Ambulance service providers in the towns of Keene and Wilmington say they will take their patients to the Elizabethtown Community Hospital if Adirondack Health moves forward with a proposal to convert the around-the-clock emergency room at its Lake Placid hospital to a 12-hour urgent care center.
The news comes as officials at the Elizabethtown hospital work to raise the profile of their emergency department in the communities currently served by the Lake Placid ER, the potential conversion of which continues to spark concern among local residents.
Adirondack Health hosted a meeting Friday to discuss the proposal with community leaders, and a pair of public forums have been scheduled in early May.
Medical staff tend to a patient in the emergency room at the Elizabethtown Community Hospital, where some local ambulance squads say they will take their patients if Adirondack Health converts the ER at its Lake Placid hospital to an urgent care center.
While no decision has been made, Adirondack Health has said the volume of patients at the Lake Placid ER doesn't justify keeping it open, that it isn't equipped with modern medical technology, and that most seriously ill patients already bypass it and are taken to the Saranac Lake ER.
In an April 3 letter to Adirondack Health President and CEO Chandler Ralph, Wilmington Supervisor Randy Preston and Fire Chief Louis Adragna said the loss of the Lake Placid emergency room will "significantly" impact the town's ambulance operation.
"If the closure goes forward, this will turn a 1-hour trip (to the Lake Placid ER) into a minimum of a 2-hour trip (to the Saranac Lake ER) for the Wilmington Ambulance," the letter reads. "The fire department and the town are formulating a plan now, which will switch our primary hospital to Elizabethtown Community Hospital."
The letter says the Elizabethtown hospital, roughly 20 miles from Wilmington, will become the town's closest medical facility, and that the trip there will be on "better roads" without "having to go through Lake Placid and Saranac Lake, which will enhance our turnaround time.
"We will still transport any Wilmington resident to Saranac Lake if they request," the letter continues. "We will also, depending on the nature of the call, transport to (Champlain Valley Physicians Hospital in Plattsburgh) when cardiac related. The remainder of our ambulance transports will go to Elizabethtown. We will not transport to an urgicare."
Adirondack Health spokesman Joe Riccio said Friday that he was aware of the letter.
"We're concerned about what it means for the patient," he said. "Randy Preston did attend (Friday's) meeting and we had a good dialogue. We are happy to sit down with the ambulance crew in Wilmington and figure out what we need to do to do the best thing for the patient."
Keene Fire Chief Jody Whitney said his department's rescue squad is planning to take its patients to the Elizabethtown ER if Adirondack Health no longer operates an ER in Lake Placid.
"I have not had any formal meeting yet as far as the ambulance squad, because it's only talk and it's one of their ideas, but the consensus of the members I've spoken to is we will transport to Elizabethtown," he said. "We will absolutely not transport to Saranac Lake. We transport to the closest receiving facility, emergency room."
The Lake Placid ER is roughly the same distance from Keene as the Elizabethtown ER, about 12 miles, but transporting patients to the Saranac Lake ER would add another six miles to the trip.
Whitney said Keene EMS personnel could bring patients to the proposed Lake Placid urgent care, but given that it won't be open around the clock, "I think our policy and procedure would reflect that we're going to transport to the closest emergency room."
He said the biggest impact of the shift to Elizabethtown would be that residents in his town would not be transported to where their primary care physicians work in the Lake Placid area.
Keene Valley Fire Chief Rusty Hall said his rescue squad is already bringing many of its patients to the Elizabethtown hospital's ER. That will likely continue, he said.
"We've transitioned a lot of our patients that we take from the assisted living facility here locally (the Keene Valley Neighborhood House) over to Elizabethtown now because they've upgraded their facility a little more expeditiously than AMC-Lake Placid has," he said. "They added a CAT scan, so it's now, on average, about an hour turnaround time versus two hours if we were go to Saranac Lake, which was happening more and more."
The only potential impact of not having an ER in Lake Placid, Whitney said, is if there were a "mass casualty" incident where many people had to be taken to hospitals around the region. If there's no ER in Lake Placid, it would take longer to get to the ER in Saranac Lake, he said.
Adirondack Health officials have said ambulances could still stop at the proposed urgent care center, which they've said would provide the same level of care and service as the Lake Placid ER, although it wouldn't be open around the clock and wouldn't require as many employees to staff.
Essex County EMS Coordinator Patty Bashaw, who also sits on the board of directors at Elizabethtown Community Hospital, said some rescue squads that bill for their services wouldn't be able to get reimbursed if they take a patient to an urgent care center.
"The billing is what helps cover some of the paid staff for these agencies," Bashaw said. "I have a paid person here at Elizabethtown-Lewis EMS. If I don't get reimbursement then I don't have enough money to cover my paid person, then we're back to the problem of not having good daytime coverage. That would definitely play into my decision as to whether or not I'm stopping in Lake Placid."
Nevertheless, the biggest issue is what's best for patient care, Bashaw said.
"The patient needs to go to the most appropriate hospital," she said. "If they're having a heart attack, they need to go to CVPH, and they're doing that already. If it's something that needs surgery, they need to go to a hospital that has those facilities. If the patient requests to go to Saranac Lake, then that patient needs to go to Saranac Lake, if it's appropriate for their care."
Jane Hooper, ECH's director of community relations, reached out to the Enterprise this week, saying some people in the area seem to be in a "panic" because they may lose emergency room care.
"We want people in the Keene, Keene Valley, Wilmington, Jay and AuSable areas to know that there is a 24-hour emergency room available 10 to 20 miles away," she said. "Those people are not going to have to travel to Saranac Lake for emergency room care, life-threatening care, strokes, heart attacks, traumas. Elizabethtown hospital is right here, is close and is open 24-7."
Hooper said ECH has a recently renovated, state-of-the-art emergency room that provides "stabilizing care" before transferring patients to higher-level facilities like CVPH and Fletcher Allen Health Care in Burlington, Vt., which ECH recently signed an affiliation agreement with.
"This hospital is a critical access hospital," Hooper said. "We basically assess the patient and stabilize them so they can survive transport to a trauma center, so they can get the specific care they need. We basically extend that golden hour so the patient has time to make it to a tertiary care center."
While Hooper didn't come right out and say it, bringing more patients from Jay, Keene and Wilmington to her hospital's ER also makes business sense, and it would likely further cut into Adirondack Health's bottom line.
Riccio declined to comment on ECH's effort to raise its profile in the area, other than saying, "Our only concern is to do what's best for the patient."
EMS providers the Enterprise spoke with said it's important to note that the Elizabethtown and Saranac Lake hospitals have comparable ERs, but that Adirondack Medical Center-Saranac Lake has more on-site hospital services, like an operating room, than ECH.
Riccio said Friday's meeting took place at Heaven Hill Farm and was attended by Adirondack Health officials, Lake Placid Mayor Craig Randall, Wilmington Supervisor Randy Preston, state Olympic Regional Development Authority President and CEO Ted Blazer, Whiteface Mountain General Manager Aaron Kellett and Jim McKenna, head of the Lake Placid Convention and Visitors Bureau and the Regional Office of Sustainable Tourism, among others.
Adirondack Health has scheduled two public meetings to gather feedback on its Lake Placid ER proposal. They'll be held at 6 p.m. May 1 and 7 p.m. May 8, both at the Lake Placid Center for the Arts.
Contact Chris Knight at 518-891-2600 ext. 24 or firstname.lastname@example.org.