Editorial: Local Health Care Requires Local Leadership in Chestertown

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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.

Letters to Editor

  1. MARY WOOD says:

    Thank you for this article. I would like to see our hospital run by a Doctor rather than someone with a degree from a business school with a major in hospital adminstration. Care of the patient should be the bottom line

    • Wayne d. Benjamin, M.D. says:

      I couldn’t agree more with Ms. Wood. This is not a unique idea. Where it has been elsewhere it has been very successful to the patients, the doctors and the ancillary staff.

  2. Your editorial is excellent! Thank you for thoughtful analysis and suggestion. May I also express thoughts that tie in with Mary Wood’s and Wayne Benjamin’s comments as well. I offer the opinion three distinct steps should be taken by USRH central office leadership. (1) Implement the local advisory board suggestion soon. I envision a group of seven individuals representing various segments of the community–gender, occupation, race, and concern for the development of our service area’s health care needs; (2) Delegate a full time administrator-manager-vice/president , or whatever to serve full-time on scene. I was in attendance at the final Chester River Hospital Board when a clear recommendation was made that as part of the merger agreement that be done- -it was not; (3) Do something that would be a credit to the USRH, the UM Medical School, USRH/Chestertown, and the entire local community it serves……Organize a service-based/medical resident teaching program in the field of Geriatrics. It is obvious to say this community has the potential age related population. It is further obvious that this state and our country need practitioners trained in this field. Why can’t USRH and the U of M Medical School team up to provide a much need service & educational initiative?
    I think all three (3) are significant and should be implemented.
    Jim Urda

    • Beryl Smith says:

      Thank you Jim for those suggestions. I hope they will be seriously considered. A part-time distant administrator for the hospital has proven to be unacceptable. Local input and on-the-job administration are key to the best operation. And, here in Chestertown there is definitely a fine opportunity for a Geriatric residency program that will demonstrate not only the needs of those who are aging but also the needs of a rural/semi-rural population that is aging and in need of care. Two for one as I see it!

  3. Stephanie Thomas says:

    This still doesn’t provide young families in this area a place to take infants/children for care. We are still having to drive 50 minutes to get care for our children. They need to bring back Pediatrics so that families have Pediatric doctors available to us so that we don’t have to travel all the way to Annapolis for care for an emergency.

  4. Stephan Sonn says:

    Oh how I wish not… The hospital facility on Brown Street is spoken for by UMMS. I for one do not expect
    the legislature to kill any tenant of an initiative they are so dearly vested in. The Middleton intervention
    is rife with nuance. This is a done deal.

    • Agree! Spilled milk. Just where were all you people eight years ago when I sounded the clarion? Don’t apologize to me! Apologize to the placenta previa, the abruptio placentae. the fetal distresses, the breaches, the acute G.I. bleeders and cardiac chest pains who are paying with their lives. Sick! J. B. Aquilla

  5. Louis Howeth Sr, says:

    My wife Edna Lee Howeth was an Rn at the Kent and Queen Annes hospital for some 40 years plus. Reported by many to be an outstanding nurse. She was also a real P.r person for the hospital. She was constantly selling our hospital to all she met, the service area of the hospital
    and beyond. She was also very active in fund raising projects. She was very saddened after encouraging fellow employees and others to contribute their time and talents, she did this in part by reminding all that this hospital was a community hospital, ownership and control by
    local people. When the hand full of board members gave the hospital to the UMMS She felt that she and many others
    had been betrayed. The hospital started sending out fund raising letters, saying things like we now have the nurses we need. We now have
    trained personal in patient education etc. I would say I thought these issues were already being dealt with. Edna Lee would say with a grin
    of coursed they are and remind me of some of the people who were a part of these programs. They would be people in most cases that I knew
    and they had subject knowledge and trained in the art of teaching. They also had a real love of the Hospital. When we met these people on the street , they would only shake their heads. THE UNIVERSITY OF MARYLAND HAD MOVED INN. They had moved in like a bunch of Drunken SAILORS. They had got another hospital and they could say or do what they wanted. They got rid of some outstanding nurses. They set up
    a local board. Mr. Gardner Vendor Ambulance owner. He even got elevated to the Big Board across the bay He was also very local he only lived in Easton,Maryland The vote to pass the resolution to merge the hospital was only passed by two votes. I understand Mr. Gardner voted
    so he plus one that went along , very possible because they knew it would pass with the Gardner vote. If this was not bad enough it surfaced that even some of their paid employees were voting members of this local board. WHAT A MESS. I could go on and on. My wife had a stroke
    early on a Sat morning in the Fall of 2013 It became very apparent that with such limited services on wkends and not much better during the wk. she would need to move to another town, so she could get the care she would need. She was in medical services in the Salis. area and I either stayed with my son and family or drove back and forth to Salis. until she passed away on June 21, 2014 I would like for her to have had the opportunity at the Chestertown Hospital for an MRI and more testing on that Sat Morning. All that was needed would have been to
    have someone on call. I have heard since that at one hospital near by, it has been determined an MRI saves at least the life of one stroke victim per month. Edna Lee who loved and supported our Hospital was let down because the UMMS was too cheap to have someone on call.

    If the UMMS is truly concerned about our hospital they should not have any concerns about pledging the hospital assets and control of the
    hospital to the town of Chestertown, the couonty, or a group of concerned Medical Doctors should they know longer desire to keep the hospital
    open. The hospital has lost much of its good reputation, and great staff, but we would at least have a fighting chance to bring the hospital back to something close to what we once had. They got with the merger, a much better hospital than we have today.
    that would be close to what we had

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