Glens falls hospital inpatient behavioral health

By Mark Frost, Chronicle Editor

Paul Scimeca, 59, has been Interim CEO of Glens Falls Hospital since Jan. 1. We decided to check in to see how he’s doing and what he’s thinking.

He’s new to the job but not to the hospital, where he’s worked for 32 years.

He praised the hospital’s personnel — “I am extraordinarily proud of how well, no matter what the challenge is, we take really good care of people” — but also frank as to needed improvements.

When The Chronicle spoke of people who’ve told us of bad experiences with the Emergency Room, Mr. Scimeca said he’s told people jokingly but truly, “I won’t retire until that ED is fixed. I mean, it is the one area in our organization that we have to do better. I am not proud of the experience for patients there, particularly for that behavioral health population. We have to fix it….The quality of care is there. But the experience is not what we want it to be.”

Mr. Scimeca detailed some of the challenges the Emergency Department faces.

“One of the biggest challenges that we’re facing right now is the variability, the volatility of volume, which is something that we’ve never seen before….

“Hospitals used to be fairly predictable in terms of their volume.”

Now, though, “there could be a day in the ED that has 90 patients and the next day has 150. And…because most of the admissions come through the ED, the same thing happens with our inpatient volume — we can swing 40, 50 patients in 48 hours. That is new. And that’s not unique to us. A lot of hospitals are seeing that volatility.”

Mr. Scimeca said, “I think some of it has to do with delayed care. I think some of it has to do with people trying to manage things in other settings before coming to the hospital. So it is delayed.

“And I will tell you, the patients who are here today, they are very sick. Not COVID, but they’re very ill, the acuity is very high. So yeah, we’ve had moments and occasions in the ED where the experience is not what we want it to be.”

On April 15, the day The Chronicle interviewed Mr. Scimeca, he said the hospital had 205 patients in beds, “where we budget to be around 140-ish.”

He said, “People are sick…People say, ‘Oh, my gosh, you have so much COVID in the hospital.’ It’s not — 10 of those were COVID. We had a little baby boom, you know, the Snuggery was busy. Behavioral Health was very busy. Med surg [surgery] was very busy. It was busy all throughout the house.

“And when we get into those surges…people will work extra, they will take on shifts. And our staff is just extraordinarily resilient to rise to the occasion when things get busy.”

In the Emergency Department, Mr. Scimeca said, “we see a significant number of behavioral health patients….

“And one of the things that has happened over the last couple of years is many organizations have chosen to limit the number of behavioral health patients that they see. This is particularly true for, for example, adolescent and pediatric inpatient facilities.

“So we have a child who comes in and needs advanced inpatient care — we don’t do inpatient Behavioral Health here for adolescents and pediatrics. If we need to find them a bed, that’s a challenge….

“We just had a patient here for two full weeks before we could find them a bed. That’s two weeks in the ED — because we’re not able to admit them, and we can’t send them out.”

“We also, not this week, but the week before, we started off Monday morning with 19 behavioral health patients in the ED. That’s with our adult unit full — 19. So that creates challenges in the ED.”

(Last week Ellis Hospital in Schenectady announced the temporary closure of its inpatient adolescent mental health unit due to the severe shortages of children’s mental health workers.)

Mr. Scimeca said Glens Falls Hospital’s Emergency Department also struggles because “it was built in the 70s…It is not built to accommodate the kind of care that has to happen now.”

On the upside, he said that “in retrospect..,the best thing that happened is that we didn’t renovate the ED three or four years ago, because we would have had to change a lot of that on the fly for COVID, because the way people were building ED’s was not going to work during a pandemic. So now we know that….

“One of the things that I have tasked our team here with is…we’ve got to fix the ED, because those experiences, some of them are just driven by the environment we’re trying to operate in.”

The Chronicle asked: Wasn’t there state aid Glens Falls Hospital received several years ago to build a new emergency de partment at the hospital’s west entry?

“We did,” Mr. Scimeca replied. “We received about $19 million in state funding to support a bunch of things. But at the end of the day, it was really to support building a new ED.

“And reality was, even with that $19 million of support, we couldn’t afford it.

“We were also pretty fortunate. We went to the state and said, Hey, this is the position we’re in. Can we use it for something else? And the state was great to say yeah, you can actually use it for other capital expenses, and we’re actually using it to pay down some of our debt.

“So we’re literally getting the last of that $19 million of funding coming in next month….Frankly, it puts us in a better financial position, so that the time comes to go finance the ED project, we’ll be in a better position.”

Once they’ve decided what they want in a new Emergency Department, said Mr. Scimeca, “then we’ll figure out how much it’s going to cost and how we’re going to pay for it. And it will probably be a combination of we’ll look for some grant support, we’ll look for some state support, we will look to the community for philanthropy support. They’ve always been extraordinarily generous to us.

“We’ll probably take some money out of the bank, and we’ll probably take out a big loan. But we got to fix the ED, because those experiences, some of them are just driven by the environment we’re trying to operate in.”

Says Covid shows ‘nothing replaces care at the bedside’

“We’ve learned a lot in the last two years,” says Glens Falls Hospital Interim CEO Paul Scimeca. “One thing that we’ve learned is nothing replaces the caregiver at the bedside.”

He says, “Pre-COVID, there was definitely lots of discussions about, what really will the role of hospitals be going forward? Will a hospital really become just an ED [Emergency Department] with maybe an intensive care unit and an OR [Operating Room] attached?

“And I think one thing that we all discovered, or we knew, but was reinforced in the last two years, when there are challenges faced in our public health world, people turn to hospitals.

“They came here when they needed to get testing, they needed to get a vaccine, they needed monoclonal antibody treatment, they needed intensive care, they came to the hospital.

“That’s what they knew. That’s the safety net for the region. And when that happens, there’s nothing that replaces care at the bedside.”

‘Glens Falls needs an acute care hospital’; sees Albany Med link being validated

“I will tell you that personally, as the leader of the organization, I am optimistic about the future” of Glens Falls Hospital, says its interim CEO Paul Scimeca.

“One of the things that was again, reinforced by the last couple of years, is that there needs to be an acute care hospital here in Glens Falls….

“Today, we have 195 patients. Where are they going to go?…We know that there’s not 195 beds available elsewhere in the Capital District, we see that data every single day, it is tight. This past January, when things were really, really tight, we were gridlocked in the Capital District.

“We had three patients one day — I’ll never forget — we had three patients, we needed to find a bed for, a higher level of care. And the only place that had beds was up in Burlington.

“And we talked to the three patients and their families. One agreed to go. The other two said, I’m not going up to Burlington, I’ll take my chances here or I’ll wait for a bed to open up either here or in Albany.

“And for me, that was a reinforcement that our decision to affiliate with Albany Med was the right decision, because that’s where we relate to, that’s where people go to when they need a higher level of care.

“And so what’s the long game? The long game is being part of a system. Independent hospitals, there are very few these days who are able to exist independent and certainly not one that is in a rural area.

“So, our long game is continue to develop and work in partnership with a system, to look at services, to look at our configurations, to figure out long term strategies for success with workforce, to grow our own, to recruit our own.

“It’s going to be a combination of a lot of things, but the long game is, as being part of the system, how do we really take best advantage of that for all of us collectively involved, so we can be assured that when patients in this region need care, it’s here for them.” — Mark Frost

‘Interim CEO’ Scimeca would love to have the job permanently

When Dianne Shugrue announced her decision last August to retire as Glens Falls Hospital’s CEO, the Board of Governors promoted Chief Operating Officer Paul Scimeca to be the interim CEO as of Jan. 1, 2022.

Mr. Scimeca, 59, has spent 32 years working for Glens Falls Hospital.

Does he expect to become permanent chief executive officer?

“I hope to be,” he replied. “This is my heart. This is my community.”

“I love the job, because I am so passionate about this organization. And I have seen us do incredible work in the most trying times.“

As to the future, he says, “I think timing is everything. There was a lot going on at the end of last year. We wanted to make sure there was a very smooth transition upon Dianne’s retirement. I’m so fortunate that we have such a great board to work with.

“We all collectively agreed at that point in time, the most important thing was continuity — a continuity of leadership for the people who work here, for this community, for working with Albany [Medical Center]. And I could provide that and I was so honored to be asked to take on that role.

“We’ll figure out the rest as we go along.” — Mark Frost

glens falls hospital inpatient behavioral health