SARANAC LAKE - Adirondack Health administrators and doctors spoke openly for the first time Thursday about their plan to convert the 24-hour-a-day emergency department at Adirondack Medical Center-Lake Placid into a 12-hour urgent care clinic.
During a 90-minute interview with the Enterprise, Adirondack Health President and CEO Chandler Ralph, Chief Medical Officer Dr. John Broderick and Emergency Department Medical Director Dr. Anthony Dowidowicz said the proposal makes sense from both a medical and a financial standpoint.
They said their Lake Placid ER doesn't have CT scan machines and other modern medical technology, and that most seriously ill patients already bypass it and are taken to the more state-of-the-art emergency department 10 miles away at AMC-Saranac Lake. They also say the low volume of patients at the Lake Placid ER doesn't justify keeping it open around the clock, and that converting it to an urgent care facility would still provide a valuable service to the community while saving the hospital an estimated $1 million.
Dr. John Broderick, right, Adirondack Health’s chief medical officer, talks about the proposed conversion of the Adirondack Medical Center-Lake Placid emergency room to an urgent care center Thursday at AMC-Saranac Lake as the organization’s communications director, Joe Riccio, listens.
(Enterprise photo — Chris Knight)
Dowidowicz said health care reform is pushing organizations like Adirondack Health to use its resources more efficiently.
"There are a lot of silos in medicine that are these hard and concrete structures that people cling onto that really don't fit with change," he said. "A lot of people don't want to give up what they've held onto for a long time. In order to survive in the future with the way things are going, you need to adapt."
By the #s
Visits to the emergency room at AMC-Lake Placid
2008 - 5,188
2009 - 5,045
2010 - 4,842
2011 - 4,855
2012 - 4,439
(Adirondack Health figures)
Rumors that Adirondack Health could close or curtail the operations of its Lake Placid ER first started circulating in early March. The Enterprise reported on it then, largely based on information from elected officials in Lake Placid and other sources because, at that point, Adirondack Health officials weren't talking.
In the weeks that followed, petitions against the possible closure of the ER started circulating, and the Enterprise received several letters to the editor from people concerned about losing what they consider a crucial service to both local residents and visitors.
Ralph said the way the news initially came out "would not have been my choice." However, she stressed that Adirondack Health's board of directors hasn't made a decision, and that a "listening tour" to gather public input has been planned since before the news broke.
Over the next few weeks, Adirondack Health officials plan to meet with the Lake Placid area business community and local elected officials. At least two public information sessions are also planned in May, with the dates, times and locations still being worked out.
Dowidowicz said that when he started working at AMC three years ago, he wondered why there was an emergency room in Lake Placid.
"I would go all night without seeing a patient, and during the day I'd see five to 10 people with sore throats and coughs," he said. "I frankly felt a bit overpaid."
The number of patients served at the Lake Placid ER has dropped from nearly 5,200 in 2008 to roughly 4,400 last year, according to figures provided by Ralph. Most come during the daytime.
"When we looked at our operations and our numbers, we didn't see a 24-7 need for the services being offered," Broderick said.
Under a bypass protocol that's been in place for several years, Broderick noted that critically ill patients are often brought directly to the Saranac Lake ER because it has more advanced medical imaging and other services.
"If you're having a stroke, and you're in the Lake Placid, Keene, Wilmington areas, if an EMS agency right now stops (in Lake Placid), that's introducing a huge amount of time that's actually hugely problematic," Broderick said. "The quicker we get that person to a CT scan to ensure there's no bleeding in the brain or in front of a neurologist, the quicker that we can provide definitive care for them."
"I think the Lake Placid community has been used to having this facility in Lake Placid," Dowidowicz said, "but I think what's happened, just as the result of the science, is that most of the medicine has been centered (in Saranac Lake), where we're able to provide state-of-the-art care."
Adirondack Health could invest more money in upgrading its Lake Placid ER to make it comparable to Saranac Lake's, but that would be a huge expense and the demand doesn't justify it, hospital officials said.
Urgent care center
Broderick said the urgent care operation at AMC-Lake Placid would provide "the same level of care, the same level of quality providers and service, but just at more limited hours." While it's been described as a 12-hour operation, he said the hours and staffing can be adjusted based on need, like for events such as the annual Lake Placid Ironman triathlon.
"By changing our designation, it lowers the minimum bar, but it doesn't mean we can't enhance our services when we need to," Dowidowicz said.
Critics of the proposal, including some of Adirondack Health's own nurses, have questioned the claim that the same services can be provided in an urgent care setting.
"We have a lot of patients that actually just show up at our door, people saying, 'My dad is having a heart attack!' or 'My baby isn't breathing!'" ER nurse Lisa Keegan told the Enterprise March 24. "We're going to have to say, 'Sorry, we're going to have to call an ambulance now because we're an urgent care.'"
Broderick noted that people should dial 911 if they have an emergency, not just go to a hospital. If someone does walk in to the urgent care center and is having a medical emergency, he said, "We'll be able to provide that same level of care because we have the same equipment, the same people, the same provider that we do now. We understand that there's limited hours, but at the same time, when we look at it, the usage at night during those hours, they are limited."
Dowidowicz said it would be better than a typical urgent care center.
"I'd really like to call it an enhanced care," he said. "We have the same staff, a lot of the same equipment and many of the same procedures are going to be able to be done. It's definitely going to be above the level of your bare-bones urgent care center."
However, not as many nurses would be needed to staff the proposed urgent care center in comparison to the Lake Placid ER. Currently, the ER must have one doctor or qualified physician's assistant and two critical care nurses on duty at all times. An urgent care would only need one doctor or PA and one nurse on duty. That would allow the hospital to potentially downsize staff, but perhaps without layoffs if nurses can be bumped to other open positions, Ralph said.
Ralph said the conversion to an urgent care center would save an estimated $1 million including reductions of staff and mandated ER services like laboratories. Right now the Lake Placid ER operates at about a $500,000 loss, she said.
She also said the change could benefit patients who have higher health insurance co-pays for emergency room care than for urgent care.
"This gives an option to people," she said.
If the Lake Placid ER is converted to an urgent care center, it likely wouldn't be located in the current AMC-Lake Placid building for long. Adirondack Health officials had previously announced plans to move all the services provided at AMC-Lake Placid, including its emergency room and the doctor's offices that make up the Lake Placid Health Center, to the nearby Uihlein Living Center nursing home campus and to sell the former Placid Memorial Hospital. Ralph said that's still the plan.
Other local doctors who aren't Adirondack Health employees have gone on record supporting the plan to convert the Lake Placid ER to an urgent care center.
"We feel that this move is both a safe and prudent way forward as health care rapidly evolves," Dr. Waguih Kirollos, president of the Adirondack Health Medical Staff, and Dowidowicz, the vice president, said in a letter to the editor published in Friday's Enterprise.
Although some nurses have been sounding the alarm about the proposal, Dowidowicz said he thinks many others are on board with it. Hospital officials have been meeting with the nursing staff to outline the plan.
"We have many nurses who know it's been a long time coming and see it as an eventuality," Dowidowicz said.