CHESTERTOWN — The battlefront to keep inpatient beds at the hospital here has shifted to the western shore and former adversaries should be allies, an official of the Easton-based health system that oversees University of Maryland Shore Medical Center at Chestertown told a roomful of people attending a Save the Hospital meeting earlier this month.
Ken Kozel, president and CEO of University of Maryland Shore Regional Health, acknowledged on Aug. 2 that the original plan was to shut down inpatient services in Chestertown.
That was before a hostile crowd of more than 500 people showed up in protest at a meeting in the firehouse two and a half years ago.
Since then, the University of Maryland Medical System, the $4.5 billion conglomerate that oversees Shore Regional Health and its underlings, has promised inpatient care in Chestertown will remain until 2022. After that date, if there is no new legislation or the governor does not step in, there will be no money to keep the hospital open.
Then it will be up to SRH and UMMS to determine the hospital’s fate.
Kozel said SRH is going to “take another swing at it,” hoping to get the General Assembly to support legislation that will create funding sources to assist small, rural hospitals. He said state representatives from Districts 36 and 37 on the Eastern Shore are unified in their support.
SRH has gone on the record as saying there should be inpatient services in Chestertown.
Kozel reaffirmed that Aug. 2, saying SRH has scrapped its original plan of a freestanding medical center here in favor of a specially designated rural hospital.
When considering the geographic challenges of Kent County as to how those relate to access, quality of care and cost, SRH rethought its position, Kozel said.
The drive from Chestertown to the nearest inpatient facility is about 50 minutes to an hour. It’s considerably longer if you are coming from other places in Kent.
“Do we want patients and their families to travel that far?” Kozel asked rhetorically. “I think that answer is ‘no,’ I think our board thinks that answer is ‘no,’ and what we’re trying to do is get the legislators to agree with that.”
“So what could work if we’re saying that a freestanding facility is not good enough and we’re struggling to keep a full-service hospital up and running?”
Kozel said SRH looked at other places in the United States that have faced similar challenges as rural Kent County.
The federal government already has created a category of health care called critical access hospital, which is pretty much what SRH has defined in its white paper, a 46-page document for the five counties of the Mid-Shore that was released in July 2017.
Chestertown’s hospital would be a “short-stay medical unit” with up to 15 beds for minimally to moderately ill patients. The projected length of stay would be about four days. There would be no pediatrics, no obstetrics, no nursery and no intensive care unit.
“Our board has said they can get behind this,” Kozel said. He said the SRH board comprises community members from Kent, Queen Anne’s, Caroline, Talbot and Dorchester counties, the area SRH serves.
Kozel received pushback from audience members and two doctors on the panel.
Anesthesiologist Ona Kareiva, who works in Easton and Chestertown, said an ICU is necessary if the hospital is going to maintain surgical services. There are patients other than surgical patients who require more intensive care, such as those diagnosed with chronic breathing problems, sepsis or having a “heart attack that isn’t going to kill you,” she said.
Internist Michael Peimer of Chestertown argued that a critical mass of services is needed to sustain a hospital. In Chestertown, where services have been taken away, the patient census has dropped and there has been a corresponding downsizing in staff, “starting to put us on a slippery slope essentially to dissolution.”
He said, “I think a small hospital needs to be able to change ... to be able to expand its beds and staffing so that we don’t send patients that we can take care of out of town.”
Kozel said SRH’s mission is not just to run the hospital. It is responsible for keeping patients healthy and out of the hospital.
To succeed in that mission, “we have to get in the employment business of providers ... beginning with primary care physicians,” he said.
In addition to two primary care physicians that have come to Shore Medical Pavilion on Philosophers Terrace, where longtime Chestertown family practitioner Dr. Susan Ross has relocated, SRH is hiring specialists in cardiology, urology and ear, nose and throat, Kozel said.
To compact cost without impacting patient care, the health system has centralized departments such as human resources and information technology, he said.
Someone from the audience said, “I don’t understand why you have to make changes when the hospital (in Chestertown) is in the black.”
Kozel responded, “We have to think of ourselves as one system. ... There’s no advantage to having one hospital better over the other, except with regard to quality and costs.”
Meeting moderator Margie Elsberg, who has been a champion of the Save the Hospital movement from the beginning, listed the attributes of the hospital in Chestertown, which include 31 beds, an established track record of operating in the black and it is less costly to operate than the hospitals in Easton and Cambridge.
Given all that, she said to Kozel, “It looks like you’re going to find a way to close it.”
“That’s not our intent,” he said.
A new voice was added to those stumping to keep the hospital open. As vice president of student affairs, Sarah Feyerherm oversees health services at Washington College.
“We really count on having a hospital close by. We rely on the hospital,” she said of the facility that is on property that abuts the college.
Having a hospital nearby also is important for the college in its recruitment of young employees, Feyerherm said.
Kay MacIntosh, economic development and marketing coordinator for the Town of Chestertown, reminded Kozel the area is trying to grow and the University of Maryland Medical System is an important part of the plan.
“But it can’t be one way. The community is hungry to hear about investment here,” she said.
Audience members quizzed Kozel about hospital-to-hospital transfers that appeared to be arbitrary, the refusal of some doctors in Easton to come to Chestertown and those doctors’ ignorance of the services available in Chestertown.
Concerns also were raised about the newly appointed executive director of the hospital tasked with continuing also as the full-time director of nursing.
“There’s no way she can do both jobs,” said Garret Falcone, executive director of Heron Point retirement community.
Kozel said he thought Shore Medical Center at Chestertown would benefit from having registered nurse Kathy Elliott as the executive director because of her nursing background and because she is a home-grown product who has come up through the ranks.
“She is going to thrive in this (new) role. She is committed to this hospital and the community,” Kozel said.
He described Elliott as an advocate for the hospital and an advocate for Chestertown.
Answering another question from the audience, Kozel said proceeds of the sale of the UMMS-owned Shore Nursing and Rehabilitation Center in Chestertown, estimated to be $7 million, is to be spent locally.
Chesapeake Bank and Trust CEO Glenn Wilson, who is president of the United Way of Kent County, said stakeholders working together gives them the best chance for retaining inpatient services here.
“I think the real issues are in Annapolis and Baltimore. ... It gets down to does Maryland want to support rural health care,” Wilson said as the nearly two-hour meeting was coming to a close. “I think our efforts have to be to work together and put pressure on the legislators.”
William Pickrum, president of the Kent County Commissioners, agreed that political support is key.
By law, the governor controls the money, Pickrum said.
“It’s important that the governor crafts his budget with Chestertown in mind,” Pickrum said. “The governor has to step forward to say he is making rural health care a priority.”