New ER upgrades will elevate St. Lawrence County facility to become first designated Rural Emergency Hospital in New York state
By Tom French
Clifton-Fine Hospital is one of the smallest hospitals in New York state and one of only three inside the Blue Line, all of which are in the northern half of the park. Built in 1951 with about 20 beds, a maternity ward, operating room, and a staff pushing a 100, it was the brainchild of Dr. Robert Persson, the only physician in the area at the time, who recognized the need because of the booming economy caused by the Newton Paper Mill and Benson Mines. The two industries employed about 1,500 and the school had over 1200 students. Now, both industries are shuttered, and the school enrollment is less than 200.
Like many rural hospitals in the United States (nearly 200 have closed in the last two decades), Clifton-Fine has had to scale back due to changes in the economy, demographics, government policy, and reimbursement rates.
In 2021, the federal government established a new provider designation for participants in Medicare and Medicaid programs. Specifically designed for rural hospitals, Clifton-Fine is becoming one of the first in the state to take advantage of the new “Rural Emergency Hospital” (REH) designation.
Meeting modern needs
The change is designed to prioritize primary outpatient care and emergency services in rural areas with more significant medical procedures consigned to larger facilities in population centers.
According to Tom Sauter, hospital board chair, “The designation was created in recognition that small hospitals don’t have the same economies of scale that big hospitals do.”
As a result of the change, Clifton-Fine will no longer provide inpatient services.
Even before the new REH Designation was created in the Consolidated Appropriations Act of 2021, Clifton-Fine had been planning a major upgrade of its emergency room. Efforts, which began in 2018, were interrupted by the COVID pandemic and supply chain issues. Initial plans and grants had to be revised due to unexpected cost increases.
Through various grants, the state is providing $21.6 million for the roughly $23 million dollar project. The hospital has also raised over $850K through a capital campaign and expects to exceed its $1 million goal. The Northern New York Community Foundation has contributed $125,000 with an additional $25,000 for the Wilderness Health Care Foundation, the hospital’s fundraising arm. Multiple individuals and the Cloudsplitter Foundation have contributed, along with a host of smaller donations.
“One hundred percent of the personal gifts are from people with a connection to the towns of Clifton and Fine. Star Lake still has a sweet spot in their heart,” Sauter said.
A groundbreaking ceremony for the new wing was held on July 1. The new emergency room is expected to be completed by September of 2025.
Upgrades and expansions
The new, 10,000-square-foot emergency room will replace the current 800-square-foot facility built in 1951. Unlike the old ER, it will have two entrances – one for the general public and another for ambulances. It will include three emergency treatment rooms, a trauma room, a decontamination room, and three private observation beds.
“Emergency room patients will be stabilized and then transferred, if necessary, as soon as possible to a larger hospital that can provide the necessary level of acute care,” said Sauter. The average patient stay has to be 24 hours or less under the new designation.
The facility will also include new X-ray, CAT scan, and laboratory spaces.
The hospital will continue to provide outpatient services through its primary care clinic including physical and occupational therapy, laboratory and imaging departments, and a new pediatric physical therapy program – the only one in St. Lawrence County for small children with growth- and developmental-related issues.
‘Strategically positioned’
Sorrell was named hospital administrator in 2018 after over 25 years with the Samaritan Medical Center in Watertown. Clifton-Fine Hospital is an affiliate of Samaritan Medical Center.A lifelong resident of the North Country, she grew up in Clayton, “when there was the outdoor rink and one store. So I get small town, and it’s comfortable for me.”
“Little rural hospitals that are strategically placed like Clifton-Fine are critical in areas that are an hour-plus away from any trauma center or bigger hospital,” Sorrell said.
Emergency responders often refer to “the golden hour” – a goal to deliver patients to a medical facility within an hour.
“You can’t appreciate 40 miles (the rough distance to the nearest Trauma (III) Center in Potsdam) until you’re sitting in the middle of Cranberry Lake and realizing you’re a good 60 minutes away from a higher level of care. Add in if someone is an hour into the woods, and that makes you two or three hours away from your next level of care. We’re strategically positioned here.”
Dierdra Sorrell, CEO of the Clifton-Fine Hospital
Addressing community concerns
The change to the REH designation has been met with some concern from the community, but Sorrell and Sauter are quick to point out that many services at the hospital were discontinued decades ago. The maternity ward was closed in the late seventies. The last surgery was in 1989.
Another misconception is that the hospital has a skilled nursing facility, which has never been the case. The hospital has used “swing beds” to house people waiting for placement into a nursing home, and sometimes it has been utilized for patients who need additional rehabilitation before going home.
“To stay on the current path as a critical access hospital was not sustainable,” Sauter said. Government reimbursement rates for inpatient care can be as low as 60 cents on the dollar for Medicaid recipients (about 30% of the population), whereas outpatient services are less expensive and provide better reimbursement rates.
According to Sorrell, “The rural emergency hospital designation will actually give us an increase for some services compared to where we are now.”
Improving emergency response time
Another challenge for rural areas involves Emergency Medical Services (EMS).
Many of the area’s EMS volunteers work a significant distance from home. As a result, the response rates for ambulance calls were below 40% during weekdays. Clifton-Fine developed a unique solution. Realizing that a number of hospital employees were EMTs, the hospital board decided to allow employees not involved in directing patient care to respond “even if they’re on the clock.”
“You can have the greatest network of hospitals throughout the Adirondacks, but if you don’t have the volunteers to answer the ambulance calls because they work an hour away out of town, it’s difficult,” said Sauter.
Clifton-Fine Central School and French’s Trucking also adopted policies allowing employees to respond to emergency calls.
Response rates jumped to over 90%. The Star Lake and Cranberry Lake Fire and Rescue Squads were recently recognized as Agencies of the Year by the Regional Emergency Medicine Advisory Council and Fort Drum Regional Health Planning Organization in part because of this success.
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Staying solvent
Sauter also volunteered to be an ambulance driver. “That’s how we solved the challenge of access to emergency care locally. You got the chairman of your board to go drive the ambulance, and we release our employees who are EMTs to work on patients in the back of the ambulance.”
With the new REH designation, the hospital will employ close to 80 people between the 24/7 emergency room, primary care clinic, and other services.
“This little hospital has had to redefine itself over the years to stay alive,” Sorrell said. “When they stopped birthing babies and doing surgeries, it was probably devastating to the community, but in order to provide the majority of the needed services, we’ve got to grow, change, and reinvent ourselves to stay relevant.”
Image at top: An architectural rendering of the roughly $23 million dollar Emergency Room at the Clifton-Fine Hospital in Star Lake. The new 10,000 square-foot facility, slated to be open by September, 2025, will replace the 800 square-foot facility built in 1951.
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Thanks Tom for such a clear description of the challenges – and potential solutions – for health care challenges. Where else does a hospital board chair drive the ambulance? I always love how you capture the unique character of the people in your writing.
As a former resident of Star Lake and former nurse at CFH, I found your article very interesting. It is exciting to see progress and the continued health care offered!