New London — Supporters of Lawrence + Memorial Healthcare joining the larger Yale-New Haven Health System as the best way to strengthen and preserve the smaller hospital met with doubters who fear the proposed affiliation will result in reduced services, higher costs and loss of local control during a public hearing Monday.

During four hours of testimony before the state health care regulators who will decide whether to approve the affiliation of the two hospital networks, more than 40 speakers weighed in on the issue during the public comment portion of the hearing. The public comment preceded presentations by the two hospitals and a coalition of 10 health care, consumer, civil rights and labor advocates granted intervenor status to challenge the proposal. After just under six hours the hearing was adjourned, to be continued in about two weeks.

While 24 of the speakers were unequivocal in urging the state Office of Healthcare Access to approve the affiliation, another 21 either opposed it outright or argued that it should be approved only with strict conditions to preserve access to care and ensure commitments are met.

“If we get certain assurances that protect our patients and our members, we could be for it,” said Lisa D’Abrosca, president of the registered nurses’ union at L+M. She and several others cited the cutting of services at Windham Hospital after it became part of the Hartford Healthcare network, a situation they did not want to see repeated in New London.

“The devil is in the details,” said Harry Rodriguez, president of the L+M health care workers’ union. “I want transparency. I want to make sure that what I’m hearing from L+M and Yale is in fact what’s going to happen.”

OHCA is considering both the application for the affiliation and a related application for L+M to transfer ownership of its affiliated physician group, L+M Medical Group, to Northeast Medical Group, Yale-New Haven’s physician organization. Both applications were submitted to OHCA in October, and deemed complete in May after additional information was submitted. While the regulatory process is proceeding, OHCA will not be able to render a decision on the affiliation at least until early next year.

Last February, Gov. Dannel P. Malloy issued a moratorium on new hospital affiliations while a task force completes a review and overhaul of the regulatory process.

First to speak at the hearing was Tomas Reyes, chief of staff to New Haven Mayor Toni Harp. He called Yale-New Haven a “strong and consistent partner with the community” that would be a positive force in New London. Two other mayors, Bruce Flax of Groton Town and Michael Passero of New London, as well as New London City Council President Erica Richardson, also spoke in favor of the affiliation as a way of stabilizing L+M’s financial condition, which has weakened in recent years.

“L+M’s condition is unsustainable,” said Richardson, who added that she is employed by Yale-New Haven.

But her fellow City Councilor Martha Marx, a visiting nurse with an L+M affiliate, said she had reservations about the affiliation as proposed.

“I cannot support this merger between Yale New Haven and L+M without concrete language and a transparent contract that protects access to health services, cost and health care that is affordable to all,” she said.

Several speakers called for the creation of a “community benefits agreement” that would describe explicitly the investments, services and other characteristics of L+M if it became part of the Yale-New Haven network, which currently includes Bridgeport Hospital, Greenwich Hospital, and the Saint Raphael campus of Yale-New Haven and the Smilow Cancer Hospital. They urged regulators to question Yale-New Haven’s pledge to invest $300 million over the next five years in the L+M network, which includes The Westerly Hospital, calling the language in the proposal vague.

“This is a financial issue. It’s not driven by altruism,” said Dennis Long, a retired local physician. “What is the merger going to do for Yale? What do they get for their $300 million commitment? How will the $300 million be used? Whose salaries will it pay? I’m not against the merger, but I’m against the merger without answers to these questions.”

Mitchell Ross, CT scan technician at L+M and vice president of the union that represents technicians and licensed practical nurses, said he was concerned that Yale-New Haven is creating a “monopoly on health care services” from the New York border into Rhode Island.

“Will the local community have any voice?” he asked.

Representatives of the chambers of commerce for Eastern Connecticut, the greater New Haven area and Westerly-Pawcatuck, however, spoke in favor of the affiliation.

“This is an affiliation that must go forward,” said Tony Sheridan, president of the Eastern Connecticut chamber. “We have an opportunity to affiliate with an organization that is one of the best in the country. The economics of small hospitals leave us no choice.”

Karen DelVecchio, executive vice president of the Bridgeport Regional Business Council, said Bridgeport Hospital and the community it serves have benefited greatly from the affiliation with Yale-New Haven. Two New Haven community activists, the Rev. Jerald Barber and William Kilpatrick, a member of the executive board of the Greater New Haven NAACP, said that based on their experience with Yale-New Haven and its takeover of the Hospital of Saint Raphael, New London will gain a positive force in the community.

“I would let the people of New London and the surrounding communities know that they will have a partner they can trust in Yale-New Haven,” Kilpatrick said.

Dan Flanagan, secretary-treasurer of the Teamsters union at Saint Raphael, said Yale-New Haven has preserved jobs and "proven to be a great employer."

Jack Callaci, director for collective bargaining and organizing for the union that represents Westerly Hospital workers, said the affiliation of the two nonprofit hospitals is a far better alternative than letting L+M's situation deteriorate further, leaving the smaller hospital vulnerable to takeover by a for-profit company.

"If this proposal is killed, what is the alternative?" he asked. "The pressures to affiliate are not going away."

Addressing the regulators, Sharon Palmer of Quaker Hill said the public's concerns about loss of services must be taken seriously.

"You have to protect us," she said. "That's your job."

j.benson@theday.com