July 28, 2013

Boothbay region 'full of fear' as hospital closing looms

MaineHealth officials call it the best path forward, but a community with many older residents worries about having no ER nearby.

By Colin Woodard cwoodard@pressherald.com
Staff Writer

(Continued from page 2)

Today's poll: Hospital closing

Do you agree with Lincoln County Health Care's decision to close St. Andrews Hospital?

Yes

No

View Results

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On Oct. 1, St. Andrews in Boothbay Harbor will cease to be a hospital.

John Ewing/Staff Photographer

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Additional Photos Below

That quality of care concern weighed most heavily in the board's decision last year to close the emergency room, says board vice chairman Jeff Curtis of Boothbay Harbor, owner of Sherman's Books and Stationery stores.

"If it were just a matter of money, we would be carrying on and finding ways to raise money to close the gap, but it wasn't," he says. "Once you get down to one doctor and one nurse, you're counting on there not being a serious emergency. The ambulances are coming for you if you're open, but you're counting on there not being any three-car accidents."

"We're a volunteer board, and when the ER docs are coming in and saying, 'We don't feel safe in the middle of the night,' you have to take that seriously, and we did," he said, adding that there was no pressure on the board from MaineHealth, which touts its track record of not interfering in local board decisions.

CHANGING FACE OF HEALTH CARE

MaineHealth administrators stress that St. Andrews isn't closing -- they hate the term -- even if it is losing its hospital designation, beds and emergency department.

The hospital's waterfront campus on the west side of Boothbay Harbor will continue to house a lab, X-ray, and physical, occupational and speech therapy services, Fourre says. On Oct. 1, the emergency room will convert into an urgent care center that can treat the roughly 80 percent of the patients who currently visit the ER during daytime hours but don't turn out to have truly emergency conditions. It will be open 8 a.m. to 6 p.m., and to 8 p.m. in the summer months, when the region's population jumps from 7,000 to between 20,000 and 50,000.

They point to the low demand for emergency services at St. Andrews, which now sees an average of 12 patients a day, most of whom arrive during daytime and early evening and only 17 percent of whom turn out to require emergency care. This means the vast majority of demand will be met by the physician-staffed urgent care center but at a fraction of the cost of maintaining the emergency department

MaineHealth will also reduce capacity at Miles, where ambulances from the Boothbay region will be diverted this fall. The number of inpatient beds will be reduced from 38 to 25, and the hospital will maintain an average inpatient length of stay of four days or less.

This means Lincoln County as a whole will see a reduction from 63 to 25 hospital beds, but MaineHealth administrators say there will be enough capacity most of the time. (Miles currently has an average daily census of 19 inpatients -- most requiring acute-level care -- while St. Andrews has nine, all of whom are so-called "swing" patients requiring a lower level of care.) On days when the scaled-down Miles can't meet demand, ambulances would likely be diverted to Brunswick's Mid Coast Hospital, Pen Bay Medical Center in Rockport, or Maine Medical Center in Portland.

The changes are necessary in order for Miles to inherit St. Andrews' status as a Critical Access Hospital under the federal Medicare program. This designation -- which supports rural hospitals -- will bring Miles an additional $5 million to $6 million in annual Medicare reimbursement payments, says MaineHealth CEO William Caron, who says it is vitally important to the long-term prospects of Miles.

"Before getting the critical access designation, I've got to tell you that hospital services in Lincoln County were under tremendous pressure," Caron says, largely the result of serving a small, increasingly elderly population base. With a large proportion of the year-round population on Medicare -- which pays hospitals less than private insurers do -- Caron says Miles and St. Andrews have had to shift more of the cost burden to privately insured clients, resulting in high prices for their insurers. "Insurers were saying, 'Your unit cost of care is excessive,' and were starting to carve us out of their networks."

(Continued on page 4)

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Additional Photos

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Hairdresser Jane Good of Southport Island talks about the proposed closure of St. Andrews Hospital in Boothbay Harbor with summer resident Walter Weil. Good's salon has become an epicenter of support for keeping the hospital alive in the community.

John Ewing/Staff Photographer

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James Donovan, CEO of Lincoln County Health Care, supports the emergency room’s closure at St. Andrews Hospital in Boothbay Harbor. “For many years now, the 24/7 St. Andrews emergency department hasn’t been busy enough to sustain itself,” Donovan says.

John Ewing/Staff Photographer

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George McEvoy of Boothbay Harbor, photographed in Portland last week, opposes the pending loss of St. Andrews Hospital, where he has had positive experiences with its medical care. McEvoy says Lincoln County Health Care didn’t want the Boothbay Harbor hospital to succeed.

Gabe Souza/Staff Photographer

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William Caron, CEO of MaineHealth: “We are changing the way care is being provided on the (Boothbay) peninsula, and it’s going to be the best care in the state of Maine when we’re done.”

John Patriquin/Staff Photographer

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After Oct. 1, the nonprofit Boothbay Region Ambulance Service will take emergency patients from the Boothbay peninsula to Miles Memorial Hospital in Damariscotta, a 30-minute drive from downtown Boothbay Harbor, above, and 40 minutes from the southern tip of Southport or Ocean Point in Boothbay.

John Ewing/Staff Photographer

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Signs of community support for St. Andrews pepper the landscape in the Boothbay region. In largely symbolic referendums held in four towns – Boothbay Harbor, Boothbay, Edgecomb and Southport – this year, 86 percent of the region’s residents opposed the emergency room closure.

John Ewing/Staff Photographer



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Today's poll: Hospital closing

Do you agree with Lincoln County Health Care's decision to close St. Andrews Hospital?

Yes

No

View Results