Gloucester's Addison Gilbert Hospital has, unfortunately, not been a full-service facility for some time.
But it is becoming even less so as the hospital's corporate parent, Northeast Health System, struggles with increased competition, a declining patient census and declining reimbursements.
Northeast, which also owns Beverly Hospital and Bayridge Hospital in Lynn, has eliminated seven full-time jobs at Addison Gilbert — part of an ongoing move to cut 100 jobs throughout the hospital chain.
Now, hospital officials have also announced the closing of the cardiac rehabilitation maintenance program, one of two Addison Gilbert outpatient programs Northeast CEO Ken Hanover has said the corporation will be eliminating.
All these layoffs and changes are part of an effort to cut $15 million from the coming fiscal year's projected operating costs, Hanover told Gloucester city officials in a visit earlier this month. And, given his announcement, the dropping of the cardiac rehab program — in large part, an exercise, counseling and support services program for recovering heart patients — cannot be called a surprise.
But it is disconcerting. And while Hanover insists that none of this puts Addison Gilbert's "core services," including surgery and the emergency care, in jeopardy, local officials have cause for concern.
Hanover, to his credit, is being vastly more cooperative and forthcoming than his arrogant predecessor, Stephen Laverty. And he deserves credit for that — even if Laverty's act was hard to top, or bottom, as the case may be.
But it's also clear that Hanover and Northeast are not fully in control of the forces squeezing health care providers. He told city councilors at the beginning of the month that this round of layoffs and other cuts might not be the last.
"I wish I could say it's over," he said, "but it probably isn't."
All of this is happening less than a year after the corporation eliminated 22 middle managers in November 2009.
The moves come at a time when patient discharges at Addison Gilbert are down 6.6 percent from a year ago. And Hanover said that, even with a $15 million cut in spending, Northeast is predicting just a 2 percent operating margin for the coming year. He expects to be running a deficit by 2013, unless there are further changes.
They also come about six months after Hanover launched a campaign to bring six new primary care doctors to Addison Gilbert — a figure the new CEO said would be the best number to serve Cape Ann's population and to help the fiscal health of the rest of the corporation by generating referrals. So far, however, only one new primary care doctor is in place.
That can be interpreted as sending an unsettling message — that prospective doctors don't want to get aboard a sinking ship.
They also come at a time when Northeast is facing brutal competition from Partners HealthCare, one of the medical giants in the state, which recently opened a major outpatient center in Danvers.
There have been regular complaints that the use of the local hospital has declined in part because Northeast diverts too many patients to Beverly.
That may be part of the problem, and hospital leaders in the Laverty era wrongly tried to hide that issue from the public.
But Hanover contends that this round of cuts will not lead to more emergency patients being diverted to Beverly — and he has been vocal in urging residents of Cape Ann to use Addison Gilbert.
"The future of the hospital relies on the community to utilize it," he said.
That is an honest message the community must take to heart. If Gloucester really wants a local hospital, its people have to use it. They must not always assume that Boston, Beverly, Danvers or Peabody are better.
In short, the fate of Addison Gilbert is not just in Hanover's hands, which seem increasingly tied by health care's harsh fiscal realities.
It is also in the hands of local health care consumers — in other words, the people of Cape Ann.