For past decades I’ve vacationed in mid-coast Maine, an enjoyable respite from sweltering Washington, D.C. weather. When I returned to Boothbay Harbor last week, I was dismayed to learn that local St. Andrews hospital will be closing its emergency room, part of its merger with Miles Hospital in Damariscotta, 20 miles away.
While I have little doubt that there are sound economic arguments to be made for doing so, I have grave concerns about how this decision was made—part of a pattern of aloof, paternalistic decision-making affecting local communities and destroying their ways of life subsequent to hospital mergers—and on its likely effect on the peninsula.
This also reopened old wounds for me about the destruction of my community’s hospital in Cumberland, MD. While details are different in Maine and Maryland, there are striking and disturbing similarities in the process. There were two hospitals in my town, the secular community hospital, Memorial, and the Daughters of Charity/Ascension Health owned Sacred Heart. Somewhere along the way, Memorial was privatized, ultimately contributing to its demise, years later. In the early 1980s, Memorial built a modern addition, with major contributions from fund-raising by employees and the community. The two hospitals, seated high atop opposing hills, were fiercely competitive. Then, one day, an “affiliation” was announced, with reassurances that each hospital would “maintain its identity.” Then came the plan to shift all acute care to Sacred Heart and turn Memorial into a nursing home. All the plans were done behind closed doors, without input from the community. The hospitals hired consultants to give them the answers they wanted about service configuration, even though the answers were ludicrous.
Desirable (read profitable) services and assets were shifted from Memorial to Sacred Heart, and the administration assumed the hierarchical Sacred Heart style and leadership rather than the ground-up style at Memorial. As is customary with secular-Catholic hospital mergers, Memorial had to agree to restrict services in acquiescence to the Catholic dogma. Ultimately, after resources were bled from the community hospital, a new hospital was built on the edge of town (relatively inaccessible to the poorer people in town, who had been able to walk to Memorial), and both of the other hospitals were closed. (Ascension Health also ultimately withdrew from Cumberland; at last check, abortions are still no longer performed).
This merger in Maryland divided the community and left wounds that linger to this day. Many physicians and nurses have left. Dissent—and even creative problem-solving input—is stifled. Those who remain are silenced by threats of termination. Instead of a friendly, home-town atmosphere, you take a number when you register, as you do at the meat market. And many patients now seek care elsewhere, though it is a hardship to travel 1 ½-3 hours for care.
I am disturbed to see similarities now in Boothbay Harbor. Tiny St. Andrews was founded about 100 years ago and was, for most of its life, supported in large measure by the good will and generosity of the community, through generous contributions, bequests, and fund-drives. The women’s auxiliary alone raised more than $100,000 annually via their thrift shop sales.
A few years ago, St. Andrews hospital became part of MaineHealthNetwork an affiliation of 9 hospitals, including Maine Medical center, then merged with Miles Memorial in 2007. Unsurprisingly, services were gradually shifted to Miles Memorial in the more trafficked and centrally-located Damariscotta (though population only 1,142), bleeding resources and funds from Boothbay Harbor and, of course, making St. Andrews less profitable. Yet St. Andrews carries the designation of a “Critical Access Hospital (CAH),” meaning the hospital is certified to receive special cost-based reimbursement from Medicare, extended to small, rural hospitals to help stabilize them financially and thereby reduce hospital closures.
So that brings us to the plan of the Board of Lincoln County Healthcare, the operating parent of the two hospitals, to close the emergency room, inpatient care, and outpatient surgeries at St. Andrews. Last week, the board of MaineHealth, the parent company of the entire 9-hospital network, approved these closures, again without any input from the community.
What are some of the likely consequences of this move?
First, it will undoubtedly make the Boothbay region a less desirable area in which to buy a home and move to, or remain year-round. (Full disclosure: after years of renting, we are now home owners here). The area has a population of ~6000 year-round residents and booms in the summer. Even if it is a limited-service hospital, it has been reassuring knowing that emergency care was locally available. Lincoln county’s population is the oldest in the nation, according to the 2010 census. There is one winding, 2-lane road off the peninsula. How will patients get to Damariscotta, 20 miles away, especially in the winter? What kind of emergency services will be provided, and what is the cost of those services?
The loss of 50 jobs in a town of 3120/region of 6000 is going to be a major blow to the economy of this small community. If these workers can’t find work nearby, which is likely, they may have to sell their homes in this terrible market…with a domino effect adversely affecting housing prices throughout the area. Obviously local merchants will be hurt—and there have been many newly vacant storefronts in the past several years.
This raises broader questions, as well. To what extent are community hospitals local assets, akin to public utilities, even though they are run as private businesses?
When a hospital that was largely funded by contributions from the public is privatized, shouldn’t community involvement be maintained? I find it appalling that decisions that have huge impacts on communities are done behind closed doors, without input from those affected. In Boothbay Harbor, which has many wealthy benefactors and no shortage of brainpower and business acumen, there should at least be an opportunity for the community to explore the feasibility of buying back their hospital and running it like an ESOP.
The Board of Lincoln County Healthcare shows a remarkable lack of understanding of human nature, presenting the closure of a town’s hospital as a fait accompli, rather than having an open dialogue with local citizens and seeking their input. This surreptitiousness, as in Cumberland, has resulted in considerable anger by those disenfranchised. Even as a new parent, I quickly learned to offer my children input and let them make choices—be it just the red socks or the blue. Everyone was happier. And better decisions are reached on complex issues, as all of us working together are smarter than any of us alone.
The paternalism evidenced also should rouse alarms. Not all decisions should be based on just the financial bottom-line. And the unilateral decision making here reminds me a bit of the Michigan Emergency Manager law that allows Gov. Snyder to suspend local decision making in the name of fiscal responsibility.
While it's unlikely to happen, my wish is that the members of the Board of Lincoln County Healthcare find a way to return St. Andrews to the community that largely paid for it. Short of that, they should have an town meeting to openly discuss the concerns of the community and to brainstorm regarding options. That is the rational, correct, and appropriate way to communicate with the community—not by decrees.
Additionally, I hope that other communities that find themselves in similar circumstances find ways to keep negotiations public and transparent, as well as to keep medical services in their communities.
Molecules to Medicine banner © Michelle Banks
Boothbay Harbor, Maine - Mark Skinner
Cumberland, Maryland's Memorial Hospital and Ft. Hill High School, courtesy of CardCow.com
Boats "Harmony" and "Dangerous Liasons" in New Harbor, Maine - Judy Stone
"Take a Number" at the meat counter - Judy Stone
St. Andrews Hospital, Boothbay Harbor, Maine - Judy Stone
Miles Memorial Hospital, Damariscotta, Maine - Judy Stone
Boat "Sold Out", mid-coast Maine - Judy Stone