In the first public meeting held after Lincoln County Healthcare announced its plan to convert St. Andrews Hospital to an ambulatory care center, Rep. Bruce MacDonald outlined a legislative proposal to create a community hospital administrative district for this peninsula. MacDonald said last week that proposal is no longer the major direction of his task force work group.

Instead, MacDonald and his work group, which includes former St. Andrews board trustee Tom Berry and former St. Andrews Hospital CEO Peggy Pinkham, are looking first to develop a financially-viable alternative to Lincoln County Healthcare’s plan.

MacDonald said this new task force plan will serve as a basis for discussing healthcare with the St. Andrews Board of Trustees. MacDonald and company hope they can convince the board to retain the critical access hospital and emergency department in Boothbay Harbor.

The community hospital concept

MacDonald said the community hospital idea is attractive because its governance structure allows public choice of hospital board members and public access to the Board’s meetings, minutes and decision-making. But he adds that it is not the only viable option for hospital governance.

Most healthcare organizations in Maine, including Lincoln County Healthcare, are private nonprofit corporations. Although these nonprofits are subject to some public disclosure, the public disclosure standard is lower than for public entities, such as town boards and public school committees.

A community hospital district could only be formed if approved by a majority of residents in each community. The district would have the power to buy and sell property, issue bonds, enter into contracts and levy taxes. Its budget would be presented to town voters annually.

MacDonald said Mayo Hospital in Dover-Foxcroft, a community hospital with 12 member communities, has not had to levy taxes to stay afloat. But there are significant differences between Mayo Hospital and St. Andrews. Mayo is about three-plus times the size of St. Andrews Hospital in terms of patient volume.

It also doesn’t face the competition St. Andrews does. Mayo’s closest comparable hospital, Redington-Fairview in Skowhegan, is about an hour away. Considering St. Andrews Hospital’s long history of financial difficulties, it seems taxation could be necessary to balance a local community hospital’s budget.

Can it be achieved here?

MacDonald’s legislation, if submitted and passed, would allow a community hospital to be created on the peninsula, but it would not convert St. Andrews Hospital to a community hospital. Currently, there does not seem to be any regulatory process that would force the existing board to change its governance structure.

In an interview October 11, MacDonald said he did not know how a forced conversion of local healthcare could take place. He said he has not yet signed and submitted a community hospital bill for this legislative session. “I will submit the bill when and if the time is right,” MacDonald said.

When it comes to Maine hospitals, the state’s Department of Health and Human Services has oversight and regulatory authority over everything from hospital beds to hospital mergers. How any group of individuals without hospital buildings, staff or expertise would have standing in that regulatory environment is not clear.

The task force’s still unannounced legal plans may provide additional information in this matter. Some task force volunteers have also begun discussions with other healthcare organizations, looking presumably for a different partner for St. Andrews Hospital.

The fact that St. Andrews Hospital’s management, staff and programs no longer exist as a distinct entity makes any proposal to return the hospital to stand-alone status a bit like “putting Humpty Dumpty back together again” MacDonald said.

Sue Mello can be reached at 844-4629 or sumello@boothbayregister.com.