LAKE PLACID - Local residents aired their concerns and questions about the proposed conversion of the Adirondack Medical Center-Lake Placid emergency room to an urgent care center at a well-attended community meeting here Monday night.
About 80 people filled a second-floor dining room of Nicola's restaurant on Main Street for what was described as a community organized informational meeting. It took place two days before the first of two public meetings Adirondack Health has slated on its controversial proposal.
Bruce Barry, an Adirondack Health emergency room nurse who lives in Lake Placid, outlined what's known about the proposal during a half-hour presentation. He said he was speaking as a concerned citizen, not representing Adirondack Health.
Much of the first half of Barry's talk repeated what Adirondack Health officials have said about the proposal. They've 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 are taken to the Saranac Lake ER so they can have access to advanced imaging and surgery. Although the urgent care clinic wouldn't be open around the clock and would have fewer staff members, the organization has said it would provide the same level of care. The conversion would also save the hospital an estimated $915,000 a year.
Barry outlined some "contended facts" about the change. He said the Lake Placid ER is an important triage facility and that some patients shouldn't be quickly bypassed to Saranac Lake.
"Someone who's having chest pains, who is having heart palpitations, who is having difficulty breathing - those patients need that immediate care and immediate stabilization before they move on," Barry said. "Critical care does still happen in Lake Placid. I want to dispel that myth that's out there that Lake Placid is just a Band-Aid station. That's not true."
Adirondack Health officials have said the Lake Placid ER saw 4,500 patients last year, a number that's steadily declined in the last five years. But Barry said "that may not be the real number" because many patients transferred from the Lake Placid hospital to Saranac Lake are not accounted for in that total.
Although Adirondack Health reported 373 ambulances stopping at the Lake Placid ER last year, Barry said that number is actually 585, based on information from local ambulance providers.
"Deception," one person said from the audience.
Barry and other speakers also questioned public statements by Adirondack Health officials that the Lake Placid ER is losing $500,000 a year.
"It's my belief that the ER is not losing money for the organization," Barry said. "I haven't seen exact numbers. They won't share them with us."
"If they're going to claim a $500,000 loss, show the $500,000 loss," said Bill Conley of the New York State Nurses Association, which represents nurses at all Adirondack Health's medical facilities. "Let's decide on a set of numbers and agree to them."
Barry noted that Adirondack Health's two nursing homes - Uihlein Living Center in Lake Placid and Mercy Healthcare Center in Tupper Lake - are bleeding money. They've lost $11 million since 2008, largely because of shortfalls in Medicaid reimbursements.
"We want those nursing homes to stay open," Conley said.
The conversion of the ER could have a big impact on local ambulance providers because they can't bill patients' insurance companies if they take them to an urgent care center, Barry said.
He also noted that an urgent care center, unlike an emergency department, isn't bound by a federal law that says a patient experiencing an emergency medical condition must be treated regardless of ability to pay.
Adirondack Health officials have said the urgent care center would be open 12 hours a day. They've also said it could have flexible hours based on community need or if there are big events in town, like the Ironman triathlon.
"Who are we catering to there?" Barry asked. "I understand that we're catering to tourists and visitors, but I hope we have the same love for our own community members.
"And the concierge service they're talking about, sending people to hotels to check on people and do house calls? I hope you, as a local community member, get the same consideration when you call in the middle of the night."
Lisa Keegan, an Adirondack Health ER nurse, said she isn't comfortable working in an urgent care clinic that wouldn't be required to have as many nurses on duty.
"Dr. (John) Broderick (Adirondack Health's chief medical officer) said we're going to do the same thing, but we are going to have less staff," she said. "I don't think I can adequately do that, and I don't want to take a chance on anybody's life."
"It's not going to be the same level of care, despite what has been stated," Conley said.
Barry said he thinks the transition to urgent care is a "buffer" for the community "because if they came in and said, 'We're going to close it altogether,' they'd get more of a kickback.
"An urgent care has more of a cushion to it, and who knows if it's going to survive or not?" he said. "What if it fails? Then we don't have anything."
Life or death?
A young boy named Cooper, who has a severe peanut allergy, told the audience that if he goes into anaphylaxis and the Lake Placid ER is closed, he wouldn't be able to make it to the ER in Saranac Lake in time.
"It's a matter of life or death," he said. "If something happens to me and the (Lake Placid) ER's not there, I might not be able to survive."
"If we save one life a year, it is worth it," said Lake Placid resident Ron Butler.
"My mother and my brother would not be here today if not for the Lake Placid ER," said another woman.
One resident asked why Adirondack Health would create a second urgent care center in Lake Placid.
"We already have one," she said. "I've never seen a waiting line out the door for Mountain Medical."
Barry encouraged people to share their concerns with town and village board members, several of whom attended Monday's meeting, and members of Adirondack Health's board of trustees, which will decide whether to approve the proposal. If it does, the conversion to an urgent care clinic will be subject to review by the state Health Department.
An option the town of North Elba has on the Lake Placid hospital property would also come into play, Barry said. Under an agreement crafted in 1990, at the time Placid Memorial Hospital merged with the General Hospital of Saranac Lake to form Adirondack Medical Center, the town can buy the property for $10 if round-the-clock emergency room services are discontinued in Lake Placid.
A public meeting on the proposed conversion of the Lake Placid ER will be held at 7 p.m. May 8 at the Lake Placid Centerfor the Arts.