Easton doctors oppose relocation of behavioral health beds to Chestertown

University of Maryland Shore Regional Health is proposing to relocate inpatient behavioral health beds and services from UM Shore Medical Center at Dorchester to UM Shore Medical Center at Chestertown.

EASTON — Citing the burden of added travel and staffing difficulties, among other obstacles, a group identifying itself as Save Easton Psychiatry Unit is pushing back against University of Maryland Shore Regional Health’s proposal to relocate inpatient behavioral health beds and services from UM Shore Medical Center at Dorchester to UM Shore Medical Center at Chestertown.

The medical director of the psychiatric unit, medical providers who work on the psychiatric unit and president of the medical staff of UM Shore Regional Health Dr. Bruce Helmly have signed a letter to the Maryland Health Care Commission opposing the move. They believe the better option is to relocate the inpatient unit and outpatient clinic to Easton, a more centralized location to the patients it serves.

Meantime, Easton-based Shore Regional Health’s board of directors remains committed to the relocation of adult inpatient behavioral health beds to Chestertown and leaders of the Save the Hospital campaign in Chestertown support the move.

UM Shore Regional Health announced in a July 1 news release that it would prepare a modified Certificate of Exemption (COE) application to the MHCC to move inpatient behavioral health beds from the hospital in Cambridge to the hospital in Chestertown.

The health system board in August approved submitting an application to the MHCC to relocate the inpatient behavioral health beds and affirmed its commitment at its September meeting, said Patti Willis, a spokesperson for UM Shore Regional Health.

On Sept. 6, UM Shore Regional Health requested a Certificate of Need exemption from the MHCC to change the proposed 2021 relocation site of the soon-to-be-closed Cambridge inpatient psychiatry unit from Easton to Chestertown.

A week later, Dr. Eric Anderson, chairman of the Department of Psychiatry for UM Shore Regional Health, sent a four-page letter to the MHCC opposing the move. Signing onto the letter were Dr. Justin Wade and two other mental health providers of UM Shore Regional Health.

They cite the burden of travel for patients and staff and the lack of community supports for mental health patients as reasons why Chestertown is not the desirable location for relocated inpatient psychiatric beds.

“We firmly believe that such a move will be disastrous for our patients, their loved ones, and the community we serve,” they say in their letter.

In a news release, Keep Psychiatry Unit in Easton says UM Shore Regional Health insufficiently sought public comment on the requested site exemption, did not consult any of the local mental health agencies on the move and did not honor the wishes of the Cambridge hospital psychiatry staff who want to keep the new site close to the patients, i.e. in Easton.

Opponents of the move say from July 2018 until April 2019 the emergency behavioral health response team saw 1,981 patients in all UM Shore Regional Health facilities. The breakdown: 2.1% were from Queen Anne’s, 4.9% were from Wicomico, 14% were from Kent, 39.6% were from Dorchester and 44.3% were from Talbot. Roughly 25% of those 1,981 patients were referred for admission to the inpatient mental health unit located at UM Shore Regional Health at Dorchester.

“Movement of services to Chestertown will remove easy access of those services from over 80% of the population base that utilizes the services,” opponents of the move said.

Many of the patients are without transportation, which could mean additional costs for them or an obstacle to their seeking treatment.

The argument also is being made that the proposed movement of mental health services will place an enormous burden of travel upon existing, experienced, difficult-to-obtain staff who currently work in the mental health department. About 75% live in areas where the move would add a minimum of one hour each way to their travel time if services were relocated to Chestertown and 75% of staff who responded to a survey indicated an unwillingness to travel to Chestertown if services were moved there, according to the Dr. Anderson-penned letter sent to the Maryland Department of Health and Mental Hygiene.

“Based upon this survey it is clear that a move to Chestertown will likely result in the loss of a majority of staff, necessitating the hiring of a substantial number of qualified and difficult-to-find mental health workers to staff a new facility,” the letter states.

In a Sept. 25 email to editors of newspapers on the Mid-Shore, Dr. Wade, a staff psychiatrist with UM Shore Regional Health, said, “It is a disservice to those requiring acute inpatient mental health care to move this unit 45 minutes-2 hours away from the primary population using it, in a laudable, but misplaced effort to help Chestertown Hospital, and perhaps save money on care for psychiatric patients.”

He said there is only one mental health prescriber (psychiatric NPs or psychiatrists) in Kent County, while four to six are needed to sufficiently staff a unit.

“It is extremely difficult to recruit prescribers to Easton, Cambridge, and Salisbury — but perhaps impossible to do so in Kent County. Having worked as a psychiatrist on the Eastern Shore for 12 years, I can tell you the hospital WILL NOT be able to recruit physicians to work in Chestertown. Even in Dorchester the hospital has only been able to recruit a single psychiatrist in the last 5 years. Washington College cannot recruit a prescriber to work with there [sic] students for years despite concerted efforts,” Wade said in the email.

He added, “I would ask you to draw a parallel. Could you see Shore Health sending all neurology, cardiac, or orthopedic patients to be cared for in Chestertown? Why would the hospital then be doing this to all psychiatric patients? Are mental health patients less valued in some way to be transported hours from home? How would these other options be any different to help support Chestertown Hospital? Does it make sense to transport psychiatric patients from our local medical services hub and geographical center away from their mental health providers, family, and friends, to an even more rural setting that lacks psychiatrists, nurses, social workers, and mental health technicians?”

“We appreciate the geography issue,” Dr. Michael Peimer, vice president of the medical staff at the Chestertown hospital, said in a telephone interview Tuesday night. “This is something we’ve been experiencing for years,” with the shrinking of staff and services locally as they are transferred to UM Shore Regional Health facilities in Easton.

Peimer, an internist who has been practicing in the Chestertown area for 16 years, has been an active member of Save the Hospital campaign here since its founding in January 2016.

He said providing cost-efficient health care is one of the biggest challenges in a rural area.

“There’s no answer that doesn’t put stress on someone,” said Peimer.” But this is a regional system and the system cannot be based solely in Easton. … The door swings both ways, and it can’t always swing in their favor.”

He added, “Where there’s a give someplace, there’s a take someplace else. We think stabilizing inpatient services in Chestertown (with the addition of behavioral health beds) justifies this.”

Peimer said he is embracing the confidence that UM Shore Regional Health has shown by proposing a move to Chestertown — an investment of money, planning and proper staffing that he believes was made after due diligence.

“I’m still optimistic,” he said Tuesday.

Ken Kozel, the CEO of UM Shore Regional Health, said the board is “very committed to the provision of inpatient and robust outpatient behavioral health services for the five-county region we serve. Our intent remains to insure the availability of regional inpatient adult behavioral health beds by providing these serves in Chestertown, and to continue to provide Intensive Outpatient and Bridge Clinic services in Dorchester County and expand those services to Talbot and Kent counties as well, as part of this transition.

“While we recognize complex changes like these rarely result in unanimous community support, we endorse the MHCC process which allows for all voices to be heard on applications and we support that transparency and engagement from those who care deeply about health care access.”

Willis said if the MHCC green lights the move, construction of the inpatient unit at UM Shore Medical Center at Chestertown would begin this winter and the unit would open in the summer of 2021, “when the inpatient beds at the Dorchester hospital are relocated and the new freestanding facility opens in Cambridge.”

If the MHCC approves the relocation of acute adult inpatient behavioral health beds to Chestertown, UM Shore Regional Health will need to modify the Certificate of Need application that is on file for the new Easton hospital.

“We will file that modification, if needed, when we know the outcome of the behavioral health decision,” Willis said in an email. “Either way, we anticipate breaking ground on a new hospital for Easton by the end of 2021.”

Kent County residents have long been concerned that UM Shore Regional Health and parent company University of Maryland Medical System are seeking to close the Chestertown hospital and like, the Cambridge facility, move to a freestanding medical center model, with inpatient services being transferred to a new regional hospital in Easton.

Kozel confirmed last summer worries that inpatient services at the Chestertown hospital were going to be terminated.

Prior to Kozel’s admission though, state lawmakers passed a bill requiring inpatient services remain here through 2020. Following a groundswell of community support, UM Shore Regional Health agreed to extend that through 2022 while moving forward with plans to build the new hospital in Easton.

The General Assembly adjourned this year without passage of a bill crafted to preserve inpatient services at UM Shore Medical Center at Chestertown. After sailing through the state Senate with no opposition, a bill sponsored by Sen. Steve Hershey, R-36-Upper Shore, never made it to the desk of Gov. Larry Hogan.

Senate Bill 1018, which would establish a Chestertown Rural Health Care Delivery Innovations Pilot Program through the Maryland Department of Health, was held up in the House of Delegates Health and Government Operations Committee without being brought to the full floor for a vote.

The Save the Hospital campaign of local doctors and community members spent the final days of the 2019 legislative session pushing for adoption of the Hershey-sponsored bill that would create a pilot program for rural health care delivery in Chestertown. Direct oversight would be by the state, not Easton-based UM Shore Regional Health, and there would be a local advisory committee that would include the county health officer and two physicians with privileges at the hospital.

The expectation is that Hershey will sponsor legislation to that effect again in the 2020 General Assembly session.

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