May 10, 2013

In My Opinion: Civil discussion of AMC plan needed

As revenues to Adirondack Health diminish from improved outpatient services and decreasing insurance reimbursement, the cost of the low-census Lake Placid Emergency Department may not be justified.

Recently, Adirondack Health presented the case for converting the Lake Placid Emergency Department to an urgent-care center with anticipated $950,000 annual savings.

 I wish to comment on several points raised at the May 1 meeting.

The financial wisdom of creating a wound center was raised. Implied was that had Adirondack Health not embarked on this project, there would be sufficient funds for the Lake Placid Emergency Department.

There had been a clinical need for such a center, given a high incidence of wounds and the inability of practitioners to devote the time required to care for them appropriately.

The board had decided to invest resources in the center after financial analysis, which had accurately predicted the center would generate revenue. The wound center was a sound clinical and financial decision.

It was stated that trauma patients should not be transported to Adirondack Medical Center in Saranac Lake but rather to Fletcher Allen Health Care or to CVPH Medical Center.

As an instructor of Advanced Trauma Life Support and a surgeon who has managed trauma at AMC and CVPH, I need to correct this misconception. A basic principle of trauma care is to render appropriate care as rapidly as possible. Most trauma patients are best served by transport to AMC in Saranac Lake staffed by qualified surgeons.

It is the responsibility of the Emergency Department staff and surgeon to determine if a patient should be treated locally or if the injuries demand a Level I trauma center, such as Fletcher Allen.

The decision to transfer is based on internationally accepted guidelines. Examples of injuries best treated at AMC are splenic injuries or penetrating trauma, where delay could be fatal. Over the years, AMC has successfully managed some highly complex trauma cases.

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