by Will Tuell

Down East Community Hospital CEO Steve Lail confronted a host of issues on the minds of local residents in a recent interview. Amongst them are the hospital’s plans to combine two key departments – Medical Surgeries and Obstetrics – which Lail sees as vital to the hospital’s long-term financial health, the continuing fallout of the COVID-19 pandemic, and the hospital’s ability to address a worker shortage that has plagued the healthcare field. 

“Our goal – I think it’s an achievable goal -- is to keep this hospital financially sustainable, [and] to keep growing Calais to get it back up to where it should be in size and services offered…We’ve seen progress and hope to continue growing there [in Calais],” Lail said when asked about the overall direction of DECH and its sister facility, Calais Community Hospital, “and adding more services here at Down East in the future – specialty services that will help keep people in the area so they don’t have to travel so far to get those services. We had several – four or five – good years, and now there’s a real challenge with the staffing and the cost associated with the temporary staff – the traveling nurses – but I think once we’re over that hump, and we can get things back to normal, I see us being sustainable for a long time into the future.”

Lail said that the cost of bringing in traveling nurses – temporary staff that provides service through an agency to the hospital for a limited period of time, usually several months – has gotten out of hand, particularly in the Med-Surg and Obstetrics departments, prompting hospital officials to make the decision to cross-train and combine the two departments. 

“The plan is to combine those two units into one unit,” he said. “That would help us utilize the nursing resources there more efficiently. Right now, we’re cross-training the Med-Surg nurses to handle the OB patients. The OB nurses already know, for the most part, how to manage the Med-Surg patients, and the goal is to always have one fully trained OB nurse and to have other Med-Surg nurses ready and trained to provide support depending on how many moms and babies we have at any one time. Right now, the biggest issue with the OB unit is that we have a lot of traveling nurses there and temporary nursing staff that costs a lot of money, and if we can combine those two units, it would help maintain full staffing on Med-Surg all the time. And then, we can eliminate most of those traveling nurse positions. That will help a lot. The per-hour cost of having even one of those nurses has probably gone up two or three, or even five times at one point to what it normally was.”

Lail went on to say that declining birth rates have also led to increased strain on the hospital and that the situation that DECH is facing is symptomatic of rural health care in general. 

“For several years, there have been numerous hospitals closing all over the place or reducing services,” he said. “OB services are obviously very challenging. It’s hard to maintain the staffing, especially when you have low patient numbers. Volume and staffing are really the two biggest issues in OB because if you don’t have the volume, it’s very difficult to justify maintaining the staff required to provide the service. It’s not just having dedicated OB physicians and midwives, and nursing staff; you also need 24-hour pediatric coverage for newborns and 24-hour anesthesia and OR coverage in case there’s an emergency, so all of that factors into the overall cost of the service itself.”

When asked about the decision’s impact on expectant mothers and young families in the area, Lail said that he supports mothers making the best choices for their families but also wants them to know that DECH is there should they want or need it during or after their pregnancy. 

“There have always been people – and probably always will be – who prefer to go to Ellsworth or Bangor to get their care,” he said. “And we have in the past – off and on – had independent midwives in the area that provided midwife services. That, of course, is a personal choice for families to make. If they want to do that, that’s fine with us, and we’re usually the backup if something goes wrong. It’s important for us to make the visits [for those who choose DECH] as pleasant as possible and that we have the appropriate staff in place and physicians to take care of them. For a lot of people going to Ellsworth or Bangor is just not an option because of the cost of going there or the transportation challenges that come with that, or being able to take off work [for appointments]. Not everybody can take a day or week [or more] and spend a full day for an OB visit.” 

When asked whether he’d heard of any criticism of the hospital’s decision to combine the two units, Lail said that the medical community has been largely supportive and understands the challenges he and his administration face. 

“I think there are always people who are going to question it, but I think especially most of the nursing and the professional staff at the hospital understand the reason why and support it because they themselves want to keep the services here,” he said. “Our OB nurses are very dedicated to their patients and want to keep the OB service here and keep delivering babies. That’s our goal. So I think they understand that this is a way for us to make it sustainable long term and keep it going so that we don’t have the service leaving.” 

As for patients who may choose home birth as a result of DECH’s decision, which is expected to be implemented over the next several months, he encouraged patients to do their homework before making the decision to have a non-hospital birth and to ask questions of the provider they are seeking care from. 

“We have seen a few patients for home births, but recently we have had a couple of instances with home births that required a higher level of care here at the hospital. One was a life-threatening situation that luckily turned out positive for the baby and the mother,” he said, “The decision for people to have a home birth or a private birth with an outside provider is obviously a personal choice, an individual family choice that they make. We respect that because they have to have those conversations with themselves. We recently did put out a post [on social media] kind of just letting everyone be aware of the potential consequences, what they should be aware of, or potential questions to ask if they are going to outside providers, just to make sure they have all the answers they need for things, and to be safe. We obviously understand that some people want to do home births and want to go to specific providers that don’t work with the hospital, and we are here in case something goes wrong, but that is an individual choice.” 

Lail also laid out some of the causes of the healthcare worker shortage on state and federal COVID-19 vaccine requirements. While federal requirements have eased in recent months, debate amongst lawmakers in Augusta on the future of COVID vaccine requirements for healthcare workers persists as facilities around the state, including Down East, have seen the pool of qualified healthcare workers shrink as a result.  

“There’s always been a healthcare worker shortage – nurses, lab techs, imaging techs – but it was manageable before the pandemic. We did use traveling nurses consistently in some departments but not the high number that we have now,” he said. “And the cost [pre-pandemic] wasn’t cost-prohibitive like it is now, but over the past year and a half to two years, that has changed dramatically with a lot of healthcare workers leaving the workforce because of the mandate, and others deciding because of the salaries they can make as travelers [that they] would leave the workforce to become travelers and make money while the salaries are still high.”

Lail went on to say that the COVID vaccine mandate particularly hurt Down East as “over half of the ER staff left because of the mandate.” 

“Those nurses had to be replaced because we had to keep the ER functioning 24/7,” he said. “There was really no option for us to shut down a floor or do something else. We had to replace those [workers].” 

At the same time, he is optimistic that “things are slowly improving” because of the push to train new nurses and healthcare workers, though it will take time for DECH and other healthcare providers to bounce back.

“The per-hour rates [for travelers] are slowly coming down,” he said. “we’re getting more permanent hires and new grads. I think with the push that the state has made to provide free education to people going into health care and providing those opportunities to start up new nursing programs like those at Washington County Community College and the University of Maine Machias, within another year or a year and a half, we’ll have a huge amount of nurses coming into the workforce, and that will definitely help alleviate a lot of these staffing issues. I think there’s hope on the horizon, but just getting through the next year is going to be the challenge, I think.” 

When asked about efforts to end the COVID vaccine mandate either legislatively or administratively, Lail said:

“I hope they do it sooner rather than later. It will help get people back into the workforce,” he said. “And if we’re one of the few states that still has the vaccine mandate in place, it makes us uncompetitive to recruit people as well. I hope they overturn the mandate soon, but we’ll see what happens. I think [if they do] we’ll have a lot of people return to the workforce. It was a shame that people with long careers in nursing or imaging or other departments in the hospital had to make that tough choice to leave the profession [or get vaccinated]. It’s easy to second guess or play Monday morning quarterback after the fact, but it was a different environment [during COVID], but that’s just the way it is.”

Lail concluded by reiterating his earlier point that the hospital is always looking at ways both to create efficiency and increase services that patients need while also maintaining its independence as a local community hospital. 

“Our goal has always been for CCH and DECH to be sustainable while remaining independent from a large system,” he said. “that’s what we’re always working towards is how we can provide more services to the community, and how can we maintain our independence.”