Maryland House passes Drug-aided Death Bill

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The Maryland House on Thursday passed a measure that would give terminally ill patients six months from death the option to end their lives by taking prescribed lethal medication.

House bill 399, or the End-of-Life Option Act, received 74 votes for and 66 against in an impassioned chamber session.

Individuals are required to consent three times to death. “Lethal injection, mercy killing or euthanasia,” would not be legal under the legislation, according to the bill’s analysis. There would be criminal penalties for people who coerce others into ending their lives.
The debate began with some tension, but soon cooled off, as personal anecdotes of experiences with death or near-death brought tears to the eyes of members of the chamber.

Democratic and Republican delegates opposed the bill, saying they had religious and moral objections, and detailing how important each day alive was to many of their relatives who died from terminal illnesses.

“Because I am a believer,” God should be answered to, not nurses or doctors, Delegate Jay Walker, D-Prince George’s, said. “Give my Lord the opportunity of a miracle.”

“Doctors take an oath, the Hippocratic oath, to do no harm,” Delegate Haven Shoemaker, R-Carroll, told Capital News Service.

“We’re encouraging (physicians) to contravene that oath,” Shoemaker said.

“Think about vulnerable populations” who could be taken advantage of by this legislation, said House Minority Leader Nicholaus Kipke, R-Anne Arundel. “Less than 5 percent of the poor receive hospice care at the end of life.”

If many people begin ending their lives prematurely, “we wouldn’t look for a cure,” to their diseases, said Minority Whip Kathy Szeliga, R-Baltimore and Harford counties.

Delegate Cheryl Glenn, D-Baltimore, spoke of her sister who died of a terminal illness.

She would not have made peace with her only son if she had ended her life early, Glenn said. “We don’t know what tomorrow will hold.”

Democratic supporters argued that individuals deserve the right and option to choose when they die.

Delegate Shane Pendergrass, D-Howard, lead sponsor of the legislation, told the stories of two people who fought breast and brain cancer.

Knowing the medication to end your life is there gives comfort and control to an individual who is suffering, Pendergrass said.

Delegate Eric Luedtke, D-Montgomery, said he had three family members attempt suicide, and spoke of his mother who tried to end her life from the pain of her cancer.

“Despite my personal hatred for suicide, I began to ask myself what right I had as a government official, and even as her son, to dictate to her how her life should end,” Luedtke said.

Individuals can already choose to not be resuscitated and be taken off a feeding tube, Delegate Elizabeth Proctor, D-Charles and Prince George’s, said. The bill just gives people at the end of life another option, Proctor said.

Delegate Sandy Bartlett, D-Anne Arundel, told her story of anguish following mastectomies for breast cancer.

Deciding to end one’s life is up to “her, and her choice only,” Bartlett said, speaking of herself.

The bill “does not impose beliefs on anyone,” said Delegate Terri Hill, D-Baltimore and Howard counties, a physician. “I expect that the positions we’ve taken have been thoughtful and spiritually guided.”

The chamber was silent following the final vote.

Now that the legislation has passed the House, an identical bill must pass the Senate, and then must not be vetoed by Gov. Larry Hogan, R, to become law.

“I’m going to give a lot of heartful and thoughtful consideration,” to the act, Hogan said in February.

California, Colorado, Hawaii, Oregon, Vermont and Washington, as well as the District of Columbia, have legalized physician-assisted suicide, and Montana has no law prohibiting it.

Seventy-two percent of Americans would support ending a terminally ill patient’s life, according to a 2018 Gallup poll.

The legislation, originally titled the “Richard E. Israel and Roger ‘Pip” Moyer Death with Dignity Act,” was first presented to the General Assembly in 2015.

Israel and Moyer were former members of Annapolis government, and both died in 2015 from Parkinson’s disease.

Pendergrass said after years of supporting the bill, it is “just a remarkable moment” to see the vote of passage for this legislation.

She attributed the bills’ success to testimony she heard and has repeated many times: “Everyone is one bad death away from supporting this bill.”

By David Jahng

UM Shore Regional Health Publishes 2018 Community Benefits Report Online

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UM Shore Regional Health’s 2018 Community Health Improvement Report has been published online and is available for viewing at https://www.umms.org/shore/news/2018/um-shore-regional-healths-2018-community-health-improvement-2018.

UM Shore Regional Health’s most recent Community Health Needs Assessment (CHNA), conducted in 2016, identified top health concerns in the region: chronic disease management (obesity, hypertension, diabetes, tobacco use), behavioral health, access to care, cancer, outreach and education (preventive care, screenings, health literacy).These are the same top health concerns and health barriers indicated by the overall Maryland Department of Health and Mental Hygiene State Health Improvement Process (DHMH SHIP) county data.

UM SRH determined that the greatest transformation in population health in the five-county region would be achieved by focusing on chronic disease management, behavioral health and cancer screenings. An implementation plan was developed for each priority, with key activities to improve care coordination and health education in community settings.

As detailed in the new report, the total value of UM Shore Regional Health’s community health improvement initiatives during 2018 exceeds $40 million. According to Ken Kozel, UM SRH president and CEO, and Kathleen McGrath, regional director, Outreach and Community Health, the document “reflects UM Shore Regional Health’s commitment to building community partnerships that help foster better health outside the walls of our hospitals and outpatient facilities, while enhancing access to care and the overall quality of life in the five counties we serve.”

As part of the University of Maryland Medical System (UMMS), University of Maryland Shore Regional Health is the principal provider of comprehensive health care services for more than 170,000 residents of Caroline, Dorchester, Kent, Queen Anne’s, and Talbot counties on Maryland’s Eastern Shore. UM Shore Regional Health’s team of more than 2,500 employees, medical staff, board members, and volunteers works with various community partners to fulfill the organization’s mission of Creating Healthier Communities Together.

Death with Dignity: DC Residents Learning about New End-of-Life Law

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More than a year after a controversial end-of-life law went into effect in the District of Columbia, advocacy groups say they are now seeing a higher public response to its efforts to ensure city residents know the law exists.

How many people have used the law will become clearer in an upcoming February report. As of last April, no patient had yet used the law, according news accounts.

The Death with Dignity Act allows mentally capable, terminally ill adults with six months to live to request lethal doses of prescription medication so they can die peacefully and comfortably in their homes or any place where they have been granted permission to do so.

One of the law’s main proponents, Compassion & Choices, has helped the District of Columbia Council advocate for the legislation and educate Washington residents about the new option for patients with terminal illnesses.

The administrative side of the end-of-life process apparently has dissuaded physicians, pharmacists and patients from using the law, but local public service announcements have helped spike interest and attention, Sean Crowley, spokesman for Compassion & Choices, told Capital News Service in an interview.

His group declined to say how many doctors in the District registered to use the law, as it did not have access to such records. But as of last April, only two doctors among the roughly 11,000 doctors in the city had registered to use the law and just one hospital had approved doctors for the practice, according to The Washington Post.

The District of Columbia Department of Health is set to release a detailed report in February on how many patients have utilized lethal drugs and how many physicians have administered them. But to date, no patients have volunteered to go public with their stories.

During September, Compassion & Choices distributed television public service announcements promoting the end-of-life law, featuring prominent Washingtonians Diane Rehm, a former WAMU radio show host, and Dr. Omega Silva, a retired physician.

The announcements, which began Labor Day weekend, aired on various Comcast stations. Compassion & Choices reported that there were 229 visits to the group’s page during September, compared to only 56 for the same month a year ago – a 400 percent increase.

In addition to the District, six states have end-of-life, or physician-assisted dying laws: California, Colorado, Hawaii, Oregon, Vermont and Washington, according to the nonprofit Death with Dignity National Center, based in Portland, Oregon.

Efforts to pass a similar law in Maryland have been unsuccessful.

Since the District’s end-of-life bill was introduced in 2015, organizations such as Right to Life and conservatives in Congress have opposed it and tried to defund it.

Rep. Andy Harris, R-Cockeysville, introduced an amendment in 2017 to defund and repeal the law. The amendment failed to pass the House Appropriations Committee.

Harris, a physician, criticized what he called “the so-called Death With Dignity Act,” saying “most people don’t associate suicide with dignity in any way shape or form.”

“It sends a strong message that regardless of the many types of disease you might have and the many types of treatment that may be available, there is one common pathway that in this case the District would say is perfectly acceptable, it is legal,” he said. “It’s actually to go to a physician and ask if they can participate in your suicide. That doesn’t lead to more choice – that leads to one choice.”

The House will be controlled by the Democrats next month, making the prospects for repealing the District bill more remote.

In any case, Crowley said that “lawmakers from outside the District should not dictate to district lawmakers what laws they should pass for their local constituents.”

“Other states would never allow lawmakers from outside their state dictate what their states can do,” he said. “Why should they be allowed to dictate in D.C.?”

Since its founding as the seat of the federal government, the District of Columbia has not had voting representation in Congress, although it has some limited autonomy. Even so, Congress has the power to review and repeal District laws.

“That Congress thinks it should substitute its judgment for the judgment of the residents of the District of Columbia is odious enough,” said Councilmember Mary Cheh, who sponsored the end-of-life bill. “That it would presume to substitute its judgment for the judgment of people who are dying is unconscionable. Such an action is fundamentally undemocratic and it should not stand.”

By Morgan Caplan

Suicidal Behavior In Children And Adolescents: Focus on Awareness and Prevention by Dr. Laurence Pezor

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As we complete a week dedicated to the awareness of suicide, it is important to review this manifestation of mental illness and what the community and we, family, friends and mental health professionals, can do to address this crisis.

Statistically, it is staggering that suicide is the 3rd Leading cause of death in 15 to 24 year-olds and the 6th leading cause of death in 5 to 14 year-olds according to data from the American Academy of Child and Adolescent Psychiatry (AACAP, Facts for Families, 2013). Center for Disease Control data from 2005 indicated that among 15 – 24 year-olds, suicide accounts for 12.9% of all deaths annually.

This is particularly a concern for high school students who, in a study by Eaton et al in 2006, indicated at 16.9% of all high school students seriously considered suicide in the previous twelve months before the study. Additionally, there are significant cultural differences. The same study documented that Hispanic female high school students reported a higher percentage of suicide attempts than their non-Hispanic peers.

These statistics, however overwhelming, are only overshadowed by the unrelenting pain suicide inflicts on surviving family and friends. Some professionals contend that suicide cannot be prevented but mitigated by focusing on providing alternative choices to desperate situations. That providing those in emotional distress with more appropriate choices to manage their feelings and instead of self harm, utilize different coping skills when overwhelmed.

To that end, open discussion about suicidal behavior and feelings as well as providing alternatives to self harm, are the goal of therapy and community support.
Providing tools to children and their families including crisis lines, access to mental health services and other professional support is key.

Recognition of potential risk factors that indicate emotional distress and could lead to suicidal thoughts or behavior is everyone’s responsibility.
Potential risk factors, described by AACAP (2004), include:

Prior suicide attempts
Substance Abuse
Change in sleeping/eating habits
Withdrawal from family and friends
Unusual neglect of personal appearance
Violent, rebellious behavior
Loss of interest in pleasurable activities
More severe psychiatric symptoms (psychosis)
Complain of feeling “bad” or “rotten” inside
Put his or her “affairs in order”
Verbalize suicidal thoughts or feelings

Underlying mental illness, lack of family and social support as well as limited coping skills also play a pivotal role in suicidal behavior.

How can we, as family, friends and community, help?
Some basic interventions include:
Take threats seriously; notify police or mental health professionals
Be suspicious when there are serious psychiatric symptoms or substance abuse issues
Keep lines of communication open
Seek professional support

Eastern Shore Psychological Services (ESPS) has therapists in all the Talbot County schools working hand in hand with the school guidance counselors ready to help.
ESPS offers mental health, substance abuse and wellness services for all ages. For those seeking mental health services, ESPS offers “same day access” appointments Monday – Thursday at 8 AM at their office at 29520 Canvasback Drive.  For more information, please contact the Clinic at 410-822-5007.

Laurence Pezor, MD is the Chief Medical Officer at Child and Adolescent Psychiatrist with Eastern Shore Psychological Services.

 

Maryland Democrats: Trump Health Care curbs could Affect 260,000 in State

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As many as 260,000 Maryland residents could see higher premiums or lose their health care coverage altogether because of pre-existing medical conditions, age or gender under a new Trump administration legal strategy, state Democrats warned on Tuesday.

Rep. Elijah Cummings, D-Baltimore, along with other Democratic members of the Maryland congressional delegation and state Attorney General Brian Frosh attacked the Trump administration for refusing to protect Americans guaranteed the right to health insurance under the Affordable Care Act.

The protections, the Democrats argued, are of the utmost importance and won’t be invalidated without a legal fight.

“We’re better than that,” Cummings said. “We’re a better country than that.”

In June, Attorney General Jeff Sessions wrote in a letter to House Speaker Paul Ryan, R-Wisc., that the Justice Department would not defend key provisions of the health care law, a regular target of attacks by President Donald Trump and repeal efforts by congressional Republicans.

Cummings released a report by the Democratic staff of the House Oversight and Government Reform Committee that detailed potential impacts of such a policy on Marylanders. Frosh is among more than a dozen attorneys general challenging Sessions’s decision in federal court.

“Even more troubling, they did not offer any alternative,” Cummings said at a press conference.

He was flanked by Frosh, Maryland Sens. Ben Cardin and Chris Van Hollen, and Reps. Dutch Ruppersberger of Timonium and John Sarbanes of Towson. All are Democrats.

Trump has largely moved to defund the ACA since taking office, scaling back federal funding from $62.5 million in 2016 to just $10 million this year.

But Health and Human Services Secretary Alex Azar has challenged attacks on Trump’s handling of the health care law.

“The president trying to sabotage the (Affordable Care Act) is proving better at managing it than the president who wrote the law,” Azar said during a Sept. 27 speech in Nashville, The Washington Examiner reported.

Under the new Trump policy, 167,000 Marylanders with pre-existing conditions could lose coverage or face hikes in premiums, the Democrats’ study estimated. Of those, 79,000 have such severe pre-existing conditions that insurance carriers could deny them any coverage.

Up to 160,000 Maryland women could be charged more than men for the same health care coverage, the report said. Such discrimination was barred by the health care law.

In addition, up to 108,000 older Maryland residents could be charged more, according to the report.

Maryland workers in higher-risk occupations also could lose protections: 19,000 construction workers, 9,700 shipping clerks and 4,800 emergency medical technicians.

“Defending the Affordable Care Act will affect the lives of Marylanders and people all over this country,” Cardin said. “It’s critically important that the American people understand what’s at stake when the president does not defend the Affordable Care Act.”

A Kaiser Family Foundation poll released in September showed that 50 percent of adults held a favorable view of the ACA. Forty percent held an unfavorable view. Another Kaiser poll found that 75 percent of people polled said it was “very important” that the ACA’s protections for people with pre-existing conditions ensuring guaranteed coverage remains law.

“When the Trump Administration decided not to defend the law … they’ve given a green light to all those who want to undo that protection through the courts,” Van Hollen said.

Trump, who said during his campaign that he wanted to put somebody on the Supreme Court who would help overturn the ACA, has done just that in nominating Brett Kavanaugh. In 2011, Kavanaugh was the dissenter in a 2-1 federal appeals court ruling on the constitutionality of the ACA’s individual mandate provision.

Cummings said the administration’s hostility to the health care law has caused unease even among government attorneys.

“Their actions are so indefensible,” Cummings said, “that three of four career attorneys representing the government withdrew from the case rather than sign their names on the brief. One attorney even resigned.”

Joel McElvain and two other lawyers withdrew from the case this summer; he later resigned. All three worked on a lawsuit brought by Texas and other Republican-led states that challenges the constitutionality of the ACA and is likely to find its way to the Supreme Court.

by Jared Goldstein

Pam Ortiz Band Concerts Benefit No Matter What. . . You Matter Suicide Prevention Campaign

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Pictured is The Pam Ortiz Band, who will provide two benefit concerts this year as For All Seasons Suicide Prevention Campaign comes to Chestertown for the first time.

According to the Center for Disease Control (CDC) every 13 minutes someone dies by suicide and for every suicide, 25 suicide attempts are made. This fall, to help create awareness about this community mental health issue, For All Seasons is sponsoring its Annual NO MATTER WHAT . . . YOU MATTER Suicide Prevention Campaign, with two concerts in Chestertown this month.

To benefit the Campaign, The Pam Ortiz Band are holding concerts on both Saturday, September 29 at 7 p.m. and Sunday, September 30 at 3 p.m. at Robert Ortiz Studios at 207C S. Cross Street in Chestertown. Tickets cost $25 per person and can be reserved at ortizconcert.eventbrite.com or bought at the door. Chester River Wine and Cheese Co. will be selling wine and mini-cheese boards beginning at 6 p.m. on Saturday night. All proceeds will benefit For All Seasons suicide prevention efforts.

According to For All Seasons’ board member Pam Ortiz, “Harry Chapin used to say he played one night for himself and one night for the other guy. In that spirit, we will be doing the two shows to benefit our friends and neighbors served by For All Seasons, a behavioral health and rape crisis center serving the five Mid-Shore counties. These events will kick off the organization’s suicide prevention initiative, No Matter What…You Matter, in Chestertown.”

The Pam Ortiz Band includes Pam on vocals, Pam’s husband, Bob Ortiz, on percussion and guitar; Ford Schumann on guitar; Nevin Dawson on viola and violin; and Philip Dutton on piano and keyboards. The band has been performing in this configuration since 2012. In 2017 the group hosted a seven-concert series, Songs for Our Future, to packed houses. Each show raised funds for an organization that supported an important right or vulnerable group of people.

Monika Mraz, Director of Development at For All Seasons, comments, “We are thrilled to have the support of The Pam Ortiz Band as we promote awareness about suicide prevention in Kent County. This is a real issue in our communities on the Shore and we hope to enhance the community’s understanding of the issue, while providing some valuable tips in how to prevent suicide with our friends and family members.”

Suicide does not discriminate, affecting people of all genders, ages, and ethnicities. Many different factors may contribute to someone making a suicide attempt. For All Seasons hopes that by discussing the signs and symptoms associated with suicide that it can raise awareness about the issue in our community. Because family and friends are often the first to recognize the warning signs of suicide, they can be critical to helping an individual find treatment with a provider who specializes in diagnosing and treating mental health conditions.

According to the Center for Disease Control (CDC), for every suicide, 25 suicide attempts are made. For All Seasons wants people to know that If they think a friend or family member is considering suicide, they should reach out and start a conversation. Talking openly about suicidal thoughts and feelings can save a life. The following are three steps to help people begin the conversation:

1) Ask directly – “Are you having suicidal thoughts?” – Let them know you care.
2) Stay and Listen – Let them share their thoughts and feelings.
3) Get help – Connect them with a friend, family member or a therapist at For All Seasons.

Beth Anne Langrell, Executive Director of For All Seasons, comments, “For All Seasons hopes through this campaign to create an ongoing dialogue with agencies about this growing issue in our communities. We want people to know that no matter what, they do matter.”

For All Seasons provides Trauma Certified Individual, Family, and Group Therapy; Child, Adolescent, and Adult Psychiatry; and Crisis and Advocacy Services for Child, Adolescent, and Adult Victims of Sexual Assault, Rape and Trauma. If you or someone you know needs help, call 410-822-1018 for a same-day crisis appointment.

Throughout the year, For All Seasons brings awareness to the community about such issues as suicide, sexual assault, trauma, and mental health needs.
Follow For All Seasons on Facebook to find out how to get involved. For further information, call Monika Mraz at 410-822-1018, email mmraz@forallseasonsinc.org or visit forallseasonsinc.org/youmatter.

 The concerts will be held on Saturday, September 29 at 7 p.m. and Sunday, September 30 at 3 p.m. at Robert Ortiz Studios at 207C S. Cross Street in Chestertown. Tickets cost $25 per person and Chester River Wine and Cheese Co. will be selling wine and mini-cheese boards beginning at 6 p.m. on Saturday night. All proceeds will benefit For All Seasons suicide prevention efforts.

United Way Research Reveal Kent County Residents Struggling to Afford Basic Necessities

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United Way releases surprising data on their 2018 Maryland ALICE Project which identifies households that have incomes above the Federal Poverty Level but struggle to afford basic household necessities. That finding is true for both Kent County and the rest of the state. 

The report, which uses 2016 data, shows that in Maryland 825,433 households or 38% could not afford basic needs such as housing, childcare, food, transportation, healthcare, and a smartphone. These statistics indicate an increase of three percent from last year’s report. Low-wage jobs, half of all jobs paying less than $20 per hour, and an increase in “gig” and contractual work all contribute to decreased financial stability for working households.

The ALICE Project utilizes standardized measurements to calculate the cost of a bare-bones household budget in each county in each state and quantifies the number of households that cannot afford even that. It includes Household Survival Budgets which have increased steadily, reaching $69,672 for a family of four (two adults with one infant and one preschooler) and $26,052 for a single adult in 2016. These conclusions are an alternative to FPL guidelines, which underestimates the number of struggling families as it does not accurately reflect current, local costs of living.

“At United Way of Kent County, the ALICE findings have reinforced our commitment to addressing the issues stressed in our Community Needs Assessment,” said Glenn Wilson, Board President, United Way of Kent County. “This updated research underscores our findings and highlights the issues that need more attention here and how to provide services to this vulnerable population.”

Following is the Kent County breakdown of Household Survival Budgets and percentage of households living below the ALICE Threshold:

“ALICE isn’t going away,” said Franklin Baker, president and CEO of United Way of Central Maryland “and as this latest report shows, the numbers are only increasing. We must continue to work together to help remove barriers in areas such as housing, transportation, and childcare that prevent so many of our citizens from leading a stable, secure life. Stronger, stable working families mean stronger, stable communities. And that’s something that United Way, our donors, volunteers, staff and partners fight for every day.”

The United Ways of Maryland join more than 540 United Ways in 18 states that are working to better understand ALICE’s struggles. The research will be used to stimulate meaningful discussion, attract new partners and ultimately inform strategies for positive change.

For more information on the ALICE report please go here

 

 

Shore Medical Center at Easton Recognized by US News & World Report

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University of Maryland Shore Medical Center at Easton is featured among the Maryland hospitals recently ranked in U.S. News & World Report’s annual report on best hospitals nationwide. The Easton hospital was ranked second among the best hospitals on the Eastern Shore of Maryland and among the top 15 hospitals in the State of Maryland. The U.S. News ranking also gave special recognition to UM Shore Medical Center at Easton’s programs for patients with chronic obstructive pulmonary disease (COPD), heart failure and hip replacement received special recognition for high quality care.

“There are so many people who deserve credit for this excellent recognition – our team members, our physicians and advanced practice providers, our volunteers and our devoted community supporters,” says Ken Kozel, president and CEO of UM Shore Regional Health. “On behalf of the Board of UM Shore Regional Health and our senior leadership, I’m very pleased to express our appreciation for the outstanding teamwork that is helping us achieve our Vision, to Be The Region’s Leader in Patient Centered Health Care.”

Issued annually during the month of August, the U.S. News Best Hospitals nationwide analysis reviews 5,000 hospitals’ performance in both adult and pediatric clinical specialties, procedures and conditions. Scores are based on several factors, including survival, patient safety, nurse staffing and more. Hospitals are ranked nationally in specialties from cancer to urology and rated in common procedures and conditions, such as heart bypass surgery, hip and knee replacement and COPD. Hospitals are also ranked regionally within states and major metro areas.

Hospital Plan Includes Patient Beds, No ICU, Kozel Tells Meeting

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Ken Kozel, CEO of Shore Regional Health; Dr. Ona Maria Kareiva; Dr. Michael Peimer; and Margie Elsberg of Save Our Hospital — Photo by Peter Heck

The upstairs meeting room of Chestertown’s Town Hall was filled last Thursday night for a meeting called by the Save the Hospital coalition. Margie Elsberg of Save Our Hospital chaired the meeting, which featured a panel of Ken Kozel, CEO of University of Maryland Shore Regional Health for five counties on the Eastern Shore; Dr. Ona Maria Kareiva, an anesthesiologist from Easton who works at the Chestertown hospital, and Dr. Michael Peimer, an internal medicine specialist, of Chestertown.

Elsberg opened the discussion with a summary of the status of Shore Regional Health’s plans for the hospital. She said that Shore Regional Health, a subsidiary of University of Maryland Medical Services, originally planned to downgrade the Chestertown Hospital to a stand-alone medical facility – essentially an expanded emergency ward, with some testing facilities but no inpatient beds. Residents’ protests, notably in a packed 2014 meeting at the Chestertown firehouse, forced UM SRH to reconsider. The community response also resulted in a measure passed by the General Assembly of Maryland, requiring the hospital to stay open until 2020 – a date that SRH extended to 2022. However, if no new legislation is passed before that date, UM SRH is within its rights to carry on with its original plan, or even to close the hospital entirely.

Shore Regional Health (SRH) owns three hospitals on the Eastern Shore — one each in Chestertown, Easton, and Cambridge.  Statewide, University of Maryland Medical Systems (UM MMS) owns 13 hospitals–that’s ten in addition to the three on the Eastern Shore.  Also, UM SRH runs numerous other medical facilities offering a multitude of medical facilities and services including doctors’ offices, testing facilities, and various medical clinics.  The Shore Medical Pavilion at 126 Philosophers’ Terrace in Chestertown–which opened a little over two years in June 2016–is owned and operated by UM SRH.

Elsberg said that UM SRH has agreed to retain some patient beds in Chestertown. However, the current plans do not include an intensive care unit, a decision that Save Our Hospital strongly opposes. She said the community will need to generate legislative support to get the action needed to prevent the hospital from closing or eliminating services. She emphasized that the facility under consideration would be a “minimal” hospital.

Dr. Kareiva said the hospital needs an ICU to care for patients with such diseases as pneumonia, who need a high degree of observation and maintenance. She said an operating room is also necessary for the community. She said Kozel has promised to provide most of what the community has asked for. “We need you to believe him and work together,” she said. She added that the community needs to use the hospital to keep it viable.

Kozel said that the nature of health care has changed significantly in the past five to ten years because of the Medicare waiver granted to the state of Maryland, meaning that health care payments are at a predetermined rate statewide. Because of this, he said, the cost of health care “is going through the roof” at 18 to 19 percent of the economy. UM SRH is under the obligation to provide access to high-quality care at an affordable rate. But it covers a rural area with a comparatively small population spread over five counties, two of which – Queen Anne’s and Caroline – don’t have hospitals.

Kozel said a free-standing medical facility – the model UM SRH originally planned for Chestertown – does 95 percent of what a full hospital does, “all except beds.” He said the plan made sense, but the firehouse meeting forced UM SRH to reconsider. The geography of the five-county area means that patients from Kent County are an hour or more away from the Easton hospital, which he said he now believes is an unacceptable distance to ask them and their families to travel. The current model is a “critical access hospital,” which would have 15 patient beds but no ICU. He said the Shore board supports the plan, although it recognizes that it’s a challenge.

Dr. Peimer said the hospital needs a critical mass of usage to stay open. It needs to keep staff at a certain level, and remain flexible. It’s important for it to be able to take care of patients locally, not send them away. That means bringing in staff to cover specialties not found in the local community. It also means finding enough hours for the nursing staff – Peimer said the hospital is losing nurses because it can’t provide enough hours for them.

Some of the audience at the Save Our Hospital meeting Aug. 2 — Photo by Jane Jewell

Garrett Falcone of Heron Point said the hospital needs to work to bring in more primary care doctors.

Kozel said the system is working to recruit more doctors for the local community. He said UM SRH worked with Dr. Susan Ross to keep her practice open and hired a new doctor to join her practice. Specialists are also being brought in at the offices on Philosophers Terrace, including a cardiologist, an ear, nose, and throat specialist and others. But because the system needs to cover five counties, it has a limited budget for what it can do in Chestertown. “We need to cut to balance what we add,” Kozel said.

An audience member asked why the hospital needs to cut if it is operating in the black, as stated by Dr. Jerry O’Connor in an interview on public radio last week.

Kozel said the hospital previously operated on a fee-for-service basis, meaning that more volume produced more revenue, allowing the hospital to be profitable. Because of the waiver, rates are now capped. “We know our revenue for the year, and we have to use it wisely,” he said. But if the hospital provides fewer services, or if its service is rated poorly, it loses revenue.

UM SRH has been consolidating such departments as human resources and IT systems while working to keep nurse/patient ratios constant, Kozel said. It’s also working to reduce “avoidable utilization” – patients who don’t need to be in a hospital at all, especially those who are readmitted after treatment.

The whole system is on a break-even budget, he said. The patient census – those kept in beds — averages about 17 a day, but can be as low as five and as high as 25, depending on seasonal variations and other factors.

An audience member said the hospital refers many patients to Easton. Kozel said that decision is up to the doctors – what’s right for the patient. The audience member said that Easton doctors who take phone calls from Chestertown don’t know what facilities are available here. Elsberg said the perception is that Easton doctors don’t listen or care about Kent County patients.

Kozel said that 95 percent of transfers from Chestertown to Easton are decided upon by emergency room doctors who have examined the patient.

Elsberg said that closing the hospital in Cambridge will produce significant savings for Shore. Beds will be moving from that facility to Easton, she said – why not to Chestertown? Or is the system just cutting patients to justify closing the local facility?

Kozel said the UM SRH board has not approved closing the Chestertown hospital and does not intend to. He said it’s working with the General Assembly to create a plan to keep it open.

Elsberg said the system asks nurses to commute to Easton to get their full quota of hours; why not ask doctors to commute to Chestertown?

Kozel said he has no control over what doctors do. He said they could see several patients in the time they would lose driving here. A few are doing so voluntarily.

Allan Schauber of Kent & Queen Anne’s Rescue Squad explains how the need to take patients to Easton impacts the county’s emergency responders — Photo by Jane Jewell

Allan Schauber of the Kent & Queen Anne’s Rescue Squad said that Emergency Medical teams are impacted by the need to transport patients to Easton. He said there had been emergency calls in Still Pond and Fairlee that very day, one of which was a woman in childbirth who had to be taken out of the county because there is no maternity ward here. All three of the available EMS teams were tied up and unavailable for any serious emergency that might have happened.

Kozel said the lack of a maternity ward was the result of the low birth rate in the local area, with less than 200 births a year. It’s impossible to keep the necessary staff in town and to keep up the level of expertise, he said. “We can’t provide all services to all communities.” He said that emergency rooms have delivered babies, but in general, the medical staff has to follow guidelines.

After several more audience members challenged Kozel on the need to transfer patients to Easton, he said he would ask his medical executive committee to look into the reasons for transfers.

Dr. Peimer said the Chestertown doctors take their jobs seriously. He said the doctors would like to see statistics on transfers out of the hospital. “We want to keep people here if we can,” he said, but the local doctors are working against “a different culture” in Easton. He said doctors have to maintain a comfort zone as far as the care their patients are getting, and the Easton doctors may not be aware of what can be done in Chestertown.

Falcone asked whether appointing Kathy Elliott, the hospital’s director of nursing at Chestertown, as executive director of the hospital, was a wise choice. He said that splitting time between the two jobs would make it difficult to succeed. He said community outreach would suffer.

Kozel said Elliott knows the system and knows what the hospital does. Nurses do 90 percent of what the hospital does, nurses have knowledge that most administrators lack. “Kathy’s got the best of both worlds,” he said. As far as community outreach, “We’re trying to get her acclimated,” he said.

Kent County Commissioner William Pickrum said the state’s budget is controlled by the governor; “We need to focus on him.” He said Gov. Larry Hogan’s constituency is heavily weighted toward rural Maryland, and Kent County should be able to “get him to pay attention to us.”

Fred Kirchner of Tolchester said that economic development is an important issue in Kent County, but “it doesn’t work without a hospital.”

Elsberg said that both sides are in agreement that Kent County should have a hospital. “The infighting is about the details,” she said. “’No beds’ is not on the table.”

Asked if Washington College is on board with preserving a full hospital, Elsberg said college President Kurt Landgraf is fully committed and fighting very hard. Landgraf knows hospitals and politics, she said, as he has previously served on a hospital board in another community for several years.

Sarah Feyerherm, the college’s Dean of Students, said the college counts on having the hospital nearby. She said it is a crucial factor in attracting both students and new employees.

Asked whether the lack of an ICU affects patients’ willingness to have surgeries performed locally, Peimer said it would make some people think twice.

An audience member asked if the lack of an obstetrics facility could be made up by using midwives. Kozel said the hospital needs full-time coverage for obstetrics. He said there are no birthing centers in Maryland, and said there might be regulatory issues behind that fact.

Carl Gallegos, a member of the hospital foundation, said the hospital realized some $7 million from the sale of Chester River Manor, the nursing home. He said the funds are being kept in the community; one of the first expenditures from the sale was a new CT scanning machine. He said the foundation needs the community’s continued support.

Elsberg, summing up the two-hour meeting, said she was encouraged by “the enormous passion the community exhibits.” She said the efforts to retain a hospital, including an ICU, are close to being on the right path. Government support will be needed to complete the community’s vision through legislation. While the local delegates to the General Assembly have done much to support the community, “we need to fire up the engines again,” she said.

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