MIDDLEBURY — It used to be that during business hours customers could pass freely back and forth between the Marble Works Pharmacy in Middlebury’s Marble Works complex and the adjacent Medicine Chest, a business that rents and sells home healthcare equipment, appliances and services.
With the abrupt Aug. 31 closure of the pharmacy (along with its Marble Works Pharmacy peers in Bristol and Vergennes) that is no longer the case.
The roll-up shutter between the Marble Works Pharmacy and the Medicine Chest was locked down on Thursday morning, covered with brown paper that rustled occasionally as pharmacy employees moved about inside, working to dismantle the business.
As it stands now the Medicine Chest, which is owned by the same entity that shut down the pharmacies — South Carolina-based Smith Management Services — is scheduled to close at the end of this month.
But not if Addison County Home Health and Hospice (ACHHH) has anything to say about it.
“The Marble Works Pharmacy has closed its doors. However, we may have an opportunity to save the Medicine Chest,” wrote ACHHH Chief Executive Officer Deborah Wesley in a Sept. 2 letter to Medicine Chest customers. “Our Board of Directors has approved a plan whereby ACHHH will consider opportunities to keep the Medicine Chest in our community. We are currently exploring details and we will work diligently to try to preserve this critical care partner.”
The day after reaching out to Medicine Chest customers, ACHHH issued a press release.
“The decision to explore the acquisition of the business was made because the products the Medicine Chest sells and rents are critical to the health and safety of many Addison County residents, including patients of ACHHH.
“At ACHHH we require an ongoing available supply of Durable Medical Equipment (DME) for our patients. Whether a hospice patient needs a hospital bed, an in-home oxygen user needs tanks or an ostomy patient needs supplies, we must assist patients in obtaining the DME they need in a timely manner,” Wesley said.
AN INTERVENTION
On Thursday morning, as legal and financial negotiations proceeded between ACHHH and Smith Management Services, Wesley sat in the back room of the Medicine Chest, conducting research in support of those negotiations.
“The Medicine Chest is an integral part of our community,” Wesley told the Independent. “As soon as these closures were announced, our board met and discussed the possibility of what we could do. We have to advocate for our patients, and if we have to stretch ourselves thin to make this happen, then that is what we will do. We’ll do whatever we can. This is our soapbox.”
Wesley’s other activities have come to a grinding halt while she works in support of this process, ACHHH Director of Development Maureen Conrad told the Independent Thursday afternoon.
“We’re very serious about this,” Conrad said. “This is a small niche business that is critical for folks in Addison County.”
There are similar businesses in Rutland and Burlington, she said, but they cannot provide the same timely — and personalized — service that ACHHH and its patients need.
“We can call the Medicine Chest and say ‘So-and-so is getting out of the hospital tomorrow and they need a bed.’ And they’ll say, ‘OK, we’ll have it ready by 10 a.m.,’” Conrad explained. “With the Rutland or Burlington companies that would take a few days.”
The difference is significant, Wesley told the Independent Friday morning.
“Hospice is a critical time for patients and their families,” she said. “Having to wait for goods and services affects their quality of life. The Medicine Chest has been timely and understanding. They’ve always been there in times of need.”
CHALLENGES
The Medicine Chest was founded in 1985. It was once owned by Porter Hospital, then by the late Bristol pharmacist Frank Buonincontro, who also owned the Marble Works Pharmacies.
The Medicine Chest was acquired by Smith Management Services on Jan. 1, 2017.
For a local nonprofit like ACHHH, acquiring the business would be no simple task.
As negotiations proceed, it’s not even clear yet whether the hoped-for transaction will be called a “purchase” or something else. The cost and timeline for the acquisition are still up in the air.
And it will not be inexpensive, Wesley and Conrad said.
“Part of the adventure will be finding the money to pay for this,” Conrad said. “We will be talking to people in the community.”
Assuming the finances work out, ACHHH still has to navigate state and federal regulations.
The biggest challenge will be getting help from the state of Vermont — which is understandably focused on the global pandemic right now — so that ACHHH can become a accredited vendor of Durable Medical Equipment.
“DME is Medicare/Medicaid-regulated industry,” Wesley explained. Further complicating the issue is the fact that ACHHH is a nonprofit and the Medicine Chest is for-profit.
Still, Wesley and Conrad are hopeful that the business can continue operating in its current home.
“We’re aggressively working to ensure that the Medicine Chest continues to provide services to the community,” Wesley said. “I can’t imagine Addison County without the Medicine Chest — I just can’t do it.”
HOSPICE MEDICATIONS
“During hospice, patients often experience pain and respiratory issues,” Wesley explained. “Medications such as (anti-anxiety medication) Ativan and (opioid painkiller) liquid morphine keep them comfortable.”
The Marble Works Pharmacy has always been accommodating to ACHHH’s hospice protocols, she said.
When Smith Management Services notified the community that it was shutting down the Marble Works Pharmacies, ACHHH had only a few days to ensure that its hospice protocols would continue uninterrupted.
All of the prescriptions handled by the Marble Works’ three locations were automatically transferred to local Walgreens locations on Sept. 1. Or they were supposed to have been.
The way that transition has unfolded so far has not inspired confidence in ACHHH.
“There was chaos at Walgreens,” Wesley said. “We were worried about our patients’ ability to get what they need.”
Indeed, as the Independent witnessed on Monday, a former Marble Works customer expecting to receive seamless service from the Middlebury Walgreens was turned away from the pharmacy counter because the hospice medication they needed was “not in stock.” When asked if they could transfer the prescription to another pharmacy, the person behind the Walgreens pharmacy counter told the customer that local pharmacies were backed up with an influx of Marble Works prescriptions and would be unlikely to fill anything in a timely manner.
Later this week, however, the pharmacist at Hannaford Supermarket in Middlebury, Patty Fogg, “stood up and said ‘I will partner with you, I will figure out how to make this work,’” Wesley said.
After several days of anxiety, ACHHH officials were relieved.
“We were reassured by her pleasantness and her awareness of how critical it is that there is an adequate supply of medications for our patients.”
Reach Christopher Ross at [email protected].