No other hospital in Massachusetts worries when they call for an ambulance to transport a patient whether that ambulance will show up or not. But our clinicians at Nantucket Cottage Hospital recently found themselves in this dilemma when the ambulance companies that previously travelled to the island to transport patients to the mainland stopped coming. For these companies, it was a matter of insurance reimbursements not covering their costs. For our team and some of our patients at NCH, it was a crisis.

These were patients who were not eligible for a MedFlight transport, typically suffering from behavioral health issues, who required ambulance transport to a licensed psychiatric hospital or drug treatment center. While there are typically only two or three of these cases per month, it is always important to get our patients the best possible care, and to ensure they are safely and efficiently transported if necessary. Nantucket Cottage Hospital is not a licensed ambulance service, so we requested aid from a number of state and local agencies to assist us in solving the issue – the Department of Public Health, the Department of Mental Health, the state Office of Emergency Services, the state Rural Hospital Program, the Massachusetts Hospital Association, and MassHealth among others – but none could offer a solution. In the interim, with no other options immediately available for these patients, Nantucket County Sheriff Jim Perelman volunteered his resources to conduct these transports off-island and we were grateful for his assistance.

This wasn’t just a hospital issue – it was an issue for the entire community. So, stakeholders representing numerous town agencies and island organizations, including the Nantucket Police, Fire and Sheriff departments, along with NCH representatives, met to discuss the situation. Our chief operating officer and chief nursing officer Greg Bird, along with Nantucket Police Sgt. Kevin Marshall and the Behavioral Health Task Force continued to seek out other options and alternatives. Thanks to their persistence, we have recently signed a contract with Cape Cod Ambulance to conduct these patient transports from NCH to the mainland. Our state representatives, Sen. Julian Cyr and Rep. Dylan Fernandes, also helped to secure funding to cover some of the costs associated with these transports in the state’s FY19 budget.

Due to the high costs of getting an ambulance and EMT team to the island via ferry, funding for this contract will be an ongoing concern. But the Nantucket community should know this is just one example of the creative problem-solving NCH and our island partners must regularly engage in to best serve our island in situations where our remote geography presents unique challenges not faced by similar communities.

As I have mentioned in many venues over the years, Nantucket Cottage Hospital is just one part of the island’s behavioral health services system that works with other agencies and clinicians to treat patients.

One of the important roles Nantucket Cottage Hospital has in that system is to be the acute safety net for patients facing a behavioral health crisis who end up in our emergency department. Hospital clinicians and staff work tirelessly to stabilize these patients, provide medication when necessary, admit them to the hospital’s in-patient floor for safety and observation, and make all the necessary arrangements when a transfer to a licensed psychiatric facility is necessary. There is no other organization on the island positioned to fill this role, and it is a responsibility we take seriously.

Providing treatment and counseling to avoid these emergencies in the first place is also extremely important. That is why Nantucket Cottage Hospital is partnering with Gosnold, a recognized leader in addiction treatment and mental health services for over 40 years, to provide outpatient behavioral health services and crisis support, with primary care integration on the horizon.  It is why Nantucket Cottage Hospital will continue investing significant funds in substance use and behavioral health services through a series of grants from our Community Health Initiative to agencies providing services on the island. It also is why Nantucket Cottage Hospital provides operating space at no cost to our community partners in behavioral health, Fairwinds Counseling Center and PASCON.

Once again, we are grateful to our community partners and government representatives, as well as Cape Cod Ambulance, for coming together to solve this patient transport issue for Nantucket.

Margot Hartmann, MD, PhD

President & CEO, Nantucket Cottage Hospital