60 more days to solve ER dilemma

Given the strength of the blowback from Lake Placid, Adirondack Health’s Board of Trustees was smart to put off its decision on whether to cut costs by converting the 24/7 emergency department at its Lake Placid hospital into a 12- or 16-hour urgent care clinic.

We hope Adirondack Health will spend the next 60 days studying further whether this is really the right cut to make now.

We also hope the Lake Placid community will use the time to do the same, and to develop alternatives to present to the Adirondack Health board. The trustees might be convinced to retain the emergency room, but they will need rational arguments to follow the emotional ones.

The Lake Placid village and North Elba town boards have so far gone the furthest in advancing the case in a way that hits home for trustees, instead of in a way that hits them over the head. Many of the speakers at public forums and writers of letters to the editor have been full of anger and scorn for the leaders of the Tri-Lakes area’s health care network. That certainly puts an exclamation point on the argument, but it also makes it personal rather than rational.

Some people believe the root of the decision is actually personal. Some seem to tie it to an old Saranac Lake-Lake Placid rivalry and say Saranac Lake’s hospital just wants to hog the goods. Some in Placid – including prominent local leaders – have told us bitterly that they knew the Saranac Lake hospital people always wanted to take the old Placid Memorial Hospital’s money and get rid of it.

We don’t believe that’s true. We believe the doctors and administrators pushing this proposal are simply convinced by the logical argument that it’s inefficient to run two 24/7 ERs 10 miles apart when one of them, in Lake Placid, gets very few patients overnight. They also say, legitimately, that health care nationwide is going through a huge transition to control costs, and part of that is to move away from using ERs for general care, since they’re an expensive way to treat people.

The problem, as we see it, is that hospitals are being forced, budget-wise, to change faster than their patients are ready. When the baby won’t stop screaming in the middle of the night and you know something’s wrong, whom do you call? You take it to the ER. Someday we may be able to get a doctor or nurse practitioner on the phone, or have doctors available for house calls at all hours like in the old days – that might eventually be more efficient than an ER – but for now, all people know how to do is go to an ER. Having one open 24/7 is a security thing, just like having fire and police departments on call even when they’re not needed.

Our tiny towns may well have more security than we can justify or afford, and adjustments may be in order to get in line with what other rural areas expect. Those will hurt someone – maybe Lake Placid, maybe someone else.

At issue is the past, particularly the $5 million endowment that Placid Memorial Hospital brought to the deal when it merged with the Saranac Lake General Hospital more than 20 years ago. Few of the investments since then have been in the Lake Placid hospital, which is 63 years old. It’s understandable that Placidians might feel they’d been gypped.

On the other hand, they shouldn’t forget a huge and ongoing investment Adirondack Health made in Lake Placid: It bought and kept alive the Uihlein nursing home in Lake Placid, along with its counterpart in Tupper Lake, Mercy, when the two were on the verge of folding. Some point to this as an example of hospital administrators’ fiscal ineptitude, but they might rather see it as a commitment to critical local services, even ones that are money pits. What if they’d let Uihlein and Mercy die? Would some of the same critics pin that on them?

The downside of letting Uihlein go would be much worse for Placidians than that of changing the ER to a 12-hour clinic.

We are worried about losing 24/7 ER care in our bustling tourism and sports hotbed. But we’re more worried about losing Adirondack Health, the region’s biggest private employer by a long shot. Being a health hub is a huge part of our rural area’s identity, and we’re lucky to have such a good provider.

Health care is going through a big transition, one we won’t be able to fully understand until we’ve lived with the Affordable Care Act (Obamacare) for a while. People here need Adirondack Health to turn the corner along with the rest of modern medicine. There will be some cuts associated with that, but they shouldn’t be ones that are intolerable to the community.

Whatever the Adirondack Health board’s decision is on the Lake Placid ER, it will be rational rather than personal. It’ll be about balancing money and services. That means locals have to speak to them on that level.

Ron Butler, owner of Howard Johnson’s and the Comfort Inn in Lake Placid, was on the right track when he suggested at a recent forum that, since the village helped bail out the National Sports Academy private high school, it could surely figure out a way to help pay for the ER. Some smart locals should try crafting a solution out of that thought.