The following article is derived from a September 27 interview with MaineHealth CEO Bill Caron. The intent of the interview was to obtain Caron’s responses to some of the questions that have been raised since the St. Andrews Hospital closure decision and as such it is presented mostly in his own words. (Part 1 of 2)

Bill Caron was soft-spoken, personable and direct when we met in a conference room at Miles Memorial Hospital. In my six-plus years of reporting, he was the first person who has ever turned the tables on me.

Most interviewees accept the one-way conversation process: this is all about them. But not Caron. Before we even began, he wanted to know who I was and what my experiences have been.

Simple human interest or business savvy? I don't know. Caron attended last week’s task force meeting and the first thing he did at the end of the meeting was introduce himself to task force members.

Caron offered no comments on that community meeting. “I came to listen,” he said after the forum.

Caron has had a long and stellar career in healthcare. He is an accountant by training; he completed his undergraduate degree at Holy Cross and his master’s at Northeastern. He worked for 17 years for the international consulting firm of Ernst and Young in Pennsylvania and Maine.

He served as vice president and treasurer at Maine Medical Center before joining MaineHealth as Vice President for System Development in 1997.

In 2000, Caron was named president and CEO of MaineHealth, the largest integrated healthcare provider in the state.

On long-term changes at St. Andrews

“People on the peninsula need to understand that this isn’t just playing out in Boothbay Harbor,” Caron said. “There is a transformation in healthcare going on across the state and country. Look at Portland, Brunswick, Bangor and Bar Harbor.

“This is happening all over and good people are trying to protect services as close to home as possible. And it is has to be justified economically and from a quality standpoint,” Caron said.

In the 15 years that St. Andrews Hospital has been part of MaineHealth, Caron said there have been “continuous discussions about the role and size of St. Andrews Hospital.” He said the St. Andrews Board underwent an evolution in perspective over the years. At first, the board was reluctant to affiliate with Miles and to adopt a vision of healthcare that was broader than this peninsula, he said.

“From the beginning, we asked to bring the two hospitals together. That resulted in some tough meetings with the St. Andrews' board,” Caron said. Ultimately, the board endorsed the broader county-wide perspective, a decision that some in the community would like to overturn.

“The board has concluded that we’ve now got to make the conversion from a hospital to an ambulatory care system to provide the best care for the peninsula. It’s where the world is going, from inpatient to outpatient.

“Today in small rural communities more than two-thirds of healthcare dollars spent are on outpatient care.  And that’s the right place to be; we don’t want people in hospitals,” Caron said.

Caron said he thinks part of the current dilemma can be attributed to poor communication. “If we had a do-over, what really needed to happen was a year or so of public education, so people had a better context for understanding the decision,” he said. “We should have held community forums; we should have held stakeholder meetings to explain the trends before the decision.”

“We have not fully communicated our vision; that’s our fault and we are working on doing that. The board truly believes that this decision will lead to a better health system for the community; it will be different, but better,” he said.

On the board of trustees

Since the August decision to close St. Andrews emergency room, the St. Andrews Board of Trustees (which is also Lincoln County's and Miles' board) has frequently been at the receiving end of criticism in public meetings and letters. Their integrity and motives have been questioned, and questions about the basic governance structure have been raised.

“These are all volunteers who have put in a considerable amount of time and are trying to do their best for the community. There’s no personal gain, no conflict or vested interest. They sit there in a tremendously difficult world called healthcare. They sit and try to analyze all that and do the right thing for the community,” Caron said.

On paid physicians on the board

Some have suggested that physicians, particularly those employed by Lincoln County Healthcare or MaineHealth, should not serve as board members. Caron strongly disagreed.

“If we’re going to have the best healthcare for people, we need to include physicians in governance, in leadership positions. Physicians are special. They are the only ones who know what care is about. You want physicians shaping what happens,” Caron said.

Caron said healthcare boards have more paid versus independent physicians, because today more physicians are employed by healthcare organizations.

“In this state, outside of Portland, in rural communities, about 80-90 percent of physicians are employed rather than independent. When 80-90 percent are employed, that’s what you’re going to get on boards is employed physicians.”

“People will say (the doctors) will do whatever their employer wants. That hasn’t been my experience. Doctors say what they think in board rooms. They do what they think is right for the patient,” he said.

On closing the ER

“The fact is that 80 percent of the people at the St. Andrews ER are really urgent care patients. Should we feel good they’re being charged for emergency care rather than for urgent care – 5 to 6 times more than if they had gotten the care appropriately? “Should we feel good that some of the people are there because they don’t have access to a primary care physician? That for some, it’s the only way to get access to dental services, because we have a lack of dentists in this state? It’s really an access issue,” Caron said.

“The toughest issue in Boothbay is emergency services. That’s the real challenge. The real challenge is to present a vision of emergency services that is just as good as today. We’re going to do that but it will take some time. We’re going to need technology and invention to be part of the solution and we will get that. I know we will,” he said.

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