Don’t rush to judgment on ER
To the Adirondack Health Board of Trustees:
Twenty-three years ago, two boards of trustees voted to consolidate their respective community hospitals into a new entity, to be known as Adirondack Medical Center. Both institutions provided valuable community health services to their respective communities and beyond. After years of failed discussions, this took place only when it became apparent neither institution independently would have a successful future. Placid Memorial Hospital, with 29 patient beds, did not have the critical inpatient population to garner new services although, given the prospect of significant endowment (Redfield Trust) in excess of $5 million at the time, could operate for several years to come. General Hospital at the time had a less than desirable reimbursement rate, and by consolidating, a new and better reimbursement rate would be achieved. The General Hospital had just completed construction of a third floor for patients and recognized, should Placid align with another health care provider, that significant patient referrals might be lost. At the time, both hospitals were served by the same medical staff.
While Placid Memorial recognized it would be giving up its inpatient service, it was not willing to be without the services of an emergency room. After much debate, it was agreed Placid Memorial would adopt the terms that exist today – reversion language that would be triggered should the new entity fail to provide such services in the future. The possibility of encumbering the Redfield funds was debated; however, it was evident they would be key to the future success of Adirondack Medical Center and should not be restricted. In fact, for the two years following the consolidation, Adirondack Medical Center continued to suffer from loss operations. At that point, outside hospital management assistance was engaged (Brim Healthcare) to assist the Board of Trustees.
While modest investments were made to maintain the Lake Placid property, the majority of investment in the years since has been at the Saranac Lake site, with additional funds invested in new services for Tupper Lake. In fact, the Lake Placid emergency room has continued to provide valuable service, not only for Lake Placid but also the surrounding communities of Wilmington (including Whiteface Mountain), Jay and Keene, despite almost no investment to upgrade the emergency room equipment. It is generally acknowledged that CT scan equipment, common to most emergency rooms, was missing, causing Lake Placid to be bypassed on occasion.
While Adirondack Health agonizes over its financial status, it is quite possible that decisions to invest in area nursing homes that were already in financial decline are the root cause of their losses. It is true that inpatient counts are declining; however, that was anticipated when the ambulatory outpatient services were expanded and should come as no surprise.
Adirondack Health started its existence as a consolidation partnership when substantial investment of trust and equity was placed under the direction of one consolidated Board of Trustees. Lake Placid is as much responsible for the success of Adirondack Health today as the day the consolidation was created. In fact, without the Redfield funds and the monies its investment has generated, Adirondack Health might never have achieved the success it has enjoyed in recent years; nor, of course, might it have become involved with the nursing homes that have dragged it down so much.
Adirondack Health is a community-owned institution governed by a self-perpetuating Board of Trustees. It is not Adirondack Health’s administrator, nor its paid professionals who control the direction of the institution – rather, it is the Board of Trustees. The Board of Trustees bears fiduciary responsibility for maintaining appropriate community health services/facilities for its communities. Certainly Lake Placid deserves better than what is proposed. Adirondack Health’s approach to their business problem might be likened to that of Wall Street in recent years – all about money, and neglects their primary purpose of being a safety net and meeting the medical needs of all the communities it serves.
For more than 60 years, AMC at Lake Placid has provided our residents and visitors with quality and timely health care services.
Today, our hospital is facing a great challenge – the closure of its emergency room with the possibility of its ultimate shutdown looming on the horizon.
Health care services provide an essential component in the durability and growth of any community. Yet hospitals like Lake Placid’s provide for more than just medical services; they support and strengthen the economics of a community – especially an internationally recognized and honored community like Lake Placid. What may make financial sense to AMC today may deter the business interests of our village and the region in the future.
The decision to transform a community hospital is significant, and requires extensive thought and careful planning. Sound decisions do not happen quickly and certainly not over the course of several weeks and two public forums. It is evident to us that there has been a “rush to judgment” by the leadership of Adirondack Health to counteract its poor business choices of the past. It was also very disappointing to learn that the Board of Trustees would be contemplating the future of the Lake Placid ER on May 30 with so many questions still unanswered and no detailed or systematic patient care or business plan in place.
The Essex County Office of Emergency Services has voiced its concerns relative to the enhanced pressures on its mutual aid system resulting from an emergency room closure in Lake Placid. Both the Keene and Wilmington ambulance carriers have publicly expressed that they will no longer transport to Saranac Lake.
In Lake Placid we remain concerned about the resulting financial strains that our own volunteer ambulance service will confront. Will more ambulances be needed to offset turn-around times? Will there be greater demand and more expectations placed on community EMS personnel? Will the loss of the Lake Placid ER result in extended waiting times in Saranac Lake? What are the employment issues associated with ER job loss or travel modifications? Unfortunately, most of these questions could not be answered by the AMC leadership during the public forums.
From our perspective, it is likely that past emergency room ambulance budgets will increase substantially, thereby shifting the cost burden to the community. This is especially tough to swallow in light of Lake Placid’s past transfer of millions of dollars of hospital endowment monies to AMC for its use elsewhere.
It would be at least palatable to weigh the prospects of a 24-hour urgent care facility. Yet AMC’s proposal to open at hours consistent with a competing urgent care facility seems both counterproductive to its financial agreement and a likely attempt to eliminate a competitor. Again, this seems to portray a lack of sound business judgment.
Lake Placid is not just any small community in rural America. Lake Placid is a legendary resort town with a prominent past and bright future. Lake Placid is why the orthopedic community has come here to live and practice. Lake Placid is the home of the U.S. Olympic Training Center, Olympic venues, state Olympic Regional Development Authority and numerous secondary schools. So many other competing winter resort communities (like Aspen, Vail, Park City, Colorado Springs and Alta) all have their own emergency room operations. It is part of their attraction; it is one of the attributes that adds to their business services. In the long run, decisions based solely on money can end up as short-sighted disasters.
As the leaders of the Lake Placid community, we respectfully ask that you give more time and consideration to your decision-making process. Sometimes the longer road is the wiser route to your destination.
We thank you for your time and consideration and urge you to use judicious deliberation.
Robert T. Politi
Supervisor, town of North Elba
Craig H. Randall
Mayor, village of Lake Placid, former AMC board chair and consolidation trustee