It was standing-room only at the Opera House at Boothbay Harbor March 20 for Lincoln County Healthcare’s first community meeting since it announced changes at St. Andrews Hospital last August.

Dr. Mark Fourre presented the healthcare organization’s vision for St. Andrews, followed by an hour of questions and answers. On occasion, the audience voiced its skepticism, there were a few outbursts of applause for both sides of the issue, and the tone throughout the evening was civil. See below for video excerpts of the meeting, courtesy of BRCTV.

Fourre outlined a shift in national and local healthcare emphasis to a patient-centered, team model of primary care. The goal is to keep people out of hospitals and emergency rooms through regular, coordinated attention to health conditions and wellness.

“When you change your practice to a medical home model, it costs less overall, because there are less mistakes and care is better, and patients do better,” Fourre said.

Fourre emphasized that most of the existing services would remain at St. Andrews and that licensing for new services, such as a retail pharmacy, beds for post-acute, long-term and end-of-life care, was being sought from the state.

The community’s greatest concern has been the change from a round-the-clock emergency department to a 10-12 hour daily urgent care facility and the resulting loss of St. Andrews’ hospital license.

“The people of the region have indicated on an overwhelming basis that they want the ER open 24/7. Their concern with the urgent care center is it will be closed for 12 hours a day. Is there a possibility of working out a compromise,” Boothbay Harbor resident Dan Jameson asked.

Fourre said the low patient volume and lack of backup physicians and specialists available at St. Andrews, particularly at night, make for an “uncomfortable and isolated” situation for emergency room doctors dealing with a true emergency.

“If you’re one of those patients with your life in the balance you need a team to take care of you,” Fourre said.

He said a critically-ill patient is better off in an ambulance attended by a paramedic en route to a bigger hospital than at St. Andrews emergency room with its small staff. He and CEO Jim Donovan outlined their commitment to working with local communities and the ambulance service to improve pre-hospital emergency care.

Boothbay Harbor resident Margaret Perritt asked about urgent care costs and the future of the Family Care Center (FCC). “Is that facility large enough to have enough primary care doctors for everyone on the peninsula or are we going to have to go off the peninsula to get our primary care as well?” she asked.

Fourre said urgent care costs would be substantially less than emergency care, which would reduce out-of-pocket expenses for individuals and help local employers who offer health insurance. He said the FCC had the space to support more physicians but hiring additional doctors was dependent upon patient volume.

Southport resident Leigh Sherrill asked if the FCC would be open evenings and Saturday. Fourre said that they were moving toward that goal but made no firm commitment to a time frame. He said expanding pediatric office hours had reduced emergency room visits.

Both Fourre and Donovan said the organization had learned it had to do a better job of informing the community.  “We’ve learned we need to do more, make more of an effort to keep people informed. We will do that,” Donovan said.

Boothbay Selectman Chuck Cunningham asked if LCH had looked into the possibility of ambulances bringing patients to the urgent care center. Fourre said that would not be the case and that the most-critically ill patients were better going directly to another hospital where resources are greater.

“Is this going to go away tomorrow, next week, next year? What kind of insurance do we have as a community that you are going to fulfill all of these grand ideas,” Dorothy Ferrell asked. Fourre said services would remain but only if people used them.

Rep. Bruce MacDonald asked MaineHealth to work with local people to keep the ER and hospital open another year or two. “I fear if you continue down the round you are going … that you will be dragging us by the feet to the future that you see. I think you could get our cooperation if you worked with us,” MacDonald said.

There was no response to MacDonald.

There were still several people hoping to ask questions when Reverend Mary Jo Zimmerli closed the meeting at approximately 8:15, shortly after the planned 8 p.m. ending.

No additional community meetings are scheduled at this time.

Dr. Fourre explains the limited resources at St. Andrews:

Boothbay Harbor resident Dan Jameson asks for compromise to keep the hospital open:

Jim Donovan answers poll question:

Bill Caron responds to Tom Hagan's assertion that St. Andrews has been profitable and LCH is misrepresenting finances:

Laurie Perkins questions the accountability of the Board of Trustees:

Bruce MacDonald:

Sue Mello can be reached at 207-844-4629 or sumello@boothbayregister.com.