In skeleton crews, LRGH-affiliated providers soldier on – sometimes for free

LACONIA – Carolyn Brown’s professional landscape has changed for the foreseeable future. 

The longtime nurse practitioner and primary care provider at Belknap Family Health in Meredith now works two days a week as a temporary employee paid by the day, by the local hospital system that employed her full time for 20 years.

Brown and a crew of nurses and physicians employed by Lakes Region General Hospital have volunteered to stay on, even though their employment contracts have been suspended during the furlough, and no one knows exactly what the future holds for the regional healthcare network. Two weeks ago, 600 employees were relieved of duties and paychecks for 120 days. A small number have signed back on part-time.

Right now, two doctors and two nurses and skeletal support staff are working daily at LRGH’s outpatient clinics consolidated at two current locations – Laconia Clinic and Westside Healthcare in Franklin. But compressing medical care for all patients into the hours allotted is a daunting hurdle.

“I can’t do telehealth visits on days I’m not in the office,” Brown said. It’s illegal to charge, or enter data in patient charts on days a provider is not actually on the payroll, she said. That means working without compensation after hours as a patient’s situation requires. “We’re going to treat patients as best we can even though we’re not being paid. We all took an oath” to put our patients' well-being first. “Everyone’s doing the best we can with the resources we have.

"Most of us are cross-trained,” said Brown, who is also qualified to work in the emergency room. “I will see people in person at the Laconia Clinic, and have done telehealth by video and phone. We’re all wearing many hats. It may take a little longer, but you’ll get a call back.”

The hospital’s financial troubles and closures have made the future of local patient care murky, at least temporarily.

Jeremy Hogan, an othropedic surgeon at Advanced Orthopedic Specialists in Gilford – which is not owned by LRGH but depends on its operating room to perform surgery – said the hospital situation keeps changing. With the hospital closed to general and elective procedures, “everybody’s equally in the dark about elective cases” – and elective procedures are an essential income generator that keeps hospitals solvent.

“We’re currently staffing with a skeleton crew for urgent office visits, including fracture care, and post-op follow-ups, but we have limited resources,” Hogan said. “Eighty percent of my practice is elective hip and knee replacement, and I can’t do any of that right now.  We’re in a subsistence mode, and we’re trying to keep our business alive.  We have to weigh the risks of people coming to our office, the needs of keeping patients safe.”

Advanced Orthopedic Specialists is still providing emergency care, but the case-by-case decision to perform emergency surgery is based on whether it’s safe and appropriate, Hogan said. Some patients may require transfer to other hospitals depending on their complexity and hospital resources.

The orthopedic practice at Hillside Medical Park is now staffed with one or two practitioners, which include medical doctors, chiropractors and physician assistants working mornings during the week,

“We’re working right now without any guarantee of compensation,” Hogan said. “We’re all going to have tough choices to make regarding our future.” Taking jobs available elsewhere is not off the table the longer the pandemic and hospital financial uncertainty wears on. “We have deeply planted roots here and are invested in the community and want to make it work, but we have to take care of our families as well.”

“When this ends there’s going to be a very large backlog of cases that need to be done. We’d like to do them here, but it’s not up to us. We’re hopeful and optimistic that we’ll be able to reopen our practices.”

“I think people are very concerned about the hospital, the 600 people furloughed, and will we ever be whole again – and if we will be ready to serve if there’s a coronavirus surge in the Lakes Region,” said Mary Bidgood-Wilson, a retired family nurse practitioner and certified nurse midwife who worked 30 years for LRGH, mostly at Moultonborough Family Practice, which became part of the Huggins Hospital system two years ago.

Many health care professionals didn’t anticipate the time and effort it would take to prepare for the COVID pandemic  – including scheduling changes and elongated shifts, and acquiring enough personal protective equipment and medications on hand, she said.

Having a local community hospital is critical to the Lakes Region, including its aging population, which requires regular and specialized services.  “Just north of Concord, New Hampshire becomes very, very gray,” said Bidgood-Wilson, who serves on the NH Legislative Commission on Primary Care Workforce.  “For health care planning, we have to do what’s going to be helpful for that aging population.

“For many people, the distance to Concord, Wolfeboro and Plymouth is farther than they want to go.  If you’re having an acute cardiac event or stroke, you want to get to a hospital as quick as you can,” Bidgood-Wilson said.  “A lot of research has shown the importance of time in those situations.”

LRGH’s website now includes a link for the public to make donations to help buy personal protective equipment and provide assistance to furloughed employees, she said.

“This is a concerning time for everyone,” Bidgood-Wilson said. “Lakes Region General Hospital was already struggling. This has made everything more difficult, and there’s a frustration in the community, ‘How did we get into this mess?’”

Chip Broadhurst, a former LRGH board member, said LRGH’s service suspension will compromise many, and the effects will ripple through the economy the longer it lasts. “The physicians are in a position to weather this for a few months.  But not nurses and technicians. As you move down the income level, the amount of resources they have diminishes.”

For many, there’s a lack of confidence in the hospital’s leadership because of the way the furlough was handled, Broadhurst and others have said.

“I want (suspended employees) to believe that if they don’t accept a job elsewhere, we want everybody to hang on” until the hospital reaches a financial solution, finalizes a partnership and becomes part of a solvent healthcare system. “We need health care in the Lakes Region. Would you want to live in a place where there’s no local health care?” Broadhurst said.