Editors Note: The Bangor Daily News was unsuccessful in attempts to interview officials at Eastern Maine Medical Center for this story. EMMC officials said they would respond only to written questions. The following is the text of the NEWS’ questions, and responses from the office of Eastern Maine Healthcare Vice President Jerry Whalen.

Question 1: How would you describe the competitive environment between St. Joseph Hospital and EMMC today?

Q2: What about in 1993?

Q3: How would you characterize how it has changed in the last seven or eight years?

Q4: If relations between the two hospitals were better, would cooperative efforts result in improved health care options for the public? If so, what would they be?

Q5: What specifically happened during negotiations between officers of St. Joseph and EMMC-EMH in 1993 and 1994 concerning a merger, sale or joint effort?

Q6: Did you offer to buy St. Joseph?

Q7: Did you offer to guarantee Sister Norberta’s salary?

Q8: Is it true that you let it be known, once it was clear the negotiations weren’t headed toward any agreement, that EMH-EMMC would put St. Joseph out of business in a short period of time?

Q9: How did those negotiations change the relations between the two hospitals?

Q10: Have tensions between the two hospitals-systems reduced opportunities to collaborate? If so – in what ways?

Responses to Questions 1-10:

Cooperative efforts between hospitals generally do provide benefits to their communities, especially when those efforts improve access and reduce unnecessary duplication. Such collaboration is the stated mission of Eastern Maine Healthcare, and it is the reason that a number of regional hospitals have joined with Eastern Maine Medical Center through EMH to seek those opportunities.

Eastern Maine Medical Center has a long history of attempts to collaborate with St. Joseph Hospital. Those efforts began under Bob Brandow, the predecessor to Norm Ledwin. During his tenure, a committee made up of administrative and board representatives from both organizations commenced meetings to find common ground. That effort continued for a time after the arrival of Norm Ledwin in 1993. Eventually however, at the mutual agreement of both boards, the committee dissolved since nothing fruitful had come from the effort. In fact, Sister Norberta stated to the EMMC-EMH board chair, in front of witnesses, that it was her preference to compete with EMMC.

Subsequent to the dissolution of the committee, Norm Ledwin continued to engage Sister Norberta in various confidential discussions, seeking opportunities for collaboration. (It is EMH policy not to publicly disclose the nature of those confidential discussions.) When nothing effectively materialized, Mr. Ledwin accepted Sister Norberta’s premise that SJH and EMMC should compete.

To speculate on what outcomes could have been accomplished is difficult. There were tangible efforts toward a common laundry and a common biomedical waste program that were abandoned because economic and regulatory issues did not make them feasible. Opportunities to collaborate on laboratory services were declined by St. Joseph. Certainly, there are abundant opportunities to ask other EMH members for tangible evidence of the enhancements they achieved through affiliation with EMMC.

While relations between the two institutions are appropriately competitive from a business standpoint, clinical relations are good. EMMC and SJH largely share the same medical staff and the physicians understand the capabilities of each institution as they seek a facility for patient referral. In addition, the two hospitals collaborate in a variety of ways to the benefit of the communities we serve:

. Emergency patient triage

. Community disaster response coordination

. Shared infectious disease specialty services

. Joint education forums

. Shared bioterrorism planning

. EMMC support to the SJH cancer clinic

. Shared smoke free campus policies, including nicotine replacement therapy approaches

. Beneficial EMMC rate structure for SJH Medicare cardiac catheterization inpatients

Q13: Are doctors employed by EMH or any of its subsidiaries who are also on the medical staff bound by legal agreements against speaking publicly about patient safety concerns?

Response to Question 13: No.

Q12: Does EMMC-EMH seek to employ doctors?

Q15: Explain who benefits from physician groups being employed by EMH or its subsidiaries. How do they benefit?

Response to Questions 12 and 15:

EMMC is a local community asset*, governed by trustees elected by over 500 community corporators. It has finite resources, which are put to use improving health care in this community. In that sense, it serves the community best if private physicians recruit additional physicians. This private practice model preserves EMMC’s resources for other needs, including the medical equipment and personnel those doctors need to care for patients.

EMMC seeks to employ doctors only as a last resort. This has been the philosophy and practice of EMMC for some time. To memorialize this philosophy, at the Medical Executive Committee meeting of March 8, 2000, and the full medical staff meeting of March 14, 2000, the following resolution was moved, seconded and unanimously approved:

“To adhere to the following order of priority in mode of recruitment:

. Request existing private practices to recruit into their groups;

. Assist private practices to recruit when needed;

. Recruit physicians to the community as independent private practice either when existing groups are unwilling to recruit or hire, or when a suitable candidate desires to be independent; and

. Employ a suitable candidate directly when none of the above is successful.”

This board-approved resolution still stands as the official policy of EMMC. The final option of employment is implemented because the community benefits when necessary physicians assure access to needed care. Examples of the use of this option include EMMC’s hiring of perinatologists and trauma surgeons. Private physicians in both obstetrics and general surgery were approached on those needs, and they deferred to EMMC to recruit these types of tertiary specialists.

* St. Joseph Hospital is controlled by the Felician Sisters in Enfield, Conn.

Q11: How many active doctors have privileges at EMMC and of those how many were employed by EMH or any of its subsidiaries – today, five years ago, 10 years ago?

Response to Question 11:

The medical staff had 207 members in 1990, 249 in 1995, and is currently at 324 active medical staff. Total medical staff, including courtesy and affiliate was 297 in 1990, 336 in 1995, and is currently 402. This figure does not include residents. In 2001, 50.55 physician FTEs (full-time equivalents) are EMMC employees. This number was 37.8 in 1997, 41 in 1998, 43 in 1999, and 51.4 in 2000. These FTEs are filled by a variety of physicians with full-time or part-time roles. Specific employed physician figures for 1995 and 1990 are not readily available today.

Q14: Why was St. Joseph Hospital to be excluded from the HMO plan put forward by EMH and Blue Cross-Blue Shield in the 1990s?

Response to Question 14:

HMOs across the nation typically develop selective networks that do not include every provider in a single market, which gives the HMO negotiation power through the volume of the insured members of their plan. Such networks are common in southern Maine.

When Blue Cross first explored a new HMO product in eastern Maine in the early ’90s, EMMC offered Blue Cross competitive opportunities based on Blue Cross’ selectivity options. The HMO was never developed.

Q16: Has EMH or EMMC ever penalized or given less advantageous reimbursement levels to doctor groups that have indicated they’d prefer to be independent instead of being employed by a subsidiary of EMH-EMMC?

Response to Question 16:

EMMC does not generally reimburse physicians for patient care; insurers or government programs do. When a physician is employed by EMMC, he or she receives a salary and EMMC receives the insurer-government reimbursement. In certain limited instances, EMMC may contract with, and pay independent contracting physicians to provide patient care or administrative services. In any event, EMMC’s compensation to these physicians is at fair market value.

Q17: Why did the EMH system refuse to provide seed funding or assistance to Sunbury’s FQHC (federally qualified health center)?

Response to Question 17:

As stated in the response to Questions 12 and 15, EMMC has finite resources. EMMC felt these resources were better applied to our own Family Practice Residency Program and other priorities established by the hospital and its medical staff.

Q18: Does Norman Ledwin receive any compensation from EMH subsidiaries, for profit or not for profit, that is not reflected in IRS 990 or related forms?

Response to Question 18: No. (Question 19 was irrelevant because it asked for amounts of compensation.)

Q20: Is it true, as alleged by Dr. David Kliewer in a letter to the medical staff this year, that the first reaction from top EMMC-EMH administrators for help in attracting new anesthesiologists to Bangor was to ask if Spectrum would be willing to cease services to St. Joseph Hospital and Acadia Medical Arts?

Response to Question 20:

Spectrum’s first approach to EMMC asked for an exclusive contract, barring any other anesthesiologists from practicing at EMMC. EMMC’s response was to ask Spectrum if it would practice exclusively at EMMC.

EMMC board policy is to maintain an open medical staff where any qualified physician may practice.