In America, losing one’s sense of autonomy runs strongly against our individualistic character; it tears at the fabric of our cultural heritage. We are a nation born of small villages, proud of our services, and reluctant to let go of what became community institutions. We cling to our small town independence and bemoan the loss of autonomy when the inherent inefficiency compromises an institution’s viability.
 
It is not surprising, then, that area residents will view with skepticism Porter Hospital’s potential path to affiliation with the 800-pound health-care gorilla to the north: the University of Vermont Health Network. If the merger comes to be, UVMHN will control Porter’s budget and, therefore, its very lifeline.
 
But is that a negative development?
 
The Porter Medical Center’s board appears to be leaning in favor. Many among Porter’s medical staff seem to agree as well. A community board has studied the potential of affiliation and most agreed the potential gained outweighs the loss of autonomy.
 
What’s the reasoning? 
 
In the best-case scenario, the loss of autonomy does not necessarily mean a loss of control. There would still be a Porter-based board of directors to advise the parent UVMHN board and reflect the county’s concerns. Porter’s operations would be little changed from a day-to-day perspective with a Porter CEO leading the show. And, most significantly, PMC would be able to tap into greater financial resources to create a far stronger medical facility. 
 
It is likely that, at least in the next several years, Porter services would be enhanced, our hospital and nursing home beds would be filled to greater capacity, our doctors would provide more surgeries and the hospital’s medical practices would attract more doctors to meet those expanding needs. That’s because Porter’s facilities are currently under-used and the UVMHN facilities are stretched beyond capacity. Porter Medical Center would likely be an outlet to provide more services and would receive needed financial investment.
 
In the near term, then, it may well be in Porter’s best interest to affiliate and expand its services and facilities to as robust an operation as it could possibly become. That’s the rosy scenario.
 
There are also practical considerations. In several areas, Porter faces critical needs. Its electronic medical record system, for example, is in desperate need of a transplant. UVMHN’s EPIC system is the perfect replacement, and part of the proposed agreement would be an influx of millions of dollars to install that system throughout the PMC network. Discussions have also touched on the possibility of a new medical office building, something Porter could not dream of having based on its current profitability. Smaller-scale enhancements and benefits would also emerge as part of a mutually beneficial partnership. Everything, as the song goes, could be coming up roses.
 
Even so, there are longer-term concerns. 
 
As it is currently being discussed, the agreement between PMC and UVMHN contemplates a five-year time frame in which Porter’s core services would not be altered; afterwards, presumably, all bets are off. It could be that in year six, if UVMHN determines that certain services at Porter need to be consolidated at UVM, Porter’s services could be diminished. And if that were to become a yearly exercise, it might not be long — 20 years or so — before Porter Hospital became a shell of its current self, and area residents would have to get used to traveling to UVMHN for what we consider today as Porter’s core services. 
 
Or it could be that the Champlain Valley’s population continues to grow and PMC is needed more than ever. 
 
Into which crystal ball do you choose to peer, and with what reliability?
 
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The appropriate response is that it is difficult, maybe impossible, to know what the world of health care will be two or three decades from now.
 
But looking ahead 20-30 years should be the town’s primary concern. The question should be: What are we leaving the next generation?
 
What should be certain is the bare minimum of services Middlebury-area residents will expect to receive from their local hospital. Town leaders should press that case. We should want the agreement with UVMHN to embrace in principle the medical services necessary for the greater-Middlebury area to thrive. Families must be confident they will have access to critical care and good family doctors. We need a healthy OB department so we don’t have to drive long distances to have babies and visit our doctors for the nine-months prior. It would be preferable to keep our current specialists and perhaps a few more. We should expect a hospital to provide a high level of emergency services, cardiac care and other basic necessities. To that end, our current medical community, and PMC board, should work together to outline the basic services needed and what could be reasonably expected.
 
And why not push to extend the 5-year moratorium on preserving core services — a ridiculously short period in the scheme of things — to 10 years. A decade is long enough to encourage UVMHN to actually invest in Porter’s facilities and gain a payback, whereas five years is like tomorrow — close enough to stall and do nothing, knowing a few years down the road services could be consolidated and provided less expensively from its home base.
And what of Porter’s exit strategy if things don’t turn out as planned? A liberal depreciation of the capital investment made by UVMHN on Porter’s behalf might be part of the deliberations — which will all be part of the process. Once the community agrees that affiliation is a logical next step, a letter of intent is signed and both sides delve into the nitty-gritty legal details of making the partnership work for both parties.
 
What UVMHN hopefully can understand is Porter’s vulnerability and the community’s fear of its hospital being diminished. If that is not its intent, then assurances in the contract will come easily. 
 
The role community stakeholders must play is to be sure we ask the right questions and seek adequate guarantees that our town’s viability — which requires adequate medical services — remains sovereign.
Angelo S. Lynn