A car drives along the entrance road to Calais Regional Hospital on Aug. 21, 2019. Credit: Bill Trotter|BDN

A court-appointed watchdog is now overseeing the care of patients at Calais Regional Hospital as part of the hospital’s ongoing Chapter 11 bankruptcy process.

A judge from U.S. Bankruptcy Court agreed to appoint the patient care ombudsman earlier this month after Maine state health officials raised alarm about the Down East hospital’s competence to handle the spread of the coronavirus and to properly document patient outcomes.

In court paperwork, the Maine Department of Health and Human Services highlighted a Feb. 15 case in which an ER doctor employed by an outside staffing agency was unable to insert a breathing tube down the throat of a patient whose windpipe was obstructed. Instead, the hospital had to call in local paramedics to intubate the patient, who ultimately recovered after being airlifted to a Bangor hospital for further treatment.

Among the responsibilities of the new watchdog will be to review the role of Envision Physician Services, the Tennessee-based company that took over the staffing of the emergency room at Calais Regional Hospital on Feb. 1.

The physician involved in the Feb. 15 case was employed by Envision and had just started working at the hospital, according to court records and a state investigation. He has not returned to the hospital for any more shifts, a spokesperson for Calais Regional Hospital said earlier this month.

Envision replaced a smaller, Maine-based staffing company, BlueWater Health, as the employer of ER doctors in Calais and at Washington County’s other hospital: Down East Community Hospital in Machias. Both hospitals said that Envision would provide the same quality of medical care more cheaply than BlueWater was able to do.

The unionized nurses, medical lab scientists and technologists at Calais Regional Hospital have “strongly supported” the appointment of a patient care ombudsman, according to Todd Ricker, a labor representative for the Maine State Nurses Association, the statewide affiliate of the national organization that represents those workers.

While patients “get very good care at Calais Regional Hospital,” Ricker said, “we want to make sure” that there is enough “oversight for the [administrators] that are ultimately making large-scale decisions around patient care.”

Calais Regional Hospital has said the handling of the Feb. 15 case has no bearing on its preparedness to handle the coronavirus and that the case was complicated by several factors, including an abnormal growth in the patient’s mouth and the fact that it happened on a weekend when the hospital’s contracted anesthesia staff do not routinely work.

In a court filing, the hospital has also downplayed most of the deficiencies that state investigators found during their inspection in early March, saying that they were “documentation matters” that do not “present any immediate risk to patient safety.”

Calais Regional Hospital, which did not respond to a request for comment this week, has generally opposed appointing an ombudsman to oversee its patient care since it first filed for Chapter 11 bankruptcy last September to help restructure its debts.

Federal law requires health care facilities that seek Chapter 11 bankruptcy to be overseen by such an ombudsman, but they can seek exemptions from that requirement, as the Calais hospital successfully did last fall. At the time it argued that it already receives enough oversight from state and federal regulators.

Maine DHHS objected to that initial motion.

At the time, it said that the Calais hospital “does not have a history of many problems with patient safety or quality of services.”

But the state agency also said the hospital’s “budget projections may not be precise,” and that it may have demonstrated “a lack of transparency” by not indicating in court filings that its unionized workers had authorized a strike as part of an ongoing contract dispute. (The unions still have not pursued that option.)

More recently, Maine DHHS received an anonymous complaint that prompted an investigation of several recent cases, including the Feb. 15 event in which the doctor could not intubate the patient.

On March 25, the agency renewed its motion that a patient care ombudsman be appointed, arguing that its “troubling findings underscore serious competency and ethical concerns” and that the coronavirus pandemic would make it harder for state and federal regulators to watch over the Calais facility.

A judge granted the motion on April 3. While Calais Regional Hospital initially opposed the renewed motion to appoint an ombudsman, an attorney for the hospital told the judge that day that he supported the final order.

Four days later, a trustee for the U.S. Justice Department appointed Jeffrey Brown, a Belfast-based health care consultant, to fill the role.

In a sworn statement to the court, Brown said that he had been planning to do research on health care delivery in Washington County this summer as part of an initiative organized by groups in Bangor and Boston, but that the work was suspended due to the coronavirus pandemic and that he had not begun identifying any organizations to participate in the study.

As part of his court-appointed duties, Brown will interview patients and physicians, review records and report his findings back to the court.

A phone call to Brown was not returned Tuesday. It was not immediately clear if the hospital will compensate him for his work.