St. Andrews emergency room in Boothbay Harbor has been closed for six months, and its former inpatient wing has been reconstructed for outpatient physical therapy.

In March, the Maine Department of Health and Human Services indicated it is likely to approve these and other changes in the local healthcare system. Despite all of that, local advocates continue to fight to restore local services and local control over healthcare decisions.

Last Thursday, Boothbay Region Health and Wellness Foundation Vice Presidents Jane Good and Margaret Jones Perritt took a ride to Augusta so they could hand deliver the foundation’s comments on the state’s preliminary analysis of Lincoln County Healthcare’s creation in 2007, and its merger of St. Andrews and Miles Memorial hospitals in 2013.

Good and Perritt didn’t just stop in at DHHS, they also provided the foundation’s comments and supporting information to Gov. Paul LePage and Attorney General Janet Mills.

“The foundation feels that the 2007 merger of St. Andrews Hospital and Miles Memorial Hospital to form Lincoln County Healthcare was illegal, as MaineHealth never applied for a Certificate of Need,” Good and Perritt wrote in a press release. “Furthermore, Lincoln County Healthcare and MaineHealth failed to apply for a Certificate of Need when they reorganized in 2013, a move that ultimately resulted in the closure of St. Andrews Hospital.”

The foundation believes there is nothing in state law that allows DHHS to issue a CON for actions that have already been taken. This isn’t the first time the foundation has raised this legal question, but representatives said they have yet to receive a satisfactory answer.

"We have been waiting to hear from the AG, the governor, and the commissioner since January,” Good and Perritt said in an email. “Actually, it is very telling that we cannot get an answer. No one wants to go on record, except the governor with a handwritten note."

In the note, dated March 19, 2014, LePage wrote, “It is still in question whether current law allows for the current CON. We shall only know if the results are litigated.”

The other major issue raised by the foundation is the unavailability of inpatient beds for Boothbay region residents due to the merger. Prior to merging under St. Andrews license, the two hospitals’ combined bed allotment was 63 beds; the current maximum, due to critical access designation limits, is 25 beds.

“It is our opinion that the most egregious error in the analysis is the failure of the (CON unit) to equate the reduction in the number of hospital and nursing home beds in the county to Lincoln County Healthcare’s inability to provide for the needs of the communities it serves,” the foundation wrote.

“The majority of patients needing beds for recuperation or end of life care have not been able to be accommodated on the Boothbay peninsula since the closure of St.Andrews Hospital on October 1, 2013,” the foundation wrote.

Lincoln County Healthcare CEO Jim Donovan said he would not address legal issues raised by the foundation, but the healthcare organization is moving forward with a proposal to provide more inpatient beds.

“The board has authorized a letter of intent for a 10 bed construction project for the Village,” Donovan said, “We expect to have a CON application for LCH board approval in May and then it will go to MaineHealth board for approval in June.” Donovan said once approved by both boards, the CON request would be sent to DHHS.

Calls and emails to DHHS and the Attorney’s General’s office had not been answered by press time. On Monday, Rep. Bruce MacDonald said he would try to get an answer from the Attorney General this week.

To view the foundation’s rebuttal, visit www.boothbayregister.com or www.boothbaywellness.org.