It is rather astonishing when one thinks about the current Chester River Hospital saga. Not that long ago, Chestertown’s small hospital was facing the subtle but unmistakable message of its parent organization, University of Maryland Medical-Regional Shore Health, that reductions of services were to be anticipated as part of a comprehensive review of regional health resources. In other words, prepare to shrink.
This in itself was not too surprising. The Chestertown community has known since the days the hospital first opened its doors that its small rural health center was a second tier faculty for medical services. But what was surprising was how quickly even some very essential services of care were now considered candidates for termination.
Year by year – some would say month by month – there was a growing pattern of actual department closings, or even worse, rumors of other departments closing. It didn’t matter whether these were fact or fiction, the increasing perception in Chestertown, and its surrounding environs, was that it was about to lose its hospital.
And nowhere was that more clear than when over 500 people showed up at the Chestertown Volunteer Fire Department auditorium (which can only hold 300) for a town meeting a few months ago on the future of the CRH with UMM officials and local politicians. While some attendees came with an open mind, it was hard not to notice the level of fear, distrust, and anger that has been building in Kent County ever since the community health center was transferred over to the UMM system.
And it is not difficult to understand why that is.
Over the last decade, not only has there been extraordinary changes in our national health system, but many of the original commitments associated with the Chester River Hospital’s acquisition by the University of Maryland have been dramatically changed as well.
The argument back then was that since the Chester River Hospital would always be a small community health center, the concept was to connect the dots with the entire Mid-Shore region (Caroline, Dorchester, Kent, Queen Anne’s and Talbot Counties) to collectively offer Eastern Shore residents a network of services that would eliminate the need to travel to the Western Shore for specialists and larger hospitals.
Central to this proposal was the construction of a primary hospital center in either Queenstown or Wye Mills, which would be centrally located (a 20 to 25 minute drive time) for the vast majority of Mid-Shore residents.
For reasons that are not entirely understood, that plan was scrapped over the last few years, and in its place is the current plan to locate the new hospital near the Easton Airport. The direct consequence of that decision would be that anyone living in Kent County would now face an average 50-minute commute (add fifteen minutes more during summer month beach traffic) to the new health facility, or about the equivalent time to Annapolis or Wilmington from downtown Chestertown.
At the same time that this important decision was being made, UMM still moved forward on the consolidation of its governance structure. Local hospital boards were replaced by one large board of directors, based in Easton; that would hypothetically have equal representation from each county.
So at the same time that plans for a regional hospital’s location were being newly determined, Chestertown and Kent County had lost its ability to hold UMM accountable for this significant change in thinking.
Under these circumstances, it is understandable why anger and fear have shown their ugly heads in letters to the editor and public gatherings. It has left many with the feeling that large organizations can simply walk away from promises without consequences and accountability.
That seems to be the case here. After many years of poor communications and a lack of representation in decision-making, this community does not have any sense of control in its medical health future.
The challenge for Chestertown is what to do.
Annapolis seems to have solved that problem, at least in the short term. Legislation is now underway that will put a freeze on any reduction of services at rural community hospitals throughout Maryland for at least one year. In response, UMM’s Regional Shore Health leaders have supported those measures as the way to regroup on how Kent County’s health care needs can be met.
That’s the good news. The bad news is that none of this solves the fundamental problem that the greater Chestertown community does not feel they have a real say in their hospital.
While there is some representation on Regional Shore Health’s current board of directors from the area, 4 out of 22 to be exact, this will not appease those who feel the community needs a real seat at a real table to care for a precious community asset. Without that fundamental level of engagement, any proposed plan for the hospital will ultimately continue this very disappointing and ugly sense of distrust and toxicity that currently exists.
Not so surprisingly, many national and regional organizations have had to confront this very issue of local versus regional control. Their solutions have been interesting to note, but there is ample reason to believe that one can have the benefits of regionalization without entirely giving up local control.
One need to look no farther than The Nature Conservancy (TNC), the country’s largest land conservation organization. While TNC has only one 501(c)(3) IRS number and only one fiduciary board of directors, they have formal advisory boards in all 50 states.
And those advisory boards have a formal role in the hiring of staff, the approval of budgets, as well as fundraising goals. With each state board, TNC has been able to attract some of the best leaders in that state from corporations, universities, medical centers, and private philanthropy. In other words, they do have a say in how that state’s program is run, but they also have a serious responsibility to ensure the success of the organization’s mission locally.
To assemble a similar group of dedicated, wise, and mature community leaders to direct the future course of the Chester River Hospital would significantly benefit both UMM and Kent County. While UM – Shore Regional Health would maintain their current board of directors and fiduciary responsibilities, a CRH advisory board would be empowered to play an active role in not only helping chart the course for CRH but act as long-term stewards for its needs, be that fundraising, the recruitment of doctors, or educating their neighbours about what a 21st Century hospital can be and cannot be.
Only local folks can do that.