with Wellpath, a healthcare company based in Nasvhille, Tennessee, to oversee clinical services. When the contract expired in May, Dartmouth took over as the provider.

In that model, Dartmouth provided all clinical staff, but top leaders were employed by the state. The partnership mimicked that of New Hampshire Hospital and Glencliff Home, the state-run adult psychiatric hospital and assisted living facility.

The new partnership with Dartmouth, though, means they would have full autonomy over staffing and operations. The state would oversee the facility through an advisory role on a joint commission.

Sununu said through negotiations the state considered a myriad of options from operating the facility itself to selling it. He always envisioned a private partnership of sorts after purchasing Hampstead, but admits leasing the entire facility is a new approach.

“It’s a great example of just because we haven’t done it before doesn’t mean it’s not going to be a home run,” he said.

As the state and Dartmouth negotiated a contract for this takeover, employees were temporarily reassigned as state employees. This was never meant to be a permanent fixture, nor does Sununu foresee it becoming one.

“These employees were never long-term state employees,” he said. “We made them ... temporary employee status while we negotiated the contract, but it was never guaranteed.”

His conviction is pretty clear – he doesn’t expect the employees’ request to hinder negotiations. The Executive Council also does not have the ability to alter contracts, said Attorney General John Formella. The vote is a binary yes or no.

All current employees will be guaranteed positions, said Henn. Plans include for all clinical staff to be hired full-time by Dartmouth and hospital leadership to be offered positions within the state department or by Dartmouth that match their skill set.

The employees’ request could arise in the Legislature. Erica Layon, a Derry Republican, has filed a bill to establish classified state employee positions for all staff of Hampstead Hospital and Residential Treatment Facility.

To state leaders, including Henn and Sununu, the partnership with Dartmouth will transform services for children at Hampstead.

With Dartmouth at the helm, the private company would have better recruitment efforts than if the facility was state-run, said Sununu. Financing will also not be subject to a two-year state budget system and he estimates the deal will save the state $20 million in expenses annually.

Henn hopes that this means more beds will be available for children, as staffing levels allow, but another factor of the contract is that Dartmouth intends to expand offerings to also provide outpatient care.

“That’s why we want to build on that even further, to not just expand beds,” she said. “We also don’t want to be putting kids in institutions.”

Still, councilors raised concerns over the scope of the 138-page contract.

“Let’s make it perfectly clear, it’s an advisory committee for the state. It’s an advisory role. Dartmouth Hitchcock and their trustees and executives have all the authority and power,” said Executive Councilor Janet Stevens, a Rye Republican. “They are going to make the ultimate decisions.”

To Executive Councilor Cinde Warmington, a Concord Democrat, if another private entity were to take control of a state facility of this scope, the process would require a “rigorous process” through the Department of Justice charitable trusts.

“They would have to show that they are capable of operating this and providing the services for the community into the future. They would have to talk to payers about the antitrust,” she said. “None of that is happening here but the process for doing something this big, in my opinion, should be equally as rigorous.”

Dartmouth has a long history with the state of providing mental health services for residents, with services at New Hampshire Hospital and the Sununu Youth Services Center. With that, Warmington is “delighted” that the hospital system is the provider in negotiation. She just has more questions.

“This is a big deal,” she said. “I hope we’ll continue working with them in the fu ture, and I want Dartmouth to be our partner, but I think that we have not gone through the process we should go through.”