St. Andrews To Close ER, Lose Hospital Tag

A series of changes at St. Andrews Hospital and Healthcare Center, effective in April 2013, will result in the loss of the facility’s hospital license.

The Lincoln County Healthcare Board of Trustees has proposed to transform the center’s 24/7 emergency department into a part-time urgent care center.

A Medicare regulation requires the presence of a 24/7 ER to hold a hospital license. As a result, the facility will cease to provide inpatient care and its name will be shortened to St. Andrews Healthcare Center.

Lincoln County Healthcare Inc. expects the changes to result in the loss of approximately 50 jobs, although it expects to offer jobs elsewhere in the MaineHealth system to more than half of those 50 employees.

The organization expects about 100 employees to continue working at the St. Andrews campus in Boothbay Harbor.

The July 2012 edition of The Current, the employee newsletter of Lincoln County Healthcare, outlines the changes, which are subject to approval by the MaineHealth Board of Trustees.

Lincoln County Healthcare management, medical staff and trustees presented the changes to municipal officials, the media and a handful of citizens July 31.

Boothbay municipal officials want MaineHealth to postpone approval of the Lincoln County Healthcare proposal until a public engagement process can take place.

The town, led by Town Manager James Chaoussis II and Board of Selectmen Chairman Charles Cunningham, has criticized Lincoln County Healthcare for what it perceives as a lack of transparency during the months-long process leading to the decision.

Lincoln County Healthcare representatives said the trustees didn’t make their decision until the morning of July 26. Vice Chairman Jeff Curtis said it wouldn’t have been appropriate to have a public debate with dozens of jobs at stake.

The urgent care center will be open from 8 a.m. to 8 p.m. in the summer and 8 a.m. to 6 p.m. the rest of the year. Patients in need of emergency – life-saving – care will be transported by ambulance to “the closest appropriate facility,” usually the Miles Memorial Hospital emergency department in Damariscotta.

The majority of services currently available at or through the St. Andrews campus, including basic diagnostic imaging, home health and hospice, physician practices, St. Andrews Village and wellness and rehabilitation, will remain available.

Lincoln County Healthcare cites demographic trends, fiscal considerations, changes in the way programs like Medicare pay hospitals, other statistics and research as contributing factors to the decision.

An average of 0.6 patients visit the St. Andrews ER between the hours of midnight and 6 a.m., according to Lincoln County Healthcare.

St. Andrews lost money nine of the last 11 years, including a total loss of $1.8 million in the last six years, Lincoln County Healthcare Chairman Peter Mundy said at the July 31 presentation.

“Unfortunately for us, that is not a sustainable situation,” Mundy said.

The chairman described the deliberations of the trustees as “intense and very deeply emotional.” The 22-member board includes equal representation from the Boothbay and Damariscotta regions, as well as several members, including Mundy, with deep ties to St. Andrews.

Mundy’s grandfather was part of a group that bought St. Andrews. He would later serve as the first chairman of the hospital’s board of trustees.

Mundy attended a two-room school in West Boothbay Harbor and returned to the area to retire in 1986.

Lincoln County Healthcare CEO Jim Donovan narrated a complex slide presentation about the trends affecting health care. “Every one of them is negative,” he said.

The trends, especially the way Medicare and other government programs reimburse health care providers, will require corporations like Lincoln County Healthcare to increase quality, safety and access while decreasing costs, Donovan said.

“We’ve always thought of ourselves as a health care system,” he said. “We need to prepare to become a care management system.”

He showed slides demonstrating a steady annual decline in inpatient discharges, outpatient visits and ER visits across the last five fiscal years.

He doesn’t expect those numbers or corresponding revenues to change.

“Neither Miles nor St. Andrews will have a positive margin in fiscal year ’12,” Donovan said. “We’re in the last quarter and we’re not doing well.”

Donovan and other Lincoln County Healthcare officials fielded questions from the municipal officials during and after the presentation.

Dr. Timothy Fox, medical director of the Miles Memorial Hospital and St. Andrews emergency departments, answered one about Miles’ preparedness to handle the additional volume it will receive when the St. Andrews ER closes.

Fox said it’s ready. Even in the event of a major disaster, like a bus crash, the emergency department could draw on the large number of physicians at the Miles campus.

“Everybody can descend upon the emergency department,” Fox said. “We don’t have that luxury [at St. Andrews].”

“There’s more of a capability to flex up in that true emergency situation when you need all hands on deck,” he said.

While the Boothbay peninsula has grown accustomed to having St. Andrews nearby, an ambulance ride of 30-40 minutes is “much more the norm” than the short ride from most locations on the peninsula to St. Andrews, Donovan said.

“We’re not proposing anything that’s unsafe,” he said. “It’s different.”

Fox responded to a question about whether the hospital had any data about whether the longer ride would have affected the outcome for any critical patients.

Fox said he reviewed the five emergency department deaths in a recent year. “Of those five deaths, not one of them was what you would call a ‘savable’ life,” he said.

Donovan, in response to a comment about the scope of the changes, said they would “pale in comparison” to future changes in Lincoln County and elsewhere in the state.

A Boothbay Harbor selectman asked what could be done to ensure there wouldn’t be a meeting in a few years about the closure of the urgent care center.

Curtis, the vice chairman of the Lincoln County Healthcare board, said the future of the urgent care center is far from certain.

“People are going to have to use it more than they use the ER,” he said. “If they don’t, the way I see the numbers, it will go away within five years.”

Curtis said he is a member of a small minority of the board that doesn’t think an urgent care center is sustainable at St. Andrews.

Donovan and others said the closure of the emergency department isn’t a cost savings measure. Although it will save money, those savings “are essentially wiped out and then some by the loss of the critical access hospital subsidy,” he said.

Chaoussis, the Boothbay town manager, brought a folder to the July 31 meeting containing more than 50 letters from angry, confused and scared constituents. He said the town has received a similar number of Facebook comments and messages, as well as many phone calls.

“Why does the public engagement have to start now?” he asked.

A few of those citizens attended the meeting.

“It’s just a little scary when you’re really ill and you know you only have a little bit of time to get where you’re going,” an elderly Boothbay Harbor woman said.

Donovan said the Lincoln County Healthcare board of trustees represents the community and always has in the structure of similar non-profit organizations.

“They are the community in this process,” he said.

Southport Selectman Smith Climo said the towns should have been included before a final decision was made. He said he expected to be able to have some input and influence at the meeting, only to discover, while watching the evening news, the trustees’ decision had already been made.

Cunningham, the Boothbay chairman, said the peninsula’s residents didn’t have an opportunity to solve the problem, and that’s what upsets many.

Boothbay Region Chamber of Commerce Executive Director Catherine Wygant echoed those concerns in her comments and in a widely distributed letter signed from Wygant and the board of trustees.

“We believe that the closure of the emergency facility at St. Andrews will have a reach far beyond anything we can imagine,” Wygant wrote. “The pride and well-being of our community will be affected. Loss of jobs will not only impact us economically, but will impact us in the loss of human spirit and well-being.

“And how can we be business- friendly without emergency care and healthcare in the immediate vicinity – what business will look at our region if we are not able to provide even the [most] basic of medical-related services?”

Mundy, the Lincoln County Healthcare chairman, expressed disappointment in the circulation of rumors prior to the meeting, as well as Boothbay’s decision to disseminate a copy of the employee newsletter.

“To be honest with you, you’ve hurt us,” he said to the Boothbay delegation. “I think you’ve hurt us badly, at the moment, with the community.”

He said the board would work to regain the trust of the community, in part through a series of meetings with various stakeholders set to start Aug. 3, the day after the MaineHealth vote.

Later in the meeting, he sounded more conciliatory.

“The process and the rumors got away from us,” he said. “I guess maybe as an old man I was naïve. I thought what happened in the boardroom stayed there.”

He said he would recommend that the board conduct a “root cause analysis” to “see if we can fix whatever went wrong” in the communications process.

“I ask you for your understanding,” he said as he adjourned the meeting. “I ask you for your support as we go forward.”