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Temporary Closing of APD Emergency Room Under Review

Valley News Staff Writer
Published: 4/29/2018 12:30:27 AM
Modified: 4/30/2018 9:45:42 AM

Lebanon — There has been at least one hiccup in the operation of APD’s emergency department since EmCare took over.

In December, the emergency department was closed through the first weekend of December when the hospital’s computed tomography scan — commonly referred to as CAT scan — machine broke down. Such machines use X-rays to make detailed pictures of structures inside of the body, and are commonly used to examine bones, organs and soft tissues.

The machine needed a part, which couldn’t be immediately replaced, and Dr. Martin Johns, the EmCare-employed medical director for the emergency and hospitalist departments, was unable to immediately sort out a way for APD patients who needed CAT scans to get them at Dartmouth-Hitchcock Medical Center, APD CEO Sue Mooney said.

After consultation with the APD administrator on call, they closed the emergency department. Mooney did not identify the administrator on call, but said it wasn’t her.

“We had concerns about patient safety,” said Mooney. “In the sense that if a patient showed up here and needed an emergent CT, we were unable to provide that. That felt as though we were putting patients at risk.”

But long-time APD Emergency Department physician Doug Cedeno — who is now employed by EmCare, but didn’t happen to be working that weekend — said a broken CAT scan machine was no reason to close the emergency department. In fact, in doing so, the hospital may have violated the federal Emergency Medical Treatment and Labor Act, which requires that hospitals that accept Medicare and Medicaid offer emergency services to everyone who shows up requesting them, regardless of their ability to pay, said Cedeno.

“Anything that deters someone from seeking care is an EMTALA violation,” Cedeno said.

Aaron Smith, the Boston-based public affairs officer for the Centers for Medicare & Medicaid Services, said in an April 19 email that the New Hampshire Health Facilities Administration is aware of, and investigating, the report of a temporary closing of the emergency department at Alice Peck Day Memorial Hospital.

The Health Facilities Administration is the state agency responsible for conducting inspections on behalf of CMS.

Generally, he said, EMTALA violations “usually target a hospital’s actions towards individuals based on things like their payment method, disease type, or other individual factor.”

But, he said, there may be other things at issue such as Medicare requirements and state laws.

Jake Leon, spokesperson for the N.H. Department of Health and Human Services of which the Health Facilities Administration is a part, said in an email that the administration “recently learned of the closure” and is investigating its causes.

“If any rules or regulations were violated, the department would issue a public statement of findings,” Leon wrote in an email.

To her knowledge, Mooney said there were no repercussions from closing the emergency department and such a closure had never happened before and will not happen again.

Since the incident, Mooney said the hospital has developed a way to quickly transport patients to DHMC for emergency CAT scans and to get a broken machine repaired more quickly.

“Just because a piece of equipment is disabled doesn’t mean you shut (down) the entire ED,” she said.

Later that December, the only available obstetrician cut her hand, which meant that the hospital “didn’t have a back-up physician to do C-sections,” Mooney said.

The emergency department was not closed, but administrators did have conversations with Dartmouth-Hitchcock to figure out: “How do we make sure this is a safe situation, given that one of our docs is in your ED getting stitches?” Mooney said.

It turned out, however, that the doctor’s wound wasn’t as bad as originally thought and the obstetrician was able to work within a few hours, Mooney said.

For Cedeno, this incident highlights the challenges ahead as APD plans to close its birthing unit. He said he worries that APD’s emergency department will be ill-equipped to assist women in labor who come to APD’s emergency room when all deliveries are moved to Dartmouth-Hitchcock Medical Center beginning on July 15.

It is in part because of this change that Cedeno plans to retire in June, before the birthing unit closes. As he approaches the age of 69, he said he doesn’t feel like he has it in him to bone up on how to deliver a baby.

“The emergency room has to be prepared for just-in-case scenarios,” he said.

Valley News Staff Writer Nora Doyle-Burr can be reached at or 603-727-3213.

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