Tough dilemma for Adirondack Health

It’s a safe bet that none of the decision makers at Adirondack Health wants to lay off 18 more staff members after laying off 17 three months ago, and we think the same can be said for the decision before them to possibly turn its 24/7 emergency department in Lake Placid into a 12-hour urgent-care clinic.

The board of the company that owns and runs all the area’s hospitals and nursing homes has not yet made a decision on the Lake Placid ED. A vote to convert it would mostly earn them hard feelings from people in the Lake Placid area. But if one sets feelings aside, one cannot deny that with revenue reduced sharply, Adirondack Health has to do something fairly drastic.

Chief Medical Officer Dr. John Broderick, in a March 8 memo to Adirondack Health medical staff, outlined some sensible reasons for converting the Lake Placid ER to an urgent-care clinic.

For patients who need advanced emergency care, local ambulance squads already bypass the Lake Placid ED and go straight to the larger one at the Saranac Lake hospital, under a protocol that’s been in place for years, Dr. Broderick wrote. The extra minutes this takes are seen as worth it.

Therefore, the loss of Lake Placid’s 24/7 ED probably isn’t a matter of life and death.

The things the Lake Placid ED is good for – e.g., mending broken bones, stitching cuts, removing fishing lures from fingers – could mostly be done at the urgent-care clinic, at the doctors’ offices in the hospital or, when necessary, at the Saranac Lake hospital.

“The reason that this is coming up now is being driven by finances,” Dr. Broderick wrote. “That is unfortunate because the medicine favored this decision years ago. Shortly after my arrival I asked Chandler (Ralph, Adirondack Health’s CEO) why we keep the LP ED open as an ED with 24/7 hours. That level of service wasn’t needed medically. A number of you approached me stating the exact same thing. The hospital kept it open as a service to the community.”

And it is a service to the community. There’s no avoiding the fact that its loss would make things a little bit harder for Lake Placid residents and visitors. The same goes for the loss of 35 staff members in three months.

But on the other side is a fiscal crunch that’s much more scary. Imagine if Adirondack Health became insolvent because it was afraid to make tough changes.

It isn’t. Much tougher than closing Lake Placid’s emergency department is the recent restructuring decision to eventually cut the number of nursing home beds in that community from 120 to 60 – while, on a positive note, adding an assisted living center and ultimately moving the hospital across the road to the Uihlein nursing home campus.

We don’t have all the data and therefore can’t confidently second-guess what Adirondack Health should do. If, for instance, it’s spending outlandish amounts of money on things like administrative pay, this nonprofit corporation’s board should correct that injustice, on behalf of the communities they serve.

If, however, things are as they seem, it’s better to make these cuts than risk the financial health of the whole company, which is one of our area’s most important resources: both as the region’s largest private employer and as a truly excellent medical care provider – something we are constantly reminded of, living here.