A public hearing by the Maryland Health Care Commission on the Rural Health Care Work Group nearly filled 164-seat Norman James Theater at Washington College Wednesday night. The audience — largely made up of older residents — was there to express concerns over the long-range future of the Chestertown hospital, now called University of Maryland Shore Medical Center at Chestertown. While officials have repeatedly said there are no plans to close the facility, there are many who doubt their reassurances. The hearing was an opportunity for the public to address the issues.
Ben Steffen, executive director of the Maryland Health Care Commission, chaired the meeting. After brief remarks by Delegate Jay Jacobs and state Senator Stephen Hershey, he summarized the 2016 legislation establishing the work group. The act, Senate Bill 707, also set a framework for hospitals that were losing patient volume to convert to freestanding medical facilities – ambulatory hospital campuses or emergency rooms. Among those affected were hospitals in Laurel and in Harford County. Among the provisions of the act was a stipulation that the Chestertown hospital would remain open until 2022.
The work group, which has been meeting since September, includes four advisory subgroups, looking at health care workforce, economic development, care for vulnerable populations, and transportation issues in rural counties. It has met four times, at different locations around the Shore, and will meet again in July and September before delivering its report to the Senate Finance Committee. “Right now, we’re really getting into the weeds and starting to address a lot of the issues with health care services in the rural counties, “ he said.
Steffen then opened the floor to comments. He asked speakers to keep their remarks brief and to the point – “We’re not looking for oratory,” he said, but he said he would not be cutting speakers off. “We want to hear your suggestions and requests,” he said.
First to speak was Carl Gallegos, who introduced himself as chairman of the Chester River Hospital Foundation, which raises funds for the hospital. Gallegos told the audience he had attended the work group session that afternoon – “it’s important to have representation at the meetings,” he said. “It’s important to make our voices known; they listen to us,” he said. The Chestertown hospital is a viable part of Shore Regional Health, the University of Maryland’s umbrella group for the Easton and Chestertown hospitals. He said it was important to maintain the Chestertown hospital.
Bryan Matthews of KRM Development addressed the impact of the hospital on economic development in the local community. KRM is in the process of developing a large business campus on the north side of Chestertown, a multi-million dollar investment, he said. In the process of recruiting new businesses to occupy the space, he said, KRM is routinely asked three questions: the quality of the schools, the availability of health care, and the current workforce. “Health care is out of our control, but we can’t attract new businesses without it,” Matthews said.
Matthews said he was particularly concerned with the uncertainty whether the town will have a hospital after 2022, which he said creates a “silent dead period” for attempts to induce new businesses to settle in Chestertown. Prospective businesses are leery of investing in a location where the hospital may not be there in five years. The project “will come to a screeching halt” if the hospital closes or downsizes, he said. “We want and need good health care,” he concluded.
Jane Hukill, president of HomePorts, asked what the effect of President Trump’s health care program would be on local health care.
Steffen said there is a broad consensus on health care in Maryland, and gains under earlier administrations won’t easily be given up. He said the state’s Medicaid expansion has benefited many residents in rural areas; “The consensus is, we’d hold onto it,” he said. Also, he said, the state has a different system for reimbursing hospitals than many others, and rural hospitals are well provided for. “So we have some protections,” he said. He noted that the Trump administration has provided some degree of flexibility for individual states under its health care proposals, and Maryland will probably take full advantage of it.
Leslie Price of Worton spoke on behalf of the retirement community, which she said requires not just good health care, but access to hospital beds. “I worry, if there isn’t a hospital with beds, how well Heron Point can keep attracting people,” she said. She said there are times when the hospital is so completely occupied that patients are put in beds in the hallways or kept in the emergency department until beds become available. She said the availability of more beds is critical to providing the kind of service the community needs.
Nancy Carter said recruitment and retention of trained personnel is a key issue. She urged the commission to pay close attention to it.
Zane Carter addressed demographics and transportation issues in Kent County. He said Kent, like a lot of rural counties, has a disproportionate number of residents below age 20 and above age 50, both groups that are more dependent on the availability of transportation than others. He said that 39 percent of students in the county’s public schools are from single-parent families. If something happens to a parent where they have to be in a hospital for several days, it becomes much harder for their children to get to school or to visit them.
Frances Miller of Chestertown said the proximity of a hospital is a life-and-death issue. She gave two examples from her own family where a relative encountered a medical emergency that would have cost their life if they had been more than a few minutes from a hospital. “Distance can be a killer,” she said. “We can’t have one major hospital down in Easton and hope we can get there in time.”
Bob Coleman spoke from the perspective of volunteer emergency medical personnel. He said the county’s small population limits the number of EMS personnel available. It takes at least two hours of volunteer time from the point when a 911 call comes in until the volunteer is available to take another call. Transports to Easton or Annapolis add another hour, with still more for patients from Rock Hall. “We struggle for volunteers,” he said, and the low population density of Kent County makes the struggle harder. He asked any audience members to volunteer. “We have three paramedics during the day, two at night,” Coleman said. He said the county commissioners had been asked to fund a third paramedic during night hours, and he hoped they would be able to do so, but he said it could easily add $1 million to the budget.
Coleman concluded by saying, “This is our hospital. Maybe the University of Maryland has some papers that say they own it, but my parents helped build it. Many citizens from this community contributed – built wings, built this hospital – it’s our hospital.” He said he was concerned that the University of Maryland was “checking boxes” on a list of criteria that would allow them to close the hospital after 2022. “There should be an opportunity to look for other mechanisms that would keep it here,” he said.
Kay MacIntosh, economic development coordinator for the town of Chestertown, said she had been following the work group’s activities since it was formed. She said the town and county had been laying a lot of groundwork for economic development, noting the KRM project and the installation of a fiber-optic network by the county, plus other signs of long-term progress. “The message that we need to get to the Maryland Health Care Commission and Shore Regional Health is that the decisions they make can greatly deter progress, or they can work with us.” She also noted that the word “hospital” carries a lot of weight with businesses or individuals thinking about moving to the community.
“I’ve got three hats on tonight,” said Glen Wilson, who was present as a resident of Chestertown, as president of Chesapeake Bank and Trust, and as chair of United Way of Kent County. He said quality health care was a key part of his decision to move here, and he was confident that the $10 million investment Shore Regional Health made in upgrading the emergency room meant a long-term commitment. “But if it’s really a triage
facility, you’re going to go somewhere else,” he said – and University of Maryland shouldn’t assume it will be its Easton hospital. He talked about the need for family members to be present for patients – which the distance to Easton makes problematic.
From the point of view of the bank, Wilson said, the health of the community is vital to the health of the bank and its business. “If inpatient beds close, I think this town will wither,” he said. He said the retirement community would not be attracted to a town without health care. And from the point of view of United Way, health care is a crucial element of its fundraising mission. He said the needs the charity addresses won’t diminish, but its ability to raise fund would be curtailed if the community begins to lose residents. “I believe the state, as the major funder of the University of Maryland Medical System, also has an obligation to the vitality of this town, and certainly the health care.”
Kevin Brien, a Washington College professor, said he was two days out of the hospital, and he characterized the care he received as “absolutely wonderful.” He said he would have to leave the community if the hospital leaves. He said he had interviewed many prospective faculty members for the college, and they invariably asked about the quality of medical care. He also said the black community needs a hospital close by.
Al Hammond, who said he had run a health care system in India, said the continuation of an inpatient facility in Chestertown should not be the only goal of the community. He said preventive care and maintenance of chronic disease are also important, and they happen in the home and the community rather than in hospitals. He said a focus on wellness, diet, behaviors, prevention and early diagnosis was necessary to the health of the whole community. Those services can be delivered at the patient’s home by paramedical personnel equipped with tablets, providing health care at much lower cost, as he saw in India, he said. “That kind of preventative care ought to be in our sights,” he said.
Bob Parks, executive director of Horizons, addressed the health care needs of the most vulnerable segment of the community. He said all the issues being considered are much more severe for the “underprivileged, underserved” portion of the county, and he urged the commission to consider their situation.
A woman from Rock Hall said she sees a lot of people who need help. She said the lack of nearby specialists is a particularly pressing problem, giving the example of a diabetic woman who had to be put in the hospital because there was no other way to get her seen by a qualified doctor. “That’s a waste of healthcare dollars,” she said.
Another resident said the loss of a maternity ward was a concern. She told of a young woman she knew who had to deliver her baby on the way to Easton. “That was horrendous; the baby could have died,” she said.
At the end of the session, Steffen asked the audience about the availability of services including medical specialists, nursing home services, assisted living, and access to home health services. Among the needs mentioned were endocrinologists, urologists, pulmonary specialists, and mental health specialists including psychiatrists and psychologists. Steffen said the latter specialties were a problem all across the shore, a problem compounded by the reluctance of insurance to cover mental health services.
Audience members also addressed the need for nurse practitioners to supplement the number of doctors in the community, and the inability of people without internet service to access telemedicine. Also, Steffen said, people need to trust the ability of EMS volunteers to diagnose them – “it’s better to call an ambulance than to try to guess what treatment you need if you’re having a heart attack.”
Steffen said the next public hearing would be in Dorchester County June 1, and asked audience members to let friends in that area know of the opportunity to have their concerns heard.
Patti Willis says
Peter: Good summary of the comments heard at this session. Please note that Senate Bill 707 included the stipulation that the hospital in Chestertown would remain fully functioning as a hospital until 2020. UM Shore Regional Health voluntarily offered that the hospital in Chestertown would remain an acute care hospital until at least March, 2022. Thanks.
Daniel Menefee says
Shore Health intends to convert the hospital here to a FMF after 2022.