Save St. Andrews Hospital

Long, Arduous Effort

The history of our community’s heroic efforts to save our beloved St. Andrews Hospital is well documented here.

St. Andrews Hospital Closing

St. Andrews Hospital will become a day-time Urgent Care Center on Oct. 1st 2013.

Result: Our local community’s hospital has been closed and merged into Miles Memorial Hospital, its Critical Access Hospital designation as a small rural hospital with a 24×7 ER misappropriated, and, as a result, the number of hospital beds in Lincoln County decreased from 62 to 25. We no longer have a 24 hr. Emergency Room on our peninsula. And our peninsula is home to the most elderly population in the country, yet we have no hospital beds and way too few skilled nursing beds.

Certificate of Need is Required in Maine for Hospital Merger or Reorganization

To approve this merger, the State of Maine’s administrative branch granted two retroactive Certificates of Need to MaineHealth: One of these Certificate of Need was granted 6 years after Lincoln County Healthcare was created (a reorganization that combined the managements of the two hospitals into a single entity governed by two identical Boards).

Yet, the fact is that when St. Andrews Hospital and Maine Medical Center Foundation formed an affiliation back in 1996 and 1997, they applied for and were granted Certificates of Need before those actions.

And yet, in 2007 when MaineHealth reorganized and formed Lincoln County Healthcare and in 2013 when MaineHealth merged two hospitals under the name of LincolnHealth, MaineHealth contended that no Certificate of Need was required.

Shortly after Oct. 1, 2013, as the doors closed at St. Andrews Hospital in Boothbay Harbor, ME, the Maine Department of Health and Human Services announced that MaineHealth must, in fact, apply for a Certificate of Need for both the 2007 reorganization and the 2013 merger. Our Foundation led the community’s efforts to clearly articulate the healthcare needs of the people in our area.

A public hearing was held in Boothbay Harbor in December of 2013 and another public hearing to reconsider one of the Commissioner’s three conditions was held in August, 2014.

You’ll find the testimony here.

Dr. David Racicot testifies that a 24 hr. ER is what's needed; more than a 24-hr. Urgent Care.

Dr. David Racicot testifies that a 24 hr. ER is what’s needed; more than a 24-hr. Urgent Care.

Our question is: doesn’t this set a dangerous legal precedent? What’s the point in having a Certificate of Need law that requires a public hearing and regulatory review before a major hospital reorganization, if that law isn’t enforced?

Don’t We Need 24-Hour Care for the Most Elderly Population in the Country?

Along with the approval of the two retroactive CONs, DHHS Commissioner Mayhew added three conditions that needed to be met by LincolnHealth:

  1. To report to DHHS on the status of Medicare’s acceptance of the “relocated” Critical Access Hospital designation (which provides greater reimbursement). This approval was granted in mid-October 2014, despite the fact that the relocated hospital is not treating 75% of the patients it formerly treated on the Boothbay peninsula, nor is it employing 75% of the staff who worked at St. Andrews Hospital. (These are two conditions required to maintain CAH designation for a “relocated” hospital).
  2. To monitor and report on progress in addressing chronic diseases on the Boothbay peninsula: tobacco use, substance abuse, mental health, cancer, COPD, diabetes, etc.
  3. To extend the hours of the 12-hour Urgent Care clinic that replaced the hospital and the ER to 24 hours/day.

However, after MaineHealth asked the Commissioner to reconsider Condition 3, and a public hearing was held in August, 2014, the Commissioner eventually (in mid-November, after the mid-term elections and 30 days after the regulatory deadline) decided to forego Condition #3.

What was our response to DHHS Commissioner Mary Mayhew’s decision to rescind her condition that LCH maintain a 24-7 Urgent Care facility in order to be granted the necessary Certificates of Need to continue operations at St. Andrews Hospital (Miles Campus and St. Andrews Campus)?

Our collective response is similar to what we heard from the community — the reactions range from being disheartened, discouraged, disappointed and outraged. Some were not surprised as they felt that politics had a hand in the ultimate decision. And now as we think over our journey of the past two years, some salient facts come to mind.

The fact is that the 24/7 urgent care facility was entirely the idea of the Department of Health and Human Services’ Certificate of Need unit and was endorsed enthusiastically by Commissioner Mayhew, when she included it as one of the conditions required for her to grant the Certificates of Need.

This condition took the Foundation, the community, and even MaineHealth completely by surprise.

The community and the Foundation were advocating for the restoration of a 24/7 emergency room and skilled nursing beds, while MaineHealth pressed to retain reduced services at the St. Andrews Campus.

When the Commissioner endorsed the concept of 24/7 urgent care, she raised the hopes of many, and the community looked with favor on her idea. When MaineHealth asked for reconsideration, we encouraged her to hold fast to what appeared to be a brilliant creation to meet the healthcare needs of our newly under-served community.

The fact is that well into the time-frame by which the commissioner’s response to the testimony presented at the reconsideration hearing should have come forth, the Foundation was contacted by DHHS and asked if we would have any objection to the department delaying the decision because the Commissioner had not had time to review the information.

At a special called meeting, the Foundation board voted unanimously to not grant a delay. It was our position that the community had waited long enough for the decision. Ignoring our vote, the department delayed the opinion until after the mid-term elections. Interestingly, the state and MaineHealth, the other two affected parties, did not object to the delay.

There still is an underlying question: Does DHHS have the statutory authority to approve a retroactive Certificate of Need? The Foundation is still seeking an answer to that question.

Replacing Some of the Lost Hospital Beds with Skilled Nursing Beds on the Peninsula

Jeff Curtis, the President of the Board of Trustees of LincolnHealth, testified that if DHHS required 24/7 urgent care, LCH would not be financially able to expand St. Andrews Village in order to provide the needed skilled nursing beds.

The fact is that with the Commissioner’s decision to rescind the 24/7 urgent care, there should be no problem financing the expansion at St. Andrews Village to add an additional 10 dually licensed (skilled nursing/nursing) beds. LCH has applied for that Certificate of Need, and expects the CON process to sail through this time.

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