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Grateful to have at least a daytime emergency room

May 15, 2014
Editorial , Lake Placid News

A 15-hour-a-day emergency room is as good as Lake Placid can realistically expect these days. Yes, it would be nice for the community to have its ER stay open overnight, but that's an expensive service (hospital officials expect the reduction to save $600,000 a year), it's underused (patients down 22 percent since 2009, according to the hospital), and isn't so necessary anymore.

There's a bigger, more robust ER 11 miles down the road in Saranac Lake, also owned and run by Adirondack Health, and Lake Placid ER patients are often sent there anyway. The Lake Placid ER can be kept open overnight for the big events when it matters most, such as the Ironman triathlon. For other times, with the increased quality of ambulance care these days, there's not much Lake Placid's ER can do to save a person's life that a modern emergency medical crew can't.

We all need Adirondack Health to stay healthy. The price to keep Lake Placid's ER open 24/7 is to threaten the network's stability, and that's not worth it.

Downgrading this ER was not Adirondack Health officials' first choice for budget cuts; it was more like the fourth wave, after cutting nursing home beds and two rounds of layoffs. That's probably because they knew Placidians would fight it, and Placidians did.

And Adirondack Health officials listened, and changed their plans accordingly. They came up with a compromise: canceling a conversion to an urgent-care clinic and instead asking New York state to change its rules to allow an ER to be open fewer than 24 hours a day. They went to great pains to lobby for that, first to the state Legislature and then to the Department of Health, and in the end, they changed state policy just for this village of 2,500 people and its many visitors.

For that, we're thankful to Adirondack Health and New York state. There are probably other, bigger New York communities with fewer health services that aren't treated so preferentially.

Adirondack Health has to cut somewhere. Its patient count is down, in large part because a recent emphasis on prevention is keeping people healthier. Adirondack Health got ahead of the curve on this trend through the Adirondack Region Medical Home pilot project. It was the right thing to do, both for people's well-being and to lower health costs for the nation as a whole, but it meant sacrificing hospital revenue for the common good.

A few years before that, Adirondack Health made another major community sacrifice in buying the Uihlein and Mercy nursing homes from the Sisters of Mercy. That has cost them a lot of money, too, but otherwise local people would have nowhere within an hour's drive to house our loved ones when they're old and frail.

You'd think the national government would reward, or at least not punish, a health network that took one or two for the team like that, but no. Congress' fiscal cliff and sequester battles cost Adirondack Health $1.7 million in early 2013.

Then again, the federal government has to cut, too. The national debt is almost $17.5 billion and growing, a nasty legacy to leave our children and grandchildren, so we'd better get used to doing without some of the services we've enjoyed.

But - and this is a big but - the sacrifice shouldn't all have to come from public services like ER hours and nursing home beds. The wealthiest among us have a responsibility to the nation and communities that have been so good to them. They must give their share, which is pretty big.

Adirondack Health is by no means out of the woods, financially, and we think its next six-figure cut should be to another area of inefficient spending - executive pay. This nonprofit corporation hires a for-profit company, Health Tech Management Services, for more than $600,000 a year to employ President-CEO Chandler Ralph and to provide other services like group purchasing and consulting. Ms. Ralph has refused to disclose how much of that fee is her pay.

Either she or the Adirondack Health Board of Trustees should disclose it and then, if it's substantially high, reduce it - and do the same for other high-paid officials. In 2010, Adirondack Health had 37 people in the $100,000-plus salary range, the Press-Republican newspaper reported last year.

Yes, these may be typical wages nationwide, but that's part of the problem. Our nation needs hospital boards courageous and moral enough to cut from their executives if they're willing to cut from their patients. Instead they've collectively let the market for executive salaries spin out of control.

Have these executives earned their pay? Quite possibly. Ms. Ralph, for instance, has done a good job guiding and managing what is arguably the area's most important institution and what is certainly its largest private employer, with roughly 900 workers. But Lake Placid has earned its ER, too. Its residents invested heavily in Placid Memorial Hospital for decades, and when they merged it with Saranac Lake General Hospital to form Adirondack Medical Center, they gave Placid Memorial's $5 million endowment, the Redfield Trust, to the partnership. A contingency of that deal was keeping the ER open in Lake Placid.

Now that sacrifice is required, it's being taken out of that ER, laid-off staff and would-be nursing home residents. That's inevitable, given the big picture, but top executives can afford to give, too. Granted, that kind of thing never happens in America today, but it could, and it should. That would truly show a commitment to the community's health and well-being.



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