ROCKPORT — An overhaul and expansion of the Pen Bay Medical Center’s Emergency Department is due to get underway July 5, a redesign that the hospital said will incorporate a more secure and efficient response to medical trauma, illness and mental health crises.

The latter has emerged as a national healthcare concern, and one intensified by COVID 19.

Health care and social service organizations are directing money into programs and facilities to tackle myriad mental and behavioral health challenges and Pen Bay’s ED improvements are one piece of a response to a systemic problem that is only getting larger, said Mark Fourre, president Pen Bay Medical Center/Waldo County General Hospital, and former emergency room physician himself.

The Pen Bay ED, which is a core element of the Rockport medical campus, will not pause functioning as the area’s emergency care facility during its rebuild, but there will be new temporary entrances and parking as the two-year, $9 million project takes shape (see sidebar).

Built in the mid-1970s, the 99-bed PBMC has expanded on its 63-acre parcel, which lies between Route 1 and the ocean.

Last year, a new $16 million physicians’ office building was built on the Rockport campus. Eight years ago, Pen Bay opened the then newly constructed 9,740-square-foot hospice facility, the Sussman House.

The existing ED, however, has remained primarily unaltered since 1997. Minor adjustments were made here and there, with hallways and doors relocated and new rooms carved into the existing footprint; yet, all have been fixes, not changes.

“It is way too small,” said Fourre “We are still able to deliver high quality care. But it is a struggle to do so, and the patient experience on a busy day is not something we feel is appropriate or up to our expectations, or the patient’s expectations.”

With 13 exam rooms, the ED currently handles approximately 22,000 patients a year; 55 is the daily average, although that increases to 70 during the summer season.

Patients stream in from the broader Midcoast — the peninsula communities of Cushing, Friendship and Port Clyde, the islands of Penobscot Bay, inland towns of Washington, Warren and Union, as well as the more populated service centers of Rockland and Camden.

Who shows up in the ED reflects the region’s way of life and its economies. Lobstermen, loggers and carpenters rush in with occupational wounds. The elderly who live alone, or in nursing homes, are transported daily to the ED. They may have fallen and been found the next day on the floor, or they suffered a stroke.

Vehicular crashes are regular occurrences on local highways and rural roads. Hikers, bicyclists and skiers filter in from the outdoors with injuries. Assault and domestic violence victims, and drug overdose patients, are not unusual to treat. 

There are also the incarcerated who need medical help, inmates from the maximum security Maine State Prison in Warren, or the Knox County Jail in Rockland.

Then there are the visits of those troubled by nagging coughs and pains. Maybe the flu turned into pneumonia, or the dysentery acquired on trip to the tropics just won’t go away.

Add to the mix a growing number of patients suffering mental health crises, and who seek help at the hospital’s Psychiatric and Addiction Recovery Center (PARC).

The ED sees it all, 24/7.

And at the busiest times, which can spontaneously erupt, patients line hallways on gurneys, with no privacy, as medical staff and other patients pass by. And it is hard to adequately monitor patients in the hallways, said Fourre.

“Daily census and activity logs demonstrate periods of time where there have been 22 patients in the ED with 13 rooms,” wrote Will Gartley, of Gartley and Dorsky Engineers, the Rockport company that represented MaineHealth at municipal planning board meetings earlier this spring.

“We’ve known for some time we’ve needed more emergency rooms,” Fourre said. “Plus, the doctor and nursing area is congested.”

 The latter is a small square space in the middle of the ED. There, staff lean over computers, doing paperwork or watching cameras that keep an eye on patients in various rooms. They peer through the glass windows to watch patients in the hallways, confer with colleagues and first responders who wheel patients in from ambulances, or law enforcement personnel accompanying prisoners.

Fourre looks forward to the redesign, which is under the direction of E4H Architects, healthcare and health science and technology architects whose primary office is in Boston, but have offices in New York City, Texas, North Carolina, Vermont as well as Portland.

The Rockport Planning Board approved the expansion project in May, and the building permit was due to be issued in late June. Lead contractor is the Lewiston-based Hebert Construction. 

Hebert recently completed the 41,513-square-foot Health Center at Pen Bay’s Rockport campus. and the Watson Medical Arts Building, in Damariscotta, and also part of MaineHealth. That 3-story steel frame structure is approximately 39,500 square feet in size.

Pen Bay ED upgrades involve expanding the emergency room footprint by 5,600 square feet, making the ED a total of 8,000 square feet in size.

“Volume trending data indicate the need for expansion as well as specific attention to a dedicated behavioral health component,” said Pen Bay, in its submissions to the Rockport Planning Board.

Demographic trends shape the changes

Hospital emergency departments have changed dramatically over the decades, but the public’s lexicon dates back a century.

“Going to the ER is what people say,” said Fourre. “And that stands for emergency room. That’s because when emergency services began, it was a room. You were either able to drive, or walk, to it. They called the only laying-flat vehicle in town, which was at the funeral home – they were the ambulance service.”

These days, a substantial part of an ED’s function is to care for trauma patients.

But, there are other indicators of changing demographic and social trends.

“People are bigger and care is more complex,” said Fourre. The population is, he said, “unequivocally older.”

That requires more complicated levels of care, more people in the room tending to the patients, and more pieces of advanced technological equipment. 

“Patients are increasingly sicker,” added Fourre — high blood pressure, diabetes, pulmonary disease — they have become common ailments that can spin out of control.

MaineHealth’s mission, the large nonprofit says, is, “dedicated to improving the health of our patients and communities by providing high-quality affordable care, educating tomorrow's caregivers, and researching better ways to provide care.”

Expanding on that, Fourre said he works to instill the passion for service through the two medical campuses he oversees.

“Throughout my career, which involves becoming an emergency physician, training emergency physicians as a residency director, being an ED director, being a chief medical officer, and now the president of a hospital, that whole concept of service is central to everything,” he said.

“When I recruited medical students for residency and when I recruited emergency physicians, and now when I recruit any type of physician, that’s what I’m looking for — is somebody who has that clear focus in terms of what their mission is. The mission for MaineHealth is working together so our communities are the healthiest in America, and the ED is there to support that mission.”

Reach Editorial Director Lynda Clancy at lyndaclancy@penbaypilot.com; 207-706-6657