LAKE PLACID - While they understand why it's happening, some local elected officials, residents, nurses and emergency medical service providers say the loss of an around-the-clock emergency room here is still a tough pill to swallow.
Adirondack Health announced May 5 that the state Department of Health has approved its plan to make the ER at Adirondack Medical Center's smaller Lake Placid hospital a 15-hour-a-day operation, the first-ever state-approved part-time ER in New York. Starting June 16, it will be open daily from 8 a.m. to 11 p.m.
"I'm sorry to see it happen, but I understand why they had to make that decision," said Lake Placid Comfort Inn and Howard Johnson's restaurant owner Ron Butler.
Butler is one of many Lake Placid residents who spoke in favor of keeping the hospital's ER open 24-7 during a series of contentious public meetings last year, after Adirondack Health proposed converting the ER to a part-time urgent care center.
"If we save one life a year, it is worth it," Butler said at the time.
After getting battered at those hearings, Adirondack Health dropped the urgent care proposal and instead pursued a part-time ER. Butler said May 7 that he's still concerned about the ER being closed overnight, saying "an emergency can happen anytime," but he noted that Saranac Lake has an around-the-clock ER just down the road. The two AMC hospitals are 11 miles apart.
"They have everything there," Butler said. "The chances are that you would have to be transferred to Saranac Lake anyway if you have something serious."
That's one of the reasons why Adirondack Health pursued a part-time ER. Hospital officials have also said the volume of patients at the Lake Placid ER doesn't justify keeping it open and that it isn't equipped with modern medical technology. It's also a cost-cutting move; Adirondack Health President and CEO Chandler Ralph said switching to a 15-hour ER will save about $600,000 a year.
Bruce Barry, an Adirondack Health nurse who works in both hospitals' emergency rooms, is one of several people who questioned some of the organization's rationale, including a claim that the Lake Placid ER was losing $500,000 a year. He said May 7 that Adirondack Health officials never provided information to support that number.
"I still think the basis for all this is inaccurate," he said.
Barry said there's "a lot of grumbling" about the overnight closure of the ER among his fellow nurses.
"From our standpoint, it's always been about patient safety," he said. "We just feel this is not a great situation to be moving into. We'll see how it plays out."
Barry also said the state's approval of a part-time ER in Lake Placid waters down the definition of an emergency room and opens the door to other emergency rooms around New York cutting back on their ER hours.
State Health Department officials said that no other part-time emergency department applications have been submitted to date, but if they are, they will be considered.
The town of North Elba, the village of Lake Placid and the state Olympic Regional Development Authority had all opposed Adirondack Health's original plan to shift from a full-time ER to a part-time urgent care. A part-time ER has been viewed as a compromise.
"I'm not going to mislead you into thinking the town board wholly endorses the move to a part-time ER, because we certainly would have rather had a 24-hour ER," North Elba Supervisor Roby Politi said Wednesday. "But given the fact that the Department of Health has endorsed the Board of Trustees' decision, a 15-hour ER is more palatable than a 12-hour ER or an urgent care."
Politi said the town had set aside roughly $20,000 in its budget this year for additional emergency medical personnel to be on hand at the Lake Placid Volunteer Ambulance Service garage during the hours the ER is closed.
LPVAS President Larry Brockway Jr. acknowledged the service is in talks with the town about how to use that funding, but he said he still has concerns about not having an around-the-clock ER in the community.
"I understand on their financial end they have to do it," Brockway said. "I just hope it doesn't impact the quality of care for the residents of Lake Placid and North Elba, and the tourists."
Brockway said he expects the overnight closure of the ER will lead to more calls for the ambulance service, which could be taxing on its volunteers. Instead of people showing up in person at the Lake Placid ER for medical help in the middle of the night, they'll instead call for an ambulance to get to the Saranac Lake ER.
"In order to pick somebody up from their home, go from Lake Placid to Saranac Lake and come back, it takes about an hour-and-a-half," Brockway said. "So if you do two calls from midnight to 6 a.m., that's three hours out of your night. And if people are volunteering their time and have to work the next day at 7 or 8 a.m., I believe that's where we're going to have a problem keeping the volunteers on our side."
Brockway also said he'd prefer the shift to a part-time ER took place after the busy summer season.
In Wilmington, local leaders and EMS providers say they're also concerned about not having the Lake Placid ER open 24-7.
"Where it's going to hurt us is at night," said Lou Adragna, chief of Wilmington Fire and Rescue. "We'll have to travel farther, either to Saranac Lake or Elizabethtown. It's going to end up taking our volunteers out of service in the middle of night longer on calls. Our turnaround times will be double."