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.

It was also inaccurately stated that stroke victims should bypass AMC. Stroke victims are treated by protocol emphasizing rapid diagnosis and treatment with clot-busting agents under the supervision of a neurologist via telemedicine available 24/7.

Certainly, if the patient has a brain bleed and requires neurosurgical expertise, then transport to Fletcher Allen is appropriate. This is the rare patient, who still needs AMC for the initial radiographic diagnosis. Finally, this writer, a vascular surgeon, can provide surgery in cases of stroke due to plaque in the carotid artery.

Excellent and thought-provoking points were made. For example, the concern regarding the anticipated stress on the EMS system deserves careful consideration.

However, I was appalled by the meeting’s tone and by the implication that the administration and board may not be acting in the best interest of the population served. The administration and the board, which volunteers countless and apparently thankless hours, are bound to preserve the institution and fulfill its mission statement. In discharging this responsibility, tough decisions need to be made. Neither the administration nor the board derives personal gain from making these decisions.

Every American needs to realize the runaway costs of health-care must be reduced and that patients, administrators, and physicians will be impacted.

We, as a community, must adapt to the national budgetary constraints and respect those who in good faith are attempting to maintain high-quality care in the context of new economic realities. If the board does not take its fiduciary responsibility seriously today, there will be no hospital tomorrow.

Having observed variable health-care delivery from Britain to Haiti, it distresses me that the adage “familiarity breeds contempt” manifested itself during the meeting.

Adirondack Health, which does not belong to any specific town, but rather to all individuals served, is an unusually well equipped and staffed facility. I brought my mother from Westchester County to AMC for major surgery recently. I know what the superb nurses and physicians of AMC do every day.

Some medical staff at AMC, myself included, have generally supported the proposed conversion. However, the upcoming discussion may raise further legitimate concerns and reveal opportunities for compromise acceptable to all. I trust that future talks will be civil and better informed of the weighty issues.

Dr. Claude Roland is a member of the Department of Surgery at Adirondack Medical Center and CVPH Medical Center and is medical director of the Wound and Hyperbaric Treatment Center.