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When An Emergency Room Closes Its Doors

Todd Bookman

Back in December 2008, with the town of Lyndeborough still frozen from an ice storm, Sue Carita and her husband went to check on a neighbor. Good deed done, they would both slip and fall on the return trip.

“We went home and called our doctors and of course, it was 4:30pm, 5:00pm on a Saturday afternoon, and there was no one there,” she recalls.

In pain, the Caritas sought care at the nearby Milford Medical Center, where x-rays showed she had a broken wrist, her husband a cracked hip.

They were able to get pain medication and arrange for a visit with an orthopedist. She says as good as the care was, the convenience of having to travel 20 minutes instead of 45 was even better.

“But if we always had to go to Nashua, from Lyndeborough…that would be a long haul. I think that if there is a real emergency, you just want to get to help as quickly as you can.”

And so Carita and others in the Souhegan Valley aren’t happy that Milford Medical Center, open since 1976, is ending its emergency services. The announcement from St. Joseph Hospital, which operates the facility, comes after months of speculation.

Still, Eric Shelburg, head of Ambulance Services for Milford, says the news came as a surprise.

“The Town of Milford, nor any other community that I’m aware of, was consulted,” says Shelburg. “In fact, it was just laid out on the table that this is what we are going to be doing, sometime in the fall.”

Shelburg calls the decision disappointing. It’s also contrary to what St. Joe’s told the Executive Council and the state’s Certificate of Need Board last spring. It gave assurances to officials that a new construction project in Milford would continue to house an emergency facility.

"For us, the marketplace is very volatile. So, a year and a half ago when those comments were made, the economics were different."

Richard Boehler, the hospital’s CEO, understands any frustration, but says circumstances have changed.

“For us, the marketplace is very volatile. So, a year and a half ago when those comments were made, the economics were different,” says Boehler.

Milford Medical Center is losing St. Joe’s $1 million dollars this year.

Too much, Boehler says, for the non-profit hospital system to absorb.

One reason for the change is health insurance. More people are carrying high-deductible plans, and co-pays for emergency room visits now commonly run $250 or $500.

Tom Charland, an industry analyst with Minnesota-based Merchant Medicine, says people are thinking twice about going to the ER for care, and he expects that trend to continue.

“There’s going to be a lot of more watchful eyes on how money is spent and the unnecessary ER visit I think is slowly going to become a thing of the past,” says Charland.

Instead, the health care system is moving toward more targeted care: emergency rooms for emergencies, but urgent care walk-in clinics for less pressing problems.

St. Joe’s says only about 10% of its patients in Milford need more advanced care.

As a stand-along facility, it doesn’t even have equipment to handle heart attacks, strokes or severe trauma. Ambulances already transfer those patients to the big hospitals in Nashua.

"The unnecessary ER visit, I think, is slowly going to become a thing of the past."

So Dr. Ateev Mehrotra argues the community could benefit from the transition. He researches urgent care facilities for the Rand Corporation.

“It is better for the patient, in the sense that they can see their problem more quickly,” says Mehrotra. “It is cheaper, if they are paying out of pocket for the care, or usually the co-payment is cheaper. And for society as a whole, the costs of an urgent care visit are much lower than an Emergency Department.”

Lower costs for society, but still a need to convince some in the Milford community that they’ll get the care they need in a health crisis.

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