Schenectady: ER care under one roof

PHOTOGRAPHER: Marc Schultz

Ellis Health Center, the old St. Clare's-turned-Ellis emergency room on McClellan Street, will close Wednesday, with those services moving to Ellis Hospital on Nott Street.

After 65 years in operation, one of Schenectady’s two emergency rooms will close this week in one of the city’s poorest neighborhoods.

Starting Wednesday, all health emergencies in the city will be handled at Ellis Hospital on Nott Street, where the hospital system has been expanding and modernizing its emergency department for the past two years. The entire $61 million expansion project is on track for completion by spring, but department officials say they’re ready for the uptick in visits expected once the ER on McClellan Street closes.

Still, the transition may prove difficult for the community in the short term. Many patients who visit the ER at 600 McClellan St. — the former St. Clare’s Hospital — have expressed concerns about traveling the 1.5 miles “across town” for medical services that have been in their community since 1949.

“They’re basically shocked,” said Rhonda Cady, a technician who’s worked at the McClellan ER since 1999. “They want an emergency room here, and if not an emergency room, they want a clinic.”

The closure has been in the works since 2007, when Ellis Hospital was still negotiating a merger with St. Clare’s Hospital. That year, Ellis requested state approval to expand its emergency department on Nott Street to consolidate ER operations in Schenectady County — one of the recommendations of the Berger Commission in 2006.

Crews broke ground on the expansion project in 2012. In September, the new portion of the expanded ER opened and the old space closed for a gut renovation. The project will double the size of the ER, to 38,000 square feet, and accommodate 90,000 visits a year. It will feature 13 more rooms for a total of 67, all private. A bigger ambulance bay will be able to accommodate 10 ambulances at a time.

Ellis Medicine officials are confident that a single emergency department with the full backing of the hospital’s resources at Nott Street is best for the city. They’re reopening a fast-track area with 17 beds that was closed during the renovations, to replace the 17 beds at McClellan Street.

“This will be a brand-new facility,” said Dr. Joanne McDonough, chairwoman of emergency care at Ellis. “If you think about the less urgent population, the colds and flus, they can get taken care of anywhere. . . . Generally, we don’t get very, very sick people at McClellan. But we get some, and I have no doubt that I can give much better care to a critically ill patient at this place than I can over there.”

The McClellan Street facility was a full-service emergency room. But the Nott Street facility comes with all the hospital support services.

“You can get an MRI here 24 hours a day,” McDonough said. “You can get an ultrasound 24 hours a day here. We have the cath lab here. If you think about a critically ill patient, they’re going to get admitted to the hospital anyway, which means I’m going to have to put them in an ambulance and transfer them somewhere, and every transfer has a lot of inherent risks.”

Of the 85 to 100 patients who show up at McClellan Street each day, about five wind up admitted to Nott Street.

“It’s not like we’re just saying, OK, we’re cutting this service,” McDonough said. “We’re just moving it. We’re taking all the staff, all the hours, and we’re opening up new beds here.”

Vital location

But the McClellan Street ER is central to some of the city’s poorest neighborhoods — Central State Street, Eastern Avenue, Vale and Hamilton Hill — where transportation is not always easy to come by. Transportation via ambulance is always an option, but even short ambulance rides come with a high price tag that costs someone — patient, insurer or taxpayer. Many patients arrive by car, taxi, bus or foot. Medicaid will cover the cost of these trips for low-income patients meeting certain criteria.

Ellis officials have been working with the Capital District Transportation Authority and Mohawk Ambulance Service to make sure drivers know to bring patients to Nott Street starting Wednesday.

“We also have a community shuttle that stops in different locations to help patients who need to be transported from one campus to another,” said Ellis spokesman Matthew Van Pelt.

It’s hard to tell just how many visits to McClellan Street are true emergencies; ERs are often used for routine care or chronic conditions that could be handled by primary care offices.

At its peak in 2000, the ER handled more than 38,000 visits. In 2013, a few years after the merger, visits had dropped to about 32,460. Part of the decline is because of a nurse navigator program, which taught patients where to go for non-emergency care.

Ellis officials say a big part of the ER consolidation has included signing people up with primary care doctors. Ellis operates three primary care sites in the Cushing Center building on the McClellan campus, as well as outpatient services like ear, nose and throat; breast surgery; diabetes and asthma education; imaging services; blood draw; CT scans; mammography; MRI; and an operating room for ambulatory surgery.

“In any ED, some percentage of patients are what we call un-doctored, and if you have high blood pressure or diabetes or asthma, the ED is not the best care for you,” McDonough said. “Your chronic conditions would be better cared for by a primary care doctor. The people who maybe have a hard time getting over to Nott — maybe they’re walkers to McClellan, maybe they were using us for non-urgent things — they would be the perfect people to transition to primary care.”

One alternative for the un-doctored who need non-emergency care is the urgent care center. Ellis Medicine has opened several such centers across the Capital Region, including in Latham and Malta.

Initially, Ellis Medicine planned to transform the old St. Clare’s ER into an urgent care center to handle allergies, flu, pink eye, strep throat and other such minor illnesses. But that plan was abandoned.

“At this time, there aren’t any plans to turn it into urgent care,” Van Pelt said Friday. He couldn’t say what Ellis plans to do with the old ER once it closes.

Spreading the word

For the past month, Ellis has worked with community organizations, including Hometown Health Centers on State Street and the City Mission of Schenectady, to let residents know about the upcoming ER consolidation. The signs outside the McClellan Street campus have been updated to indicate the change, and social workers at the entrance let visitors know about the change and answer questions.

Colleen Liberatore was born at St. Clare’s, and said some in the community are sad to lose the emergency room.

“I think it just feels like losing a part of Schenectady,” she said.

Liberatore is a nurse manager of the Ellis emergency department, and wholeheartedly agrees that a consolidated emergency department will better serve the city.

“We’re just letting people know that this was always the vision of the Berger Commission,” she said. “This is why we’re building the Neil and Jane Golub Center for Emergency Care. We want to accommodate everyone under one roof.”