Adirondack Health announced the closure Friday, Oct. 7 in an open letter to the community, which was obtained by the News. The letter was signed by multiple Adirondack Health administrators, staff and board members. The letter attributes the ER’s imminent closure to the rising cost of “doing business” as inflation continues and medical supplies become more expensive. Hospitals across the country are experiencing similar increases in costs, with around 33% of hospitals nationwide operating on negative margins, according to an April report from the American Hospital Association.

The demand for healthcare services also hasn’t returned to pre-pandemic levels, according to the open letter. During the first six months of 2022, according to Adirondack Health President and CEO Aaron Kramer, Lake Placid’s emergency department averaged fewer than eight visits a day. In 2019, Kramer said the department averaged 9.9 visits a day.

Kramer said there were 1,394 total visits to the Lake Placid ER in the first six months of 2022. Of those visits, 89% were considered non-urgent or semi-urgent, 9% were considered urgent, and 2% required emergent or resuscitative care. The low patient volumes translated to a $2.2 million loss for Adirondack Health, according to the open letter. So when Adirondack Health officials considered making department cuts to save money amid a $10 million deficit this year, the Lake Placid ER registered at the top of the list.

“To make a long story short, we are spending more money than ever before to provide the same high-quality care to relatively fewer people than ever before,” the open letter reads. “This is a problem, and things are coming to a head.”

The open letter also attributes the closure to staffing challenges that have led the hospital to rely “much more heavily” on workers contracted through third-party staffing agencies. Kramer said that the current lack of available housing in the area “absolutely creates another barrier to recruitment across our primary service area” in Lake Placid as well as in Saranac Lake and Tupper Lake.

“It’s not the only challenge, but it’s a big one,” he wrote in an email on Oct. 7.

Adirondack Health submitted a closure plan for Lake Placid’s ER department to the state Department of Health on Oct. 6, according to Kramer. The plan was supported by a resolution from AMC’s board of trustees and medical-executive committee, which the boards unanimously approved on Sept. 27 and Oct. 3, respectively.

The closure plan is subject to DOH approval, according to Kramer. He said he wasn’t sure how long the department’s review process takes, but he thought it could be up to 90 days before a decision is made about the closure — that’s just over a week before the 2023 FISU Winter World University Games begin on Jan. 12, 2023.

Kramer said Adirondack Health always anticipates “mild-to-moderate” ER volume increases during major regional sporting events, and he said Adirondack Health is working with regional EMS providers and the 2023 Games organizing committee “to ensure there are no major disruptions to medical transport and care” during the Games. He said Adirondack Health is reviewing staffing plans for January to ensure as much preparation as possible ahead of the Games, though he said the Lake Placid ER was already limited in hours — it’s open from 8 a.m. to 8 p.m. — and in equipment like CAT scan and MRI machines.

“Major traumas and other actual ’emergency’ patients are typically transported the 11 miles to Adirondack Medical Center in Saranac Lake anyway,” he wrote.

In the past, Lake Placid’s ER scaled up its hours to 24 hours a day as needed for large-scale events like the Ironman Lake Placid triathlon or for natural disasters.

Kramer said that full-time and part-time staff in Lake Placid’s emergency department won’t be fired — they’ll have the opportunity to work at Saranac Lake’s full-time emergency department. Scollin said that shifting these staff members could reduce AMC’s reliance on “costly” temporary staffing, and he said the move could “augment our capabilities and bandwidth at Adirondack Medical Center” before the 2023 Games.

When asked if Adirondack Health is considering making more department cuts in the future to help further bridge the financial gap, Kramer said “everything is on the table, taking into consideration the total impact to the communities we serve.”

“Adirondack Health is committed to the community of Lake Placid and the Tri-Lakes region,” Kramer wrote. “That commitment includes a responsibility to efficiently manage our resources and protect our long-term sustainability.”

Adirondack Health is partnering with community stakeholders and state government officials to “reimagine” and reshape the Lake Placid emergency department, according to the open letter, and Kramer said this uncertain future is “at the top of our minds.” He said Adirondack Health operates a busy primary care practice out of the Lake Placid Health and Medical Fitness Center, and he said the hospital system “needs to look closely at potential care settings that could bridge” primary care services with emergency services.

“Is that walk-in primary care? Is that some type of urgent care? These are the conversations we continue to have internally and with the state,” Kramer wrote. “Thursday’s submission was the first technical step, as part of a much larger process.”

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Local leaders respond

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Local leaders on Friday expressed a mixture of support for and frustration at the imminent closure, with some saying the closure could negatively impact local volunteer ambulance services that are already strapped for manpower.

North Elba town Supervisor Derek Doty said he’s still waiting on more details about the closure before he makes any “opinionated statements” on it, and Lake Placid village Mayor Art Devlin and Wilmington town Supervisor Roy Holzer echoed his desire for more information — they all wanted to know more about the hospital’s financial state, what led to the closure and the hospital’s plan to reimagine what kind of emergency services could be offered in the future. Doty said that with rural hospitals in trouble all across the country, the community will have to work together to make sure that more services aren’t lost here. He said he has “faith” in AMC’s decision.

“I have faith in all the people at Adirondack Health in coming up with decisions that protect us all,” he said. “It’ll be emotional for many people, but I prefer to help be part of the solution and not be part of the problem, so I’m willing to listen and hopefully help in some manner to guarantee the health of all our residents.”

Wilmington town Supervisor Roy Holzer said that he was “hot” about the closure, and he plans to submit a resolution to the Essex County Board of Supervisors — which he sits on, along with all the town supervisors in the county — opposing the change. He thought that closing Lake Placid’s ER was AMC’s “game plan” when the hospital pared its 24-hour emergency room down to 12 hours. Adirondack Health’s Lake Placid emergency room shifted from a 24-hour model to a 15-hour model in 2014 before moving to its 12-hour model in 2020.

Holzer said he first heard about the closure on Thursday night, and he believed that something could have been done to rally community support for the hospital’s emergency services if local leaders had known earlier that the services were at stake.

“It just boggles my mind,” he said. “And I understand they’re under fiscal stress, but this is where transparency right from the get-go would have probably helped a lot,” he said. “If I was up in Lake Placid I’d be very disappointed (that) our 12-hour ER is now closing, no matter what else they may try to offer down the road.”

A common concern among local leaders was the added drive time for volunteer ambulance drivers who used to stop at the Lake Placid ER and will now have to drive patients to the emergency room in Saranac Lake — that’s another 10 miles or so, one way, tacked onto their trips. Devlin said the closure would have ripple effects on volunteers with Lake Placid’s “already overtaxed” ambulance service with the added hour or so of round-trip drive time to Saranac Lake and back. He said the increased drive time could be hard on the department, which is already struggling to keep up.

Holzer said he spent five of his 25 years with the Wilmington Volunteer Fire Department as an EMT, and he said that every second counts when rushing someone to the ER.

“I can tell you right now, when we had someone in cardiac arrest, you could not get to Lake Placid hospital quick enough (while) doing CPR on an individual,” he said. “So can you only imagine doing another 10 miles of someone from our neck of the woods going into full cardiac arrest?”

Holzer said Wilmington’s ambulance service has a limited number of volunteers as it is. He said the department was already looking to hire more paid EMTs, and with the ER closure, he said, “it’s not realistic to expect that our volunteers are going to spend four hours every few nights going to the Saranac Lake ER.”

Holzer said his town’s ambulance service has already started going to the Elizabethtown Community Hospital emergency room — about 24 miles away — more often since Wilmington ambulances are sometimes sent to the Saranac Lake ER after arriving at the Lake Placid ER.

Holzer said he was “amazed” at the idea that the state might approve the ER closure after investing hundreds of millions of dollars into state Olympic Regional Development Authority-managed winter sports venues ahead of the 2023 FISU World University Games.

“How can we be promoting ourselves as a world-class sports facility and then have the ER so far away?” he said.

When asked how the closure could affect operations during the 2023 Games, Jon Lundin, the Lake Placid 2023 FISU World University Games’ head of communications and media, said that part of the organizing committee’s planning ahead of the Games “includes contingency.”

“We will await the outcome and act accordingly to ensure the well-being of the participants in the Lake Placid 2023 FISU World University Games,” Lundin said in a statement.

According to Adirondack Health’s open letter, AMC is working with the organizing committee of the 2023 Games, along with regional EMS providers and state partners, to address potential disruptions the closure could have on the Games.

“We live in a community that needs good healthcare,” Devlin said. “We also have a lot of tourists and we also have a lot of sporting events, and all three depend on that (healthcare), so we’re going to have to do the best we can to make it work for everybody.”