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Fort Fairfield Health Clinic Public Hearing Draws Capacity Crowd
By: David Deschesne
Fort Fairfield Journal, January 25, 20120
To download an mp3 audio file of the public hearing, click here (61.1 Mb)
It was a full house as nearly three dozen people crowded into the Fort Fairfield council chambers on January 17 to make their thoughts known on the proposed town-owned health care clinic in Fort Fairfield.
The Aroostook Medical Center (TAMC) currently operates a health care clinic in the former Community General Hospital. The real issue being discussed was not whether or not TAMC provides a good service, but whether or not they will continue to do so in town for the foreseeable future and the town’s interest in acquiring a facility that would guarantee same. A 2008 decision to close their facility and move it to Presque Isle raised some concern in Fort Fairfield with a health care facility that is beholden to the whim of outside sources and decision makers.
Community General Hospital was built in the early 1950s to provide local health care for the town of Fort Fairfield - then a growing and bustling community of around 6,000 people. In 1949 the Fort Fairfield Chamber of Commerce adopted as its major project a campaign to build the much needed new hospital. The original hospital committee was Dr. Thomas Harvey, Percy Johnston, Mrs. Fern Buck, Claude Bishop and Don Eisensmith. The fundraising effort coordinated by George Findlen started on October 25th and by November 22nd they had raised $228,124 which was $30,000 more than their goal. The actual cost of construction was $430,500 and the formal opening was on April 10, 1952. To illustrate how much money went into that project, $430 thousand in 1950's money would be the equivalent of $12.9 million in today's depreciated, watered-down federal reserve note paper currency (figuring a 1950 silver dollar = $1.00 per ounce and the same silver dollar is worth $30 in federal reserve paper notes today). So, the town of Fort Fairfield raised today’s equivalent of $6.8 million from local citizens and businesses in less than a month’s time to build their hospital.
In 1981 TAMC was given, for free, $1,128,405 worth of net assets and the fully functional Community General Hospital that served Fort Fairfield. According to current town manager, Dan Foster, who has exhaustively researched this issue, several public hearings regarding the proposed transfer were conducted and the following assurances were made at those meetings:
- Enhancement of healthcare services currently provided by our hospitals
- Development of new services at CGH, which previously have not been available;
- Improved utilization of our hospital’s physical facilities and personnel resources, to gain improved economics of operations and avoidance of unnecessarily duplicated operating expenses;
- Strengthened representation of area residents’ heath care needs to regulatory agencies and legislative councils
- Enhance ability to recruit new professionals needed for high quality medical services; and
- Improvement of each hospital’s fiscal strength, important for long-range success in providing high quality medical services in a cost effective manner.
In 2008, TAMC chose to renege on that agreement and close the hospital facility they were given for free nearly thirty years earlier.
Since then, the town of Fort Fairfield went through a process to develop an economic development investment strategy with one of the goals being an enhancement to local health care services by seeking grant funds to finance construction of a facility that will house a health care clinic and a wellness fitness center. The town determined to aggressively seek health care providers to utilize this space by creating a lease agreement with the provider that would articulate the expected level of services and allow the community to change providers should these expectations not be met. The town's ultimate goal is to be in control of the space that provides health care services so they can be assured of being involved in the decision making process regarding the level of services that are provided to the citizens in the community.
When TAMC announced the closure of the Fort Fairfield health clinic in 2008, The town council created a Community General Hospital committee comprised of David Dorsey, Gary Sirois, J.R. McGillan, Shawn Murchison, Dick Langley, members of the town council, Tony Levesque and Dan Foster.
"The committee met to see how we could stop this from happening. We met a number of times with the TAMC senior leadership team and we met once with their board of directors. Really what it boiled down to was that 49,500 square foot building was really providing services out of about 4,000 to 5,000 square feet,” explained Foster. “It was inefficient, it was expensive, it was costing these guys a lot of money to be able to keep up, maintain this facility to provide the services they were providing and it was just not financially prudent for them to continue to do that. That was the reason why they had come to this conclusion.”
At the time, the town of Fort Fairfield showed an interest in working with TAMC to help develop the CGH building into a more profitable model, but would only do so if ownership of the building would be turned over to the town. TAMC refused to transfer ownership. “We were trying to figure out a way to make that facility useable while substantially reducing the overall occupancy cost to the clinic,” explained Foster. “This would eliminate the reason for having to close the clinic. While we were trying to figure out whether we could use this facility for housing we told TAMC that if we were going to invest several million dollars into this facility we needed to own it, which they steadfastly refused to do. It was only after we started negotiating with Cary/Pines about possibly providing services to Fort Fairfield did they finally budge on this issue. On April 10, 2010, a full two years after they had announced the closure, David Peterson, from TAMC, sent a letter to Greg Murchison, President of the Fort Fairfield Residential Development Corporation stating they would transfer the property to Fort Fairfield Residential Development Corporation. It is interesting that after two years of negotiating the Town was purposefully kept out of the loop. By that time it had been determined that the cost for renovating the old CGH was not cost effective and Greg indicated to David that he needed to address the issue regarding the clinic with the Town.”
Foster says this move is not an indictment on TAMC. “This is not about TAMC. This is not about Cary Medical Center. What it's about is Fort Fairfield, it's about our ability and our willingness to be able to ensure that this community has health care services and that we're going to be willing to ensure that we have it and do what we need to do. If we're going to control our own destiny we need to be aggressive about what is important to us. We need to be willing to assume some of the responsibility to make it happen and we need to be able to collaborate with other entities very similar with what we did with the Housing Authority or the Residential Development Corporation on the Meadows Project senior citizen housing to be able to reach our goals.”
“What we're looking to do is we want to establish a service that's going to ensure quality health care to all of our citizens of Fort Fairfield, in Fort Fairfield for the foreseeable future. We're willing to assume responsibility for the construction of the facility to minimize the occupancy costs to the provider. In exchange for that favorable lease agreement, we're going to receive a long term commitment from a provider who's going to provide a broad range of services and also give us the opportunity to provide input on what those services are going to be and how they're going to be provided.
Jim Davis, CEO of Pines Health Services spoke at the public hearing to highlight some of the features of the Pines proposal, one of which is the fact that Pines is designated a Federally Qualified Health Center (FQHC). “It simply means that not only are we a recipient of a federal grant to operate our health centers, principally to make sure we're able to have the wherewithal to provide care to any member of the community regardless of their ability to pay, but it also means that for anybody who might be on Mainecare or Medicare we're able to receive some enhanced reimbursement for that,” explained Mr. Davis. “That FQHC designation is important because it talks about a fundamentally different business model that we're able to utilize that effectively allows us to keep our doors open for everybody in the community regardless of their ability to pay; to staff health centers in areas where typically they may not be economically feasible. Our mission and the mission of community health centers nationwide is to provide access.”
One of the stipulation of the health provider agreement with the town of Fort Fairfield is the provider must have at least two members of the community on their board of directors. Pines currently has two members from Fort Fairfield on its board of directors - Dana Rattrey and Shawn Rogers.
“I think the points that have been made here this evening about local health care and access to health care, wellness programs and the other things that have been pointed out are critical to a community being able to sustain itself,” said Mike Eisensmith, from Fort Fairfield. “I think the process that's been described and the work that's gone into this, the comments that have been received from a wide number of people all support what's being proposed here this evening. Personally, I think it's great that we're going to be in a dialog with folks that are going to be providing health care in the community and that the shape of what that is will be an ongoing process rather than a decision from afar, so I'm very supportive of this.”
Joe Lalland, a Fort Fairfield inhabitant and board member of TAMC spoke in opposition to the clinic. “One of the important things that we're all aware of but sometimes forget is that our financial resources are not unlimited and we need to make a decision as to what's the highest and the best use of our investment dollars. It's been pointed out this evening that this project will be a $600,000 project, it's going to require at least $300,000 of input from the community of Fort Fairfield and that doesn't speak to the ongoing operating costs, some of which may be offset by the lease agreement but it depends on the terms of the lease agreement. I'm concerned about that expenditure of dollars when there's already an existing health care provider in Fort Fairfield that's been here since 1981.”
His sentiments regarding the financing were echoed by Margaret Spence, also from Fort Fairfield, who said, “My biggest concern with this is the $300,000 that we are going to have to match. That is a big chunk of money. Having another health care facility; can we actually support it with the people that we have here? I don't know. I think that is something that should be seriously looked at as well.”
Under a program from the Maine State Housing Authority (MSHA), developers of housing projects are reimbursed some of the money for the construction and development of the project as it complies with MSHA criteria. Normally, developers are private individuals or corporations but Fort Fairfield is setting precedent by being the first town to qualify as a developer with their Meadows Project—a 21 unit senior citizen housing complex where the proposed clinic will be situated. As the project developer, Fort Fairfield will receive nearly $300,000 from MSHA for developing those senior citizen housing units. That money will then be used to cover the balance on the clinic construction costs, it will not come from the local taxpayers or local town tax receipts. “One of the unique things about this collaboration is that the developer is the town of Fort Fairfield,” explained Foster. “That is probably a first as far as Maine State Housing is concerned, they have never seen that before. The primary reason why we're the developer is there's a developer's fee that is associated with that. We are looking at netting close to $300,000 out of being the developer for the construction of [the Meadows] project. That is where the money is coming from in order to build this clinic, here. That's going to be our share. It's going to be the hard work of myself, Tony and Mike Bosse. It is not coming from the taxpayers.”
The town council recently voted to allot the developer's fee to go to either Fort Fairfield Housing Authority or Fort Fairfield Residential Development Corporation in the event the clinic is not built.
“In 2008 TAMC had indicated its desire to close this facility but after having met with the town of Fort Fairfield, they rescinded that decision and they're on the record as having committed to staying here and providing high quality medical services,” said Lalland. “TAMC has indicated that they're here to stay. So what we're looking at in my view is a duplication of services.”
It was not Fort Fairfield's intent to duplicate services since they did offer TAMC a chance to submit a proposal and inhabit the new, modern health care clinic building at a substantially reduced cost compared to the building they currently inhabit. The town of Fort Fairfield requested a proposal for health care services from both TAMC and Cary/Pines Health Services. After reviewing proposals from both TAMC and Cary/Pines, the town council voted to move forward with the proposal from Cary/Pines. “TAMC had every opportunity to work with us regarding the providing of health care services in this community,” said Foster. “We requested proposals from TAMC and Cary with TAMC's response being a three paragraph e-mail. Cary's was a four page well-thought out proposal regarding health care issues and how they would work with us to meet them. It was an easy decision for the Council to make. The decision is in the best interest of Fort Fairfield, that is the Council's responsibility.”
“What I've heard here tonight is mostly the concern raised by the decision in 2008 to move the health center to the North Street location [in Presque Isle] and the concern that that generated,” said Dr. Dan Fowler, who has worked at the TAMC health center in Fort Fairfield for the past twenty-one years. “The response was we need to have control in town, we need to be able to determine our own destiny. I would just like to call attention to the fact that when the concerns of the town was voiced - and I met with town members, I met with TAMC, I talked to a lot of people - the response was TAMC heard the concerns and the commitment was to maintain the health center and I think that's been done.”
“I'm old enough to remember when Community General Hospital was transferred to TAMC,” said Gary Sirois, from Fort Fairfield. “At that time there were some assurances made that we would have ongoing services for our community. I am concerned about having ongoing commitment to the citizens of Fort Fairfield. That's my concern. We had that way back when and then TAMC backed out of that, for good reasons I'm sure, but I don't like the fact that they backed out of their commitment. I'm not saying that we can rely on Cary any more than we can on TAMC but that still sticks with me, it bothers me that those commitments that were made when the facility was transferred were not honored and I don't know how long this commitment that we got recently will stick.”
“We don't have any guarantee as of right now that a health clinic will continue in this town,” said town councilman, David McCrea during the discussion period of a vote on the issue in the following evening’s town council meeting. “I see this new facility and having a second provider of medical service to this community as a very, very positive thing. It does ensure competition, it does ensure the fact that we will have some control of our own destiny. We will never be caught again not having a facility to put a clinic in.”
The proposed clinic is also supported by the Fort Fairfield Quality of Place Council (FFQPC). “One of the things we've been working on for the past year is to further Fort Fairfield. It's important to have local health care,” said Brent Churchill, chair of the FFQPC during the public hearing. “The importance of having known health care in the area - I know that Dan pointed out with the existing clinic, the potential for it being closed, it is staying open - but also giving the citizens of Fort Fairfield a choice. Some choose to have their health care rendered at Cary Medical Center and having the physicians locally that can provide those services is to the betterment of our citizens.”
David Saucier, who moved to Fort Fairfield a couple of years ago spoke in support of the clinic. “I used to be in the health insurance business. This geographic area has the highest level in the country for people not being healthy. I'm encouraged that there is going to be competition. I volunteered for Aroostook Regional Transportation (ART), but had to get done due to health reasons. A lot of people can't get to their appointments because they depend on volunteers. These Mainecare people that depend on volunteers to get them from Fort Fairfield to Caribou - there are just not enough [volunteer drivers]. So a lot of people are told they can't be brought to Caribou because they don't have a driver. Having a facility right here in Fort Fairfield should help take that pressure off to get people to their doctor's appointments. Saucier also spoke on the competitive aspects of having a second facility in Fort Fairfield. “I come from the Bangor area and there's a lot of competition from a lot of different medical facilities and we really enjoyed that. That's one of the things that we miss from Bangor is having competition not only in your restaurants but in your medical. If my wife is not happy with her doctor she had a lot of different choices from a lot of different medical facilities. There's a lot of competition and I think competition is good. I think it's going to give you better services, it's going to give you better care. Again, this population is getting older and it's getting sicker and having competition will make everyone feel a lot better. I'd like to see more competition up here, not less; not having one facility controlling our health care.”
Gerald Saucier, president of Fort Fairfield senior citizens’ Sunshine Club said he finds overwhelming support within his group for the clinic. “We now have fifty four members. In talking to them I hear more positive to having the clinic - they're excited about it - than negative,” said Saucier. Everybody is looking forward to the new clinic, as I can tell there are only a few that disagree with it. The majority of our members are agreed to have a new clinic.”
Terry Greenier, owner of ICare Pharmacy and member of Fort Fairfield town council spoke in favor of the clinic. “I want to go on record in saying that I'm actually for this. It's really not a TAMC/Cary thing, it's about the citizens of Fort Fairfield. The Federally Qualified Health Centers is the big piece that helps a lot of our community who can't afford health care. Pines has that in place. So this is something I believe personally is going to help our community more to provide that ability for people to actually get the access to that health care.”
Nadine Lamoreau, a nurse practitioner at the TAMC health center in Fort Fairfield noted there is extremely high quality health care at the TAMC facility. “We've all met the gold standard of the National Commission for Quality Health Assurance. We have a satisfaction rate of 96 to 97 percent, very consistently.
We have same day access, we're all committed to having the health care needs, if you call that day we try to get you in. Our concern is that if we start splitting services that what's going to happen is the service is going to diminish for the town. We are extremely committed to this community and really pleased to be here and we are striving always to make sure that we're giving the very best care. We're the model now for the medical home and we've started to do case managing. Additionally we provide lab services here so that people don't have to travel, they can get their lab work done. In terms of seeing people, I don't think that cost ever comes into it. If you make an appointment with us we see you, we don't care whether you can pay, or not. So the whole cost thing is kind of a non-issue.”
During the following evening’s town council meeting, town council member, Terry Greenier rebutted Lamoreau’s point regarding TAMC’s billing practices. “Pines is a Federally Qualified Health center which means that they kind of grab the gap of people who don't qualify for assistance within the Medicaid or Medicare roles but yet can't afford to have any health care. Which means that at any given time somebody can walk in that door and of they cannot pay for it, they will actually have somebody that helps them - the federal government - to actually cover those costs. Last night it was brought up that TAMC does not turn people away; however, they will send you a bill and you will have to pay it. So, my mind goes to this Federally Qualified Health Center as something we don't have currently that would be a huge thing that would help the people in our community.”
Jay Reynolds, citizen of Fort Fairfield and Chief Operating/Chief Medical Officer of TAMC in Presque Isle echoed Lamoreau's statements during the public hearing. “I think we provide excellent primary care to the citizens of the town, I think we provide excellent access to the citizens of the town, more than a third of our citizens get their health care from the Fort Fairfield health center. More than two thirds of our senior citizens get their health care at the Fort Fairfield health center.”
“This will not decrease the cost of health care it will actually increase the cost of health care overall, by increasing inefficiency,” said Reynolds. “To summarize: I think we already have an excellent primary care clinic here in Fort Fairfield, it meets the needs by the opinions of the citizens of Fort Fairfield for their primary care I've heard little to no compelling reasons other than choice is good. But, really looking at it from the nitty gritty operational issues it's going to be bad for both clinics to have two here in Fort Fairfield because there's just not the demand for that.
David Saucier then queried Reynolds, “What you're saying is that you're fully confident that you provide the services in this area; that your patients are loyal. So, why are you worried about the competition?”
“Because there are a limited number of citizens of Fort Fairfield,” Reynolds answered. To which Saucier noted, “But if they're happy, they're going to stay with you.”
“I believe that the vast majority will,” said Reynolds “But again, I think if we weren't talking about a 100 percent subsidized clinic coming to town, we wouldn't be discussing this at all.”
To summarize, Fort Fairfield once had their own locally controlled hospital. It was given to TAMC for free in 1981 with their promise to continue local health care at that facility. TAMC chose to renege on their agreement in 2008, then changed their mind after public outcry, setting a tone for local control of a health care facility. Despite their continued assurances that they are in Fort Fairfield to stay, the town is not convinced and is seeking ways to assure the local citizenry that a local clinic will be available to townspeople for the foreseeable future and health care services will be contracted out to successful bidders to occupy and provide services out of that town-owned clinic.