The local board that oversees Pen Bay Medical Center, Waldo County General Hospital, the Knox Center, Quarry Hill, the Sussman House and nearly all the physician offices in the Midcoast will be seeking public comment over the summer on a proposal to merge its operations under one statewide board.

The Coastal Healthcare Alliance Board voted June 6 to "take a draft plan into the community for discussion."

In a series of votes at nine of the 10 entities that make up MaineHealth, the individual boards decided over the course of the past month that "the time was right to engage their communities in a dialogue over what the organization calls 'unification,'" according to a news release from Coastal Healthcare Alliance.

The CHA Board and local hospitals have been in discussions internally for the past eight months.

The proposal, however, has been met with concern from physicians at both  Pen Bay in Rockport and Waldo County General in Belfast.

Those concerns were about the local community's losing control over its health care operations if a single MaineHealth Board is created.

The proposal under discussion would create a single, system-wide Board of Trustees for MaineHealth members, including CHA. The proposal also would leave in place local boards, which would retain significant responsibility for hospital services and other care delivered in local communities, according to the CHA news release.

"The inability to deploy resources across the system has become a significant problem for MaineHealth’s community hospitals in recent years, which are under increasing financial pressure because of changes in the way health care is being delivered," the release states.

Relatively simple procedures are moving into outpatient settings, while complex care is migrating to regional medical centers that can afford new technologies used by highly specialized providers, CHA stated in its release.

The result is that much of the revenue from surgeries and other procedures that sustained community hospitals in the past is no longer available to them, and many community providers are struggling.

Bill Caron, president of MaineHealth,  said, "Overall, MaineHealth is in strong financial shape. We believe that MaineHealth is positioned, as a system, to deliver the right care in the right place at the right time for all our patients.”

The news release states that while unifying MaineHealth members under a single budget overseen by a system Board of Trustees will strengthen local health services and help preserve community hospitals, "the proposal has stirred debate within MaineHealth’s member boards. The new structure being considered leaves in place a strong role for local boards and includes safeguards aimed at making sure communities will continue to receive the services they need."

The governance proposal under consideration includes local oversight of care quality and the credentialing of doctors and other providers, a continued relationship with local donors, a defined role in the budget and planning process, and oversight of community health initiatives. The proposal also guarantees local representation on the system board for at least the first five years and requires any significant changes in local services to be approved by 67 percent of the system board’s members, according to the news release.

“It is very important we preserve local identity and don’t lose the input of people in our communities,” said Susannah Swihart, chair of the MaineHealth Board of Trustees.

Throughout the summer, MaineHealth member organizations will meet with individuals and community groups to explain the unification proposal and gather feedback. Each member organization also plans to hold one or more community forums open to the public between now and the end of August. For more information about MaineHealth’s unification dialogue, visit

The unification would create a single, $2 billion organization with 18,000 employees.

The medical staff at Waldo County General in Belfast voted unanimously Nov. 15 to urge its local hospital board to vote against the MaineHealth proposal at that time.

"We fear that further loss of the independence of our hospital will lead to decisions by others who are not a part of, nor equally concerned about our community as those of us who live and work here — and that 'something special' will be lost," the letter from the Waldo County doctors states.

"We are concerned that a geographically remote and diverse Board cannot make the same well informed decisions about staffing, services, finances and appointments for our hospital and community that our current local Board can. What affect will unification have on our charitable contributions and endowment? Community involvement? Staff engagement? There are many other very important questions, about which we don’t even know enough to ask, for we have so little knowledge of the details of the proposed agreement," the letter states.

The same concerns were voiced by PBMC physicians in January.

"The floated governance model of a single board, of which 50 percent is Portland-based raises real concerns about preserving a rural voice, as only one small hospital would have to vote with Portland to create a majority on any issue. Moreover, as PBMC is now rolled into CHA, it appears there would be only one board member for both PBMC and Waldo, meaning in essence that PBMC, one of the largest smaller hospitals, would have a half vote on the proposed new board. How could this half person adequately and fully represent all of the needs/nuances of our hospital is not clear," a Jan.9 letter from the Pen Bay medical staff president, summarizing the staff's sentiment, stated.

The only organization within MaineHealth that has not voted on moving ahead with discussions is Memorial Hospital in North Conway, N.H., which will be slightly delayed in its outreach and procedural votes so that it can address a regulatory process specific to New Hampshire, according to the news release.

Correction: The original version of the story incorrectly stated that Kno-Wal-Lin was part of Coastal Healthcare Alliance. The home health agency remains a part of MaineHealth, but is part of a new organization, MaineHealth Care at Home, which formed in May 2016.