St. Andrews, part III

Hospital decisions explained

ER closure, loss of 50 jobs is about quality, not savings, hospital administrators say
Wed, 08/01/2012 - 6:30am

    On July 31, hospital administrators said the changes planned for St. Andrews Hospital in Boothbay Harbor are more about quality than finances.

    “Essentially there are no savings (from the changes),” Lincoln County Healthcare CEO Jim Donovan told a room of town officials, Sen. Chris Johnson and handful of private citizens. “We are shoring up quality and safety. Savings from expense reductions are wiped out by the loss of (St. Andrews) critical access hospital designation.”

    In a 2.5-hour meeting at the hospital, Lincoln County Healthcare administrators and board members said low patient numbers affected both finances and the quality of care, and coupled with other factors, were key to the decision to close the emergency room at St. Andrews Hospital. “It’s all about volume, and patients are not using this hospital,” Donovan said.

    The decision to close the hospital was announced July 30, but for weeks the towns have feared the hospital was closing. Without an emergency room, St. Andrews will not be open 24-hours and will lose its hospital license. When the news that the emergency room is closing became public, town officials petitioned Lincoln County Healthcare administrators to hold the July 31 meeting to give the towns a chance to voice their opinions before the plan is presented to parent organization MaineHealth on Aug. 2.

    Boothbay town officials encapsulated local fears during a July 23 meeting of Boothbay Selectmen.

    “The jobs at the hospital help create business for other local businesses,” Selectman Steve Lewis said. “People base part of their decision to move here on the fact that there is a hospital on this peninsula; taking away the hospital will influence where they go. Closing St. Andrews is not in the best interest of our citizens and makes people think again about coming here.”

    Town Manager Jim Chaousis agreed. “The hit on the region's identity will be irreparable.”

    By the end of the meeting, while many continued to lament both the loss of the hospital and a decision-making process that did not include the community, they also seemed to accept the inevitability of the changes.

    Under the plan, approved by the Lincoln County Healthcare Board of Trustees but still awaiting MaineHealth approval, St. Andrews Hospital’s emergency department and skilled inpatient care programs will end in April 2013. Lincoln County Healthcare proposes to open an urgent care clinic at St. Andrews, with similar staffing but shorter hours than the emergency department. Fifty employees will lose their jobs under the current plan.

    Donovan provided an exhaustive review of the financial drivers affecting healthcare, the trends in the healthcare market, the declines in patient volumes and revenues and the federal incentives to increase access, decrease costs and increase quality. 

    Dr. Tim Fox and Dr. Mark Fourre discussed how seeing fewer patients and emergency situations, as is the case at St. Andrews, can affect the quality of care. They also said it is more difficult to respond to emergency situations when there is a small staff available on site.

    “I am often uncomfortable that we don’t have as many hands as we need,” Fourre said. “If someone is critically ill, we need more hands, and for these kinds of skills, we need to do them over and over again. From a quality standpoint, what we are proposing is a better option.”

    Boothbay representatives, who rallied in the last few days for a delay in decision-making, criticized the board for not involving local communities sooner. Southport Selectman Smith Climo and local residents echoed Boothbay’s concern. Representatives and residents also expressed concerns for longer transport times to Miles Memorial Hospital in Damariscotta, the health and safety of residents and the ability of Miles to handle the increased ER load. 

    Board of Trustees Chairman Peter Mundy, defended the trustees’ decision-making process. Mundy said because the decision affects employees it needed to be kept confidential and could not be discussed publicly sooner. Donovan said the Board of Trustees' purpose is to represent the community in the decision-making.

    Town Manager Chaousis said the loss of 50 jobs, the additional stresses to the Boothbay Region Ambulance Service, the shock to the community from the loss of the hospital and the need to educate the public about the changes for emergency and urgent care would be “a lot to absorb in nine months.”

    Mundy said the trustees and Lincoln County Healthcare are committed to working with local communities, and particularly the ambulance service, throughout the transition process.

    MaineHealth is expected to approve the proposed changes at their meeting on Thursday, Aug. 2. Boothbay Manager Jim Chaousis will address the MaineHealth Board before they make their decision.

    For more on changes at St. Andrews, read the rest of our series:

    Part I, A community waits

    Part II, No longer a hospital

    Part III, Hospital decisions explained

    Part IV, Hospital transition begins

    Part V, Ambulance service plans for ER closing

    For the story told through community response, visit our Storify