BOOTHBAY HARBOR, Maine — A plan to close the emergency room and revamp services at a small Lincoln County hospital won final approval Thursday, highlighting challenges faced by many rural hospitals in the state.

St. Andrews Hospital and Healthcare Center in Boothbay Harbor, operated by Lincoln County Healthcare, will drop the word “hospital” from its name next April.

The plan got the green light Thursday by a unanimous vote of the board of trustees of MaineHealth, parent company to Lincoln County Healthcare.

St. Andrews will cease inpatient care and outpatient surgical services and replace its emergency room with a daytime urgent care center. The century-old hospital, which serves Boothbay, Boothbay Harbor and Southport, isn’t treating enough patients to warrant keeping the ER open, according to James Donovan, president and CEO of Lincoln County Healthcare.

“We’re looking forward to what we believe the new health care environment is going to require of us,” he said.

The hospital averages about 11 patients a day in the emergency room, Donovan said. Between midnight and 6 a.m., just one patient typically visits every other day, he said.

The majority of those patients needed less intensive urgent care for maladies such as the flu or sprains, Donovan said.

Most residents who need emergency care are expected to go about 20 miles away to Miles Memorial Hospital in Damariscotta, also operated by Lincoln County Healthcare.

The change will triple average ambulance response times from about half an hour to one hour, 45 minutes, said Scott Lash, operations manager for Boothbay Regional Ambulance Service.

“It does change the dynamics of how health care is going to be delivered in this community,” he said.

While ambulances often deliver much the same care on the road as patients get in an emergency room, such as for cardiac arrest cases, the sooner sick and injured people get to a hospital, the better, Lash said.

“On any ambulance call, the longer you’re outside the emergency room, the risk goes up,” he said.

The overhaul at St. Andrews will eliminate 50 jobs, with about half of the affected employees expected to find positions elsewhere in the MaineHealth system, Donovan said. The hospital currently employs about 150.

The changes in Boothbay Harbor may be more drastic, but hospitals throughout Maine are reacting to similar pressures, including the weak economy, shrinking reimbursements for patients covered by Medicare and Medicaid, more patients who can’t pay their hospital bills and debt owed by the state, said Jeff Austin, a spokesman for the Maine Hospital Association.

“This particular solution is unusual but the factors are not,” he said. “That’s why you see layoffs and downsizing across the state.”

St. Andrews is distinct, however, as one of the smallest of 16 hospitals in Maine designated a “critical access hospital” by the federal government. The special category dates back to legislation enacted in 1997 aimed at boosting the availability of health care in rural parts of the country.

Critical access hospitals are reimbursed differently for Medicare patients to help them stay afloat in areas with fewer patients. But for some hospitals, the trickle of patients is too low to justify the expense of full emergency and inpatient services, said Andrew Coburn, a rural health expert and chair of the Master of Public Health program at the Muskie School of Public Service at the University of Southern Maine.

It often costs critical access hospitals more to treat patients than the government pays them back for, he said.

“[St. Andrews] is not the only one in this situation across the country,” Coburn said.

The Boothbay Harbor hospital has lost money in its operations for 10 of the last 12 years, Donovan said. About 70 percent of its patients are covered by Medicare and Medicaid.

“We don’t have the size to weather the storm,” he said.

With Congress and the state Legislature in belt-tightening mode, Lincoln County Healthcare didn’t want to wait until government money dried up to adapt, Donovan said.

“We want to be out in front of it,” he said.

Come April, Donovan expects patients to get better value for their health care dollars by taking advantage of much-less-expensive urgent care instead of unneeded emergency treatment.

Catherine Wygant, executive director of the Boothbay Harbor Region Chamber of Commerce, had hoped to see Thursday’s decision about St. Andrews’ future postponed. She outlined concerns about the loss of jobs and local emergency care in a July 31 letter to the MaineHealth board of trustees. Recent meetings have answered some of the unknowns, but many uncertainties remain, she said.

“We need to be educated about how this is going to affect the community,” she said.

Jackie Farwell

I'm the health editor for the Bangor Daily News, a Bangor native, a UMaine grad, and a weekend crossword warrior. I never get sick of writing about Maine people, geeking out over health care data, and...