A car drives along the entrance road to Calais Regional Hospital on Aug. 21, 2019. Credit: Bill Trotter

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Staff at Calais Regional Hospital recently had to ask local paramedics to stick a breathing tube down the windpipe of a critically ill patient after a doctor was unable to perform the lifesaving task himself.

That case is among the reasons state officials are now raising alarm about the Down East hospital’s readiness to handle the spread of the coronavirus across Maine — a pandemic that is requiring many U.S. hospitals to intubate patients who can’t breath on their own.

[Our COVID-19 tracker contains the most recent information on Maine cases by county]

But a spokesperson for Calais Regional Hospital said that the case of the doctor who couldn’t perform the intubation does not reflect on its preparedness for the virus. She also noted that the emergency room doctor, who was employed by an outside staffing company, is no longer working in the Washington County hospital.

On Feb. 15, that doctor attempted to intubate a man who was having trouble breathing because of an abnormal growth in his throat, but failed to do so, according to court records and a state investigation.

During that time, the patient reportedly lost his pulse and required CPR to be resuscitated, investigators found. Hospital staff also requested assistance from the Calais Fire Department, which sent paramedics who were able to successfully insert the breathing tube. The man was then taken by helicopter to a Bangor hospital for more treatment, and he has since recovered.

In part because of the way that case was handled, the Maine Department of Health and Human Services is now seeking to appoint a special ombudsman to oversee the care of patients at Calais Regional Hospital during an ongoing Chapter 11 bankruptcy case. The hospital first sought bankruptcy protection last September to help repay its debts.

In a document filed last week with the U.S. Bankruptcy Court, Maine DHHS said that it investigated Calais Regional Hospital in early March based on an anonymous complaint and discovered numerous violations of health and safety regulations. While the agency did not say whether the treatment of the patient on Feb. 15 by itself violated any rules, it did find that the hospital failed to quickly review and properly document the event.

Maine DHHS also raised concern about the timing of the hospital’s deficiencies. While COVID-19, the disease caused by the new coronavirus, has not yet been detected in Washington County, it has been confirmed in two neighboring Maine counties and across the Canadian border in New Brunswick.

“The Department’s patient care concerns are exacerbated because of the COVID-19 pandemic,” an attorney for Maine DHHS said in the March 25 court filing. The “troubling findings underscore serious competency and ethical concerns.”

State and federal regulators will now have a harder time overseeing the facility “given the pandemic’s demand on their limited resources,” the attorney said.

Calais Regional Hospital has opposed appointing an ombudsman to monitor its patient care, which will be the subject of a court hearing on Friday afternoon.

In a response to the state’s motion, attorneys for the hospital said that it began investigating the case the day it happened, but that the work was delayed because “key personnel” were on vacation. They said that many of the deficiencies identified by the state do not “present any immediate risk to patient safety.”

The hospital said that the handling of the Feb. 15 case was complicated by several factors, including the growth that was obstructing the patient’s breathing — which they likened to a kidney stone — and the fact that it happened on a Saturday, when the hospital’s contracted anesthesiology staff do not normally work.

“For a rural hospital that does not have 24 hour access to anesthesia specialists, the treatment provided by the physician was a normal course of action in the care of a patient in this condition,” Calais Regional Hospital spokesperson DeeDee Travis said in a statement.

“Thanks to the quick decisions that were made, the patient has recovered and is a grateful member of our community.”

Chief Kenneth Clark of the Calais Fire Department declined to comment on the case.

One experienced emergency room doctor said that intubating patients is a basic part of the job and that it’s very unusual a physician would need EMS workers to help with the task. It’s a skill that will become even more necessary in the coming weeks as the number of coronavirus cases continues to grow in Maine, along with the portion of patients who lose their lung capacity because they have become critically ill.

“It’s one of the most core skills in emergency medicine,” said Dr. Charles Pattavina, the former medical director and chief of emergency medicine at St. Joseph Hospital in Bangor and a past president of the Maine Medical Association. “In this time of COVID-19, when an increased number of patients will need to be intubated because of respiratory failure, it’s even more critical — if that’s even possible. There will be a lot more intubations under very difficult circumstances.”

Travis said that Calais Regional Hospital is working carefully to prepare for the arrival of COVID-19 and that this “case has absolutely no bearing on” that work, which has included regular meetings and coordination of resources by a committee that’s tracking the disease.

She also said that the doctor who was not able to intubate the patient is no longer working shifts at the Calais hospital, but did not provide more explanation except to say the change “has nothing to do with this case or any clinical care issues.”

In court filings, the hospital’s attorneys said the doctor had “decades of experience” but was working his first shift in Calais on Feb. 15 after completing an orientation. They also noted that the hospital’s nurses “did not get along” with the doctor, although why that was relevant was not clear.

The doctor worked for Envision Physician Services, a Tennessee-based company that took over the staffing of the emergency room at Calais Regional Hospital on Feb. 1. Envision replaced a smaller, Maine-based staffing company, BlueWater Health, as the employer of ER doctors in Calais and at Washington County’s other hospital: Down East Community Hospital in Machias.

Both hospitals said that Envision would provide the same quality of medical care more cheaply than BlueWater was able to do. Travis did not respond to a question about Envision this week.

A spokesperson for the Tennessee company, Aliese Polk, said the company prioritizes patients’ health and safety, but declined to go into detail about the physician who briefly worked in Calais.

“As a leading multispecialty provider group, Envision Physician Services adheres to the highest quality of care standards,” she said. “The provider in question is board certified in emergency medicine and trained to perform such procedures. The physician no longer provides services at the hospital. We cannot comment further on patient care issues due to patient privacy concerns.”

Pattavina, the physician at St. Joseph Hospital in Bangor, said the case reveals some of the danger in outsourcing work to companies such as Envision without being able to fully vet their physicians. While many providers from those companies do their jobs well, some may not be up to the task, according to Pattavina. He added that he knows the physicians who work for BlueWater and that they are “all good doctors.”

“The community has no idea that one day they had a great doc, and the next day, when the contract changes, they don’t,” Pattavina said.

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