Adirondack Health is laying off 18 more full-time employees and reducing the hours of another 15 full- and part-time workers in response to a loss of more than $1.7 million in revenue.
Today's news comes just three months after the organization laid off another 17 employees as part of a long-term restructuring plan.
Meanwhile, Adirondack Health's board of directors is set to vote tonight on a proposal to convert the around-the-clock emergency room at Adirondack Medical Center-Lake Placid into a 12-hour urgent-care center. That's according to the New York State Nurses Association union, which is urging the board to delay the vote.
Adirondack Medical Center at Lake Placid
(Photo for the Enterprise — Rich Rosentreter)
The news of the 18 layoffs came in a press release titled "Adirondack Health restructuring services." It says the organization lost $1.2 million in revenue through elimination of a Medicare provision in the fiscal cliff negotiations. More recently, automatic federal spending cuts known as sequestration have cost Adirondack Health another $500,000, the release states.
"That's nearly $2 million in revenue reductions in the first three months of this year," Adirondack Health spokesman Joe Riccio told the Enterprise. "It's something we were aware of but we were hoping and advocating hard against, because the effects are, as you see, not good."
Riccio said all of Adirondack Health's departments were affected by the layoffs and cutbacks, but he didn't provide a department-by-department breakdown. He said one management-level position was cut. The employees losing their jobs were notified Wednesday, he said.
"Patient care areas will remain properly staffed, and Adirondack Health is working closely with affected employees to provide support and outplacement services through human resource programs," the release states. "Those affected by the reduction have contributed to the success of Adirondack Health in a meaningful manner, and they will be missed."
Bill Conley, a labor relations representative with the New York Nurses Association, said five of his registered nurses who work for Adirondack Health were notified Wednesday that they were "displaced" from their jobs but will be able to maintain employment by "bumping" people with less seniority in other nursing positions.
"The association would hope that Adirondack Health would explore all options before resulting to staffing cuts of any sort," Conley said.
Riccio said the layoffs were "an option of last resort."
While federal revenue reductions sparked this round of cuts, the December layoffs and restructuring were blamed on what Adirondack Health President and CEO Chandler Ralph called a "seismic shift" in health care toward more home-based care, the effort to reduce patient readmissions and a growing demand for outpatient services. That's led to a 10 to 20 percent decline in inpatient volume at the Adirondack Medical Center hospital in Saranac Lake over the last two to three years, Ralph said at the time.
"We have to radically rethink how we approach health care delivery, not just here but across the country," Riccio said Thursday. "There's been a dramatic focus on patients getting the right care at the right time and in the right place. That's OK because we're doing what's best for the patient, and that has always been our focus."
Lake Placid ER
Just two hours before Adirondack Health announced the layoffs, the New York State Nurses Association issued a press release calling on the organization's board to put off a planned vote on converting the AMC-Lake Placid emergency department to a 12-hour-a-day urgent care facility. It said the public should be allowed to weigh in before a decision is made.
The NYSNA release said losing the emergency department will impact people in the Lake Placid, Keene, Wilmington, and AuSable communities, and the tens of thousands of tourists who visit the area each year.
"These communities should be able to depend on access to 24-hour, critical care," the release states. "The complicated, sometimes life-saving care provided daily in the Lake Placid emergency department cannot be accommodated in an urgent care center, a facility more akin to a physician's office than an emergency room. Patients in trauma will be forced to travel an extra 15 to 20 minutes to Saranac Lake for critical care, and in an emergency, those extra minutes can be a matter of life or death."
More than 800 people have signed a petition circulated by some of Adirondack Health's nurses to keep the Lake Placid emergency room open, the release states.
Riccio declined to respond to the Enterprise's questions about the NYSNA release and the fate of the Lake Placid ER. He said the announcement of the layoffs and restructuring "is separate from that story.
"We're evaluating all our programs and services on a daily basis to ensure patients are receiving the highest level of care in the appropriate setting at the appropriate time," Riccio said. "This may result in the reorganization of how services are delivered, but we're not going to change our level of commitment to patient care, patient quality or the communities we serve."
Asked if the community would have a chance to weigh in on any changes to the Lake Placid ER, Riccio said, "absolutely.
"It's absolutely essential to have community input in this process," he said. "We're going to have a discussion based on the facts. It's going to be thoughtful; it's going to take into account the needs of the community. We're not going to do anything that jeopardizes patient care in any aspect of the operation."
In a March 8 memo to Adirondack Health medical staff, Chief Medical Officer Dr. John Broderick outlined reasons to convert the Lake Placid ER into what he called a "daytime outpatient urgent clinic"
The memo, a copy of which the Enterprise has obtained, says the Lake Placid emergency department provides "a valuable daytime service to the residents and visitors of the Lake Placid region" but sees few patients during the overnight hours.
Typically, patients in need of more advanced care bypass the Lake Placid ER and go straight to the AMC-Saranac Lake ER under a protocol that's been in place for years with local EMS agencies, Broderick wrote. He also said ambulance traffic would still be able to stop at the Lake Placid clinic for treatment of "appropriate non-life threatening injuries as we do now.
"The reason that this is coming up now is being driven by finances," Broderick wrote. "That is unfortunate because the medicine favored this decision years ago. Shortly after my arrival I asked Chandler (Ralph) 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."
Broderick acknowledged that Lake Placid residents will be concerned that they're losing critical, life-saving medical care, but he said he's convinced that won't be the case. He urged the medical staff to help allay people's fears.
"I want to be able to go to the community leaders and members of the community in Lake Placid and tell them that we, the medical staff of Adirondack Health, do not believe the conversion of the LP ED to a daytime outpatient urgent clinic providing the same services, staffed by the same nursing and medical staff will endanger the medical well-being of the Lake Placid and surrounding communities," Broderick wrote.
While Broderick says a Lake Placid outpatient clinic would provide the same services as the emergency department, Conley argued that's not possible with the staffing levels it's planning.
"Emergency departments must have two registered nurses on duty at all times," he said. "Right now there are two nurses and a physicians assistant. Under the employer's proposal, the proposed staffing is to have one nurse on duty for only 12 hours a day, along with one physicians assistant."
Conley also noted that urgent care nurses aren't required to have critical care training, and he said it's "extremely unlikely" that ambulances would still stop at the Lake Placid ER if it becomes an urgent care clinic.
"According to local EMS providers, they will not be reimbursed if they drop off patients at an urgent care center," Conley said. "That would be detrimental to the EMS providers. Secondly, and much more importantly, it's just common sense that if an individual considers their family member sick enough to require ambulance transportation, it's very unlikely family members will want that individual transported to an urgent care center rather than an emergency department."
If the board decides to make a change at the Lake Placid ER, the town of North Elba may be able to buy the property under an agreement crafted in 1990, at the time Placid Memorial Hospital merged with the General Hospital of Saranac Lake to form Adirondack Medical Center. Town Supervisor Roby Politi first cited the agreement last year when Adirondack Health announced that it planned to move the services it provides at AMC-Lake Placid to existing space or a yet-to-be-constructed building on the nearby Uihlein Living Center nursing home property and sell the hospital building.
The agreement says if the hospital determines "to not staff and operate the existing hospital facility ... by either abandoning, closing, selling or otherwise, resulting in depriving the residents and visitors to the Town of North Elba of (primary health care services or 24-hour, 7-day-a week emergency room services) at the existing facility ... town shall have the exclusive right to buy the property ... for the total sum of $10, said sum being the total purchase price."
Contact Chris Knight at 518-891-2600 ext. 24 or firstname.lastname@example.org.