A new report by an outside watchdog has identified several issues with patient care at Calais Regional Hospital, including delays for those seeking breast cancer screenings, billing mistakes that are time-consuming to fix and poor communication between management and frontline workers.

The watchdog, an ombudsman who was recently appointed to monitor the hospital’s patient care during its ongoing bankruptcy proceeding, also gave some positive feedback based on his review of hospital records, a visit to the facility and interviews with patients, staff and other health care professionals.

The ombudsman is a Belfast-based consultant named Jeffrey Brown and he found that patients have expressed a willingness to keep going back to the hospital and particularly appreciate its home health and hospice programs.

He also noted that the hospital has recently hired an experienced quality management director to help address the documentation problems that state health officials flagged during an inspection in March, which helped prompt the appointment of an ombudsman.

But in the 10-page report filed on Monday, Brown cautioned the leaders of Calais Regional Hospital to be vigilant about identifying areas where quality is slipping, especially given the hospital’s ongoing financial struggles that include millions in outstanding debts and steep revenue shortfalls related to the coronavirus.

“It is important to note that conditions that may compromise patient care quality and safety can arise quickly and insidiously as an unintended consequence of changes, e.g., in staffing, technologies, processes, clinical environments, or organizational structure,” Brown wrote. “This is true for any hospital, large or small, but it is a heightened concern in hospitals that are struggling financially, and which must consider the risk-trade-offs of belt-tightening and quickly detect and mitigate any deleterious effects of change.”

Brown declined a request for an interview.

After canceling many non-essential services during the pandemic, Calais Regional Hospital said in late April that it would eliminate 10 percent of its staff and warned that it might have to close its doors by June without outside financial help. It has more recently been awarded more than $3.7 million in federal stimulus funding, which has allowed it to stay open.

DeeDee Travis, a spokesperson for Calais Regional Hospital, said that the hospital made staff reductions on April 27, but she did not confirm how many workers were let go. She also noted those changes happened before the ombudsman finished his interviews and visited the hospital for the new report.

Travis said that the hospital was already addressing “many” of the issues highlighted in Brown’s report, since state health officials had highlighted many of them earlier this year. And she said the hospital was “pleased” with the sections of Brown’s report that highlighted the “quality care, satisfied patients and the value of the services” provided by hospital staff.

The ombudsman’s report found the hospital’s care “has not declined significantly, nor been materially compromised based on documents reviewed, onsite observation and information elicited during interviews,” Travis said.

Todd Ricker, a labor representative for the Maine State Nurses Association, the union representing more than 50 nurses, medical lab scientists and technologists at Calais Regional Hospital, said he’s not aware of any union members losing their jobs.

The nurses and lab scientists have been in contract negotiations with the administration since October 2018, when their last contract expired. A newer technical bargaining unit is still negotiating as well.

Ricker said he agrees with the findings of Brown’s first report, including that frontline workers have been in the dark about the hospital’s future and feeling “anxiety” about that “uncertainty.”

“It paints a picture of a hospital that is run in a top-down manner with resulting problems that frontline staff are willing and able to help solve, except that management is not properly communicating with them and not giving opportunities that should help to get the hospital back on its feet,” Ricker said of the report. “That said, these staff are working really hard in really difficult circumstances, and it shows that patients still seek care at the hospital.”

When a judge appointed Brown to monitor the patient care at Calais Regional Hospital during its Chapter 11 bankruptcy restructuring, he also tasked the ombudsman with reviewing the role of Envision Physician Services, a Tennessee-based company that the hospital hired to staff its ER doctors beginning on Feb. 1.

Envision replaced a Maine-based company that had offered a similar service for higher fees. It also employed the doctor involved in a Feb. 15 case that was among the reasons state health officials became concerned about Calais Regional Hospital’s readiness to respond to the coronavirus pandemic and requested the appointment of an ombudsman.

In that case, the Envision doctor was unable to intubate a patient who was having trouble breathing, prompting the hospital to call in local paramedics to complete the lifesaving service. The doctor has not returned to the Washington County hospital since that event, which the hospital has previously said did not have any bearing on its readiness for the pandemic.

Brown did not specifically address that case in his report, but he said that Calais Regional Hospital has been updating its procedures for vetting and training new contractors. He also said that it should work with Envision to determine a set of physicians who can consistently rotate through the ER in order to build a rapport with its nurses and technical staff.

As part of his ombudsman assignment, Brown is supposed to file additional reports on Calais Regional Hospital every 60 days.