Update on the continuing saga of my Boothbay, Maine coastal community's struggle with the Goliath of Lincoln County Healthcare and MaineHealth:
The "big health network"--Goliath--is planning to shift the status of our land/sea/air accessible hospital from Critical Access Hospital certification (get premium payments from Medicare/Medicaid for offering rural care, have 24 x 7 ER service, beds for skilled nursing and rehab, and ambulance service to the hospital) to a walk-in clinic open only during the day.
If you have an emergency, you're expected to call 911 and go in an ambulance over a narrow, winding, often impassable road to the somewhat larger Miles Memorial hospital on the next peninsula (at least 45 minute drive from my house--longer for many people).
Here are just a few examples of why that WON'T work in our area from the interviews I've been doing with local residents:
“I was about 30 miles out at sea in January fishing for shrimp when I had what I now know was an epileptic seizure. My captain called the Coast Guard and started into shore. The Coast Guard came right away, but they couldn’t beat us to the dock, so we went right to the St. Andrews dock. I didn’t know what was happening. I was foaming at the mouth and thrashing around, they put me on a stretcher and rushed me into the ER and probably saved my life.”
“My wife had an acute condition: aspiration pneumonia. She would often have trouble breathing, especially at night. I don’t know how many times we went to the St. Andrews ER in the last few years! Dr. Cook or Dr. Carter were there on duty. They got to know us well. They would always call Dr. Barker to check in with him. They understood what was going on. It was comforting that we only had to drive 5 mins to the hospital.”
Boothbay Harbor resident
“Our 38-year old son’s life was saved at St. Andrews. He had a heart attack on a Sunday. When he realized he was in trouble, he drove to St. Andrews, but the Southport bridge was closed! When he finally got to the hospital, he told them, ‘I need to be seen now!’ They gave him two shots of a clot buster. But it didn’t work. So, they called Maine Med, and said: ‘he needs to be airlifted.’ The helicopter from Lewiston was there in about 15 mins. They kept him stable until they got to Maine Medical where a team was waiting to put in a stent.”
Southport residentsSouthport Swing Bridge Opens when there's boat traffic. Photo by Jay McGillicuddy
"It was very early in the morning. I had a stroke. We drove right to St. Andrews, a wheelchair was waiting for me and they wheeled me right into the ER. After they treated me, they kept me at St. Andrews for observation. The next day, I was sitting in a chair and I felt weird and my head rolled back and I passed out. The nurse came rushing in. They were watching me from the nurse’s station. My heart had just stopped. I’m not sure they would have noticed that at Miles [Miles Memorial Hospital in Damariscotta]! Besides, I absolutely refuse to go there!
Boothbay Harbor resident
How many of these people would have died if St. Andrews’ ER and excellent care hadn’t been here for them? Tell me again, why you'd throw away a perfectly good Emergency Room/ER Dept, skilled nursing facility??
Last Monday, I went to the Boothbay Harbor town meeting where they dropped the bombshell about the increased costs of supporting the volunteer ambulance service that will need to be ramped up to handle the increase in the number and length of ambulance trips per year that will be required to take people to the hospital in Damariscotta, rather than to our local ER, after it has been shut down. I quickly emailed, Dr. Judy Stone--summer resident of, and taxpayer in, Boothbay Harbor about the increased ambulance costs being shifted to the taxpayers because of a profit-making decision on the part of the Corporate parent that had absorbed (through affiliation--no $$ changed hands) our local hospital.
Dr. Stone wrote yet another excellent blog post to the Scientific American blog network An Emergency Room's Closure: A Community's Betrayal, and included in it a letter to the CEO of Lincoln County Healthcare, Jim Donovan:
"Dear Mr. Donovan,
Please tell me again how closing St. Andrews’ ER will result in a significant cost savings for the citizens of the Boothbay peninsula and improve their quality of care, and otherwise create the best of all possible medical worlds? On the other hand, moving towards telemedicine, as is increasingly being done in rural communities throughout Maine (including Miles) and the rest of the country, has been cost-effective. So why not offer this at St. Andrews?
The delays in patients receiving care due to the transport time to Miles will certainly not improve the quality of care—(certainly not for those patients who die en route to Miles.)
And now we learn that the shift will increase the Towns’ subsidy of the Boothbay Region Ambulance Service from:
- $34,205 to $187,676.13 or an increase of 549% for Boothbay
- $38,215 to $223,549.39 or an increase of 585% for Boothbay Harbor
- $8,044 to $48,529 or an increase of 603% for Southport.
And that’s just for the next fiscal year. Costs are likely to continue to increase in the future due to the added costs for salaried EMTs (including health insurance), training, equipment. Would Mr. Donovan like to cover the town’s subsidies that will result?"
What Will Happen Next?
I expect that our Goliath--Maine Health and Lincoln County Healthcare--will "promise" (but not in writing and not in a timely manner) to cover some of the ambulance costs in order to lull our selectmen and taxpayers. Then, they'll keep the clock ticking and let it run out to our April 1st, 2013 deadline.
What we want, instead, is for MaineHealth to let us undo our original affiliation with MaineHealth (which took place 16 years ago). We want our own Board of Directors that is responsive to the people of the Boothbay region, not a board captured by and comprised of the management team who run Lincoln County Healthcare. As Judy Stone explains in her blogs, one good solution to the problem of providing high quality emergency care in a rural setting is to take advantage of telemedicine to get real-time consults for any cases that are tough to diagnose and treat by local physicians.