When the New York State Department of Health closed the lab at EJ Noble Hospital in Gouverneur early in October, it forced the hospital to close down—and it made headlines. The New York department of health cited EJ Noble for imminent risk to patients because of deficiencies in its lab.

Nurses at EJ Noble Hospital in Gouverneur have been laid off. They held a vigil earlier this month. Photo: Julie Grant

When I spoke with EJ Noble Administrator Charles Conole three weeks ago, just after the hospital closed, he was optimistic that it would reopen.

“When I came to the hospital 20 years ago, there was this very same concern. The concern that we were going into bankruptcy, etc. We were able to work out of it, were able to keep going. It took us a good three or four years to work out of it. But we did. We’ve had other issues over the years. This is part of the ups and downs of running a rural hospital. The key is to not give up and to keep plugging away.”

A spokesman at the health department couldn’t say when it might reopen. The state is working on a collaboration between the lab at EJ Noble and Samaritan Medical Center in Watertown.

EJ Noble Hospital is no longer admitting patients. Photo: Julie Grant

Massena Memorial Hospital has done some downsizing this year. After months of financial losses, it laid off two employees, and left 13 full- and part-time positions unfilled.

 CEO Charles Fahd points to the rising costs of the state pension system, and health insurance for hospital employees. And he says an increasing number of patients – now nearly 75 percent — are on government-funded health plans, such as Child Health Plus. 

“The reimbursement from both of the government plans, both Medicare and Medicaid, is decreasing year by year by year. They’re talking about decreasing it again next year by 2 percent, if things don’t change in Washington.”

Fahd says that would mean $400,000 less for Massena Memorial next year.

And there are other issues. In recent years, emergency visits have been up dramatically, especially by people on low-paying government plans, or without any insurance at all. Meanwhile, overnight visits are down. None of this is good for the bottom line.

A new project that Fahd calls “the solution” is being built across the street—it’s a $4 million medical office building, and the hospital is paying for it in cash:“We were able to stash some cash. The good years, when we were able to put some money away. We were able to put $22-23 million dollars in the bank when things were well.”

Fahd is hopeful good times are again on the horizon, because Alcoa is considering a billion dollar expansion at its Massena plant. To Fahd that means more people with jobs that carry private health insurance, and more business for Massena Memorial.

There are only 230,000 people in St. Lawrence and Jefferson County combined. So the ten hospitals have had to compete for patients, too.

David Acker is CEO of the Canton-Potsdam Hospital. It's been operating in the black for years. He’s been thinking a long time about the structure of the North Country’s health care system. Acker says it needs right-sizing.“I do foresee that in the next five to ten years it’s likely there will be fewer hospitals open, period. And I think it is inevitable that there will be fewer independent hospitals in the next five years.

Acker says each community enjoys having its own hospital. But there are too many patient beds. He says the North Country can’t financially support them all: “I understand the issues that come along with having to drive even 30 miles for care when you’re used to having it delivered locally. But I’m not sure our wishes are going to predominate here. I think the realities of the economy are going to hold sway.”

Both Massena Memorial and EJ Noble Hospital are adamant that despite their current difficulties, the community needs them and they will not close. 

Denise Young agrees with them.

She’s director of the Fort Drum Regional Health Planning Organization. And she’s been working with a consortium of seven hospitals, including EJ Noble, to create a collaborative health care system in the North Country:“I don’t think you see fewer places to get health care, I don’t see that. I mean hospitals are critical. You need to have an emergency department in Gouverneur, oh my goodness. There’s no question.”

Young says as the nation’s health care system changes, each North Country hospital needs to figure out how it can survive as part of the regional system: “I think that they all have some unique issues. But I think they all recognize that they need to collaborate and they need to work together to serve the populations that they need to serve.”

Young’s organization and its partners in the North Country Initiative received a $3.8 million state grant this year. They will be identifying the health care needs, and developing a regional health care system.

At Massena Memorial, Charles Fahd says his hospital is part of a group of six that’s been working together for years. He says talks about collaborations are becoming more serious each year: “I guess what we’re looking at is share, share, share. Are there going to mergers of the six organizations together? I’m not going to say there isn’t going to be, but I don’t think it’s going to be this year or next year, but it could be in the future…I am talking about consolidating and becoming one entity.

Denise Young at Fort Drum isn’t sure what the new regional health care system will look like, exactly. But she says it should be healthier for North Country hospitals and their patients.