by Chris Chase
Coastal Journal staff
BOOTHBAY — The St. Andrews task force has released an official legal position paper outlining what they feel are possible legal avenues they can pursue to prevent the closure of St. Andrews emergency department in April of 2013.
The paper, titled “St. Andrews Hospital: Breach of a community’s Trust,” outlines the task force’s belief that the proposed actions of Maine Health and Lincoln County Healthcare (LCH) would constitute a breach of trust, and would in fact be illegal under Maine law.
Currently, officials at LCH have not come out with an official response to the paper, which was presented to the task force on Nov. 27.
The paper itself details the belief that, because the hospital is a charitable organization that has received donations in the express belief that those donations would go towards hospital care, a closure of the hospital would constitute a breach of trust with those who have donated.
Unfortunately for the task force, the legal precedent doesn’t really exist, as according to their own report, “Maine courts have not had an opportunity to define ‘breaches of trust’ as the phrase relates to nonprofit corporations.”
The threat of possible legal action comes on the heels of the task force’s previous meeting on Nov. 20, a meeting that established that no concrete pathways for successfully keeping the hospital open have been worked out by the task force yet.
According to Scott Shott, the vice president of community relations LCH, the Maine Health and LCH organizations have shared all the info they have with the task force.
“We had our own consultants, and we shared all of our data from our consultants with the task force,” said Shott. “If it had anything to do with data that was used to make decisions, they’ve got it all.”
According to Shott, the decision to close down St. Andrews came from a clinical recommendation by their joint conference committee by physicians specialized in emergency medicine.
“There’s certainly financial ramifications from this decision, but essentially the decision is clinical,” said Shott.
The emergency department itself, which is the source of most of the controversy, has seen a large decrease in the number of patients utilizing its services. According to Mark Fourre, an emergency room physician and Chief Medical Officer for LCH, they have seen a decrease in roughly 1,000 patients per year from previous years and help “on average about 10 patients a day.”
Fourre was one of the main advocates for the closure of the emergency department, and feels that the services offered are too limited and sees too few patients, which has an effect on the skill of the physicians working in the department.
“The more you do something, the more practice you have, the more skilled you become. Whether it’s something like woodworking, or taking care of patients,” said Fourre.
According to Fourre, the decrease in the number of emergency room visits is in many ways a positive thing, and is a part of a national trend that is moving away from reactionary care and leaning towards preventative care.
“We expect emergency department visits to decrease because of all the work we are doing at a state and national level to decrease visits,” said Fourre. “As we get better at keeping people out of the emergency department, we’re losing patients, which is what we want.”
With this national shift towards more preventative care and less emergency care, the number of patients that emergency departments across the country are seeing is expected to drop, according to Fourre. With St. Andrews already seeing very few patients, the expectation that that number is going to decrease even further has a large influence on the choice to close it down.
Financially, the hospital as a whole is still somewhat successful. St. Andrew’s form 990s, the document they are required by law to submit to the IRS as a nonprofit organization, indicate that the hospital is, for the moment at least, surviving financially overall. In 2009 and 2010, the organization was running in the black, with revenue outweighing expenses by over $800,000 in 2010. However, a portion of the revenue comes from grants, donations, and other sources. If these other sources, to the tune of almost $1.2 million, are discounted and only program service revenue is included, the outlook is a bit different. However, hospital finance isn’t as cut and dry as that of a traditional business, as funding sources are numerous and multifaceted.
The emergency departments at both St. Andrews and Miles Memorial Hospital, taken on their own, do not make any money, according to Shott.
The simplest solution to keep the emergency department open, is to simply receive more patients. But as both Fourre and Shott have mentioned, healthcare as a whole is trying to decrease the number of patients that need to visit the emergency room.
In essence, the fear of what may happen to the area if the hospital closes is largely an emotional response influenced by public perception of what the emergency department actually does, according to Fourre.
“People have a great fear that something is going to go wrong, and if they don’t have an emergency department next to them something will happen,” said Fourre. “If you look at TV shows and watch when somebody has a heart attack and their heart stops, they have chest compressions and most of the time they come back. But in reality, the chance of that happening is very small; only a small percentage, something like 10 percent, survive. And those compressions would be handled by the paramedics in the ambulance on the way to the hospital.”
According to Fourre, having a trip that is 20 minutes longer will not make a difference in cases that require immediate attention, as most of the preliminary stabilizing work is done by the paramedics.
“A large amount of what we do the paramedics can do in the short term in the ambulance,” said Fourre. “They have all the medications that we have to treat those emergencies, and they’re quite good at it.”
A lot of communities across the state already have hospital commutes that are longer than even the most negative estimates of increased travel times to Miles instead of St. Andrews. According to Fourre, the real crux is, the chance of a decrease of a few minutes in travel time making a large difference in a truly life threatening situation is incredibly small.
“While some people find it to be concerning or frightening, the reality is these kinds of changes are going in the right direction towards improving everybody’s health,” said Fourre.