Union Hospital Merges with Delaware’s ChristianaCare, After Struggle to Save Local Care

NEWS ANALYSIS

Cecil County’s community hospital, the more than century-old Union Hospital in Elkton, is merging with ChristianaCare in Delaware, bringing the struggling local hospital into the fold of the nationally recognized teaching hospital and trauma center that dominates health care in the First State. While many questions remain about the practicalities of the merger, the fact that the local hospital will survive is a welcome outcome that had been in some doubt for several years.

Union will lose its independence and much of its identity in the agreement, which was announced Thursday (1/2/2020) after officially taking effect on January 1. The 72-bed local hospital will be officially known as ChristianaCare-Union Hospital and its Elkton real estate, which includes medical office space, will be dubbed “ChristianaCare-Cecil County.” Union, and its parent organization Affinity Health Alliance, now joins the Delaware institution which operates its main hospital in Newark, DE, Wilmington Hospital in that city, and the ChristianaCare emergency hospital in Middletown, DE. The Middletown operation, opened in 2013 with a $34 million, 36,500 square foot emergency medical services facility, is utilized by many southern Cecil County residents.

Christiana officials said in a written statement that the process of fully integrating the two health systems would take about a year and for the time being all operations in Cecil County would continue uninterrupted. “As we bring our organizations together, our number-one focus will be on providing uninterrupted high-quality, safe care to the people we serve, and on building relationships among our caregivers in an environment of collaboration and respect,” said Sharon Kurfuerst,, chief operating officer of ChristianaCare. “Together, we will examine our operating processes and our clinical services, and develop a thoughtful, methodical integration plan that builds on our values-driven culture and our shared commitment to excellence.”

It has been a long and difficult journey to save the local hospital, against a backdrop of changes in the way healthcare is delivered nationally and regionally, Maryland’s unique regulatory structure controlling hospital costs, and a statewide pattern of mega-hospital systems taking over smaller regional hospitals.

Union initially explored co-operation arrangements with the University of Maryland ‘s Upper Chesapeake Health operations in Harford County, but UM’s all-consuming, tight control of regional hospitals it has taken over left little room for Union to maintain local independence and services unless it ceded patients, and control, to UM with much patient care shifted to Aberdeen and Bel Air. Then Union sought an “affiliation” with LifeBridge Health, which is anchored by Sinai Hospital in Baltimore, that would have retained local control over services. But the state Health Services Cost Review Commission, which tightly controls hospital costs under a unique in the nation regulatory system, weighed in against the plan, concluding that Union was a “high cost” and low-volume facility

Dr. Richard Szumel became Union’s president and CEO four years ago—on 1/1/2016—and most of his tenure has been consumed with figuring out a future for the struggling community hospital, seeking out the partnerships and affiliation agreements with other larger Maryland medical institutions that ultimately did not work out. It was perhaps fitting that the Christiana merger was finalized on his fourth anniversary in his post, and he is staying on as president of the re-named Elkton hospital.

To some extent, Szumel is a bit like Captain “Sully” Sullenburger who landed the disabled plane on the Hudson River in New York many years ago, with Szumel landing the hospital in a safe harbor that is already well known to local residents. Hours after the merger was announced, Szumel told Cecil Times in a brief interview that he was preparing to spend much of the night at the hospital, meeting with the night nursing staff and other employees to re-assure them and discuss the merger.

A follow-up call to discuss the long journey toward the merger, and its future implications for health care in Cecil County, was scheduled for Friday morning but shortly before the time set for the call Cecil Times was contacted by a public relations official from Christiana saying that Dr. Szumel “was not to be a spokesman” on the merger.

The official statement, while predictable, didn’t answer many questions. “ChristianaCare and Union Hospital have been serving the people of Cecil County as neighbors for many years. This integration will advance our ability to make a positive impact on the health of health of every person in every community we serve,” ChristianaCare President and CEO Dr. Janice Nevin said. That includes providing high-quality, safe, affordable hospital care when people need it — and it also includes a wide array of services and partnerships to help people achieve their best health and manage chronic conditions where they live, work and play. We’re incredibly excited to welcome the caregivers of Union Hospital as we join together in service to the greater Cecil County community.”

The merger has been in the works since last June, when Christiana and Union signed a letter of intent to pursue negotiations toward an agreement. A Christiana spokesman said the merger had received approval from Maryland regulatory authorities and that the Elkton hospital would continue to be subject to state regulations by the Maryland Health Services Cost Review Commission. Delaware does not have remotely comparable regulatory structures for hospitals located in that state.

In response to written questions from CECIL TIMES, a Christiana spokesman said that the Union Hospital Foundation, which has long conducted fundraising activities to support the local hospital, “remains intact and all funds raised will continue to be used to support the health care needs of the greater Cecil County community…” County residents would benefit, although the statement does not commit to direct support for the hospital itself.

Local residents, in Cecil County and in Delaware, have long complained about elongated wait times at the emergency room at the main ChristianaCare facility, while Union’s emergency room has had limited services available, with more serious cases routinely sent to Christiana. CECIL TIMES asked if the Union emergency room be expanded and services upgraded, and would Union be utilized to help reduce emergency room wait times at Christiana. A written response did not directly answer the question and left open the possibility of “community” alternatives: “As the integration process is just getting under way, it is too early for us to speculate on the future state of specific services such as the emergency departments. Over time, patients and the community will begin to experience enhanced services and more convenient access to high-quality care—in the hospital and in the community.

In addition, Union’s agreement with the renowned Ashley Addiction Services, from Havre de Grace, to operate an addiction treatment program in Elkton will continue during the transition period and Union’s free-standing urgent care center services will also continue, the Christiana spokesman said. And “as the integration process continues, we anticipate that we will have many opportunities to enhance existing services or add new services to the community,” the spokesman added.

The Union-Christiana merger comes at a crucial time for residents of western Cecil County, who face loss of the aging Harford Memorial Hospital in Havre de Grace, where emergency and general hospital services were provided a short trip over the Hatem Bridge. Upper Chesapeake plans to close that hospital and re-direct patients to a new emergency room being built in Aberdeen and a general hospital in Bel Air, both in Harford County. Cecil County volunteer fire companies, which provide basic ambulance services, have been very concerned about the situation, fearing their crews would face longer travel times and be tied up with transfers to even more distant Harford facilities.

Wayne Tome, president of the Cecil County Fireman’s Association, as well as the Mayor of Port Deposit and EMS chief for the Water Witch fire company, told Cecil Times that no one from Christiana had consulted with the local ambulance services during the negotiations process for the Union merger. He said the new operators of Union should “reach out to the volunteer services” to discuss the future of medical services affecting the western sector of the county and whether enhanced services at Union’s emergency room would be available to keep patients in local care.