CHESTERTOWN — Susan DeSimone has visited the hospital in Chestertown so many times "she could drive there blindfolded."
She and her husband moved to the Heron Point retirement community in 2013 in large part because it was just blocks from the University of Maryland Shore Medical Center at Chestertown.
"When you're up in your 80s, you want to be a near a hospital when something goes wrong," Susan DeSimone said. "The hospital was very important in our decision to move where we did."
The DeSimones and others in this town of about 5,300 on the Eastern Shore have been worried about the hospital ever since learning that University of Maryland Shore Regional Health, which oversees the medical center, might be considering turning it into an outpatient care center.
Concerns have been building since at least 2014, when Shore Regional Health officials sought advice from a consulting firm.
Exactly what the consultants recommended is a point of contention. At least two doctors who say they saw the consultants' report say the consultants recommended that Shore Regional Health system turn the 30-bed, full-service facility into an ambulatory care center that would provide outpatient and emergency medical care but not inpatient or nonemergency care.
They also recommended that the three-hospital system replace its aging facility in Easton with a new state-of-the-art building that would provide health care to residents of Chestertown and the rest of Kent County, according to Dr. Jerry O'Connor, a surgeon at the hospital. He says he was shown the report but not given a copy.
That change would mean Chestertown patients would have to drive 45 minutes or more for procedures that require a hospital stay. Residents say that would be inconvenient for some, impossible for others, and dangerous for those with chronic health problems and diseases.
Shore Regional Health officials dismiss the accounts of their plans for the hospital as pure speculation.
They haven't made any firm decisions, they say, but they must adjust to a changing health environment that emphasizes fewer hospital stays and preventive care, and focuses spending on programs that help patients manage medication, improve nutrition and maintain their health in their homes or doctor's offices.
Shore Health spokeswoman Patti Willis said she would not provide a copy of the report for proprietary reasons. She said the health system simply asked the consultants for general information about how people in the area use health care and how rural health care is changing.
The battle pits the residents of a small community trying to hold on to already limited medical services against the state's largest medical system, which is facing pressure to cut costs and operate more efficiently.
The cost-versus-need problem can be even more pronounced in rural communities, where it is hard to attract doctors and maintain the number of patients needed to turn enough of a profit to stay open.
The health system board is expected to vote on the future of the hospital in May, and the community has grown more vocal in its protests as the date approaches.
A group that includes 30 doctors, heads of community groups and residents placed an advertisement in the local newspaper to oppose converting the local hospital into an ambulatory care center. A petition to save the hospital is making the rounds, and a crowd gave Shore Regional Health CEO Kenneth Kozel an earful about it at a recent community forum.
"We wanted to make sure that they heard loud and clear where the community is coming from," said state Sen. Stephen S. Hershey Jr.
The Republican is co-sponsoring legislation that would give individual hospitals that get state money more say in decisions made by hospital systems controlling them.
Residents say the health system has made little investment in the hospital beyond beefing up emergency room services. Millions of dollars were spent to overhaul the emergency room, while the number of inpatient hospital beds and many services, such as obstetrics, were cut or reduced. They say these moves all seem to point to a transition to outpatient-focused services.
Kozel said officials made the decision to overhaul the emergency room out of "necessity" because it was outdated, not because there is a larger plan to focus on those services.
The number of beds has been reduced because hospitals must curb overnight stays and readmissions or face penalties, he said. New rules also require patients be put on observation status before they are formally admitted.
The Chestertown hospital remains profitable for now, Kozel said, but any changes that will be made will take the next five years into account as changes under a new payment system and health reform mature.
"As our industry has changed, we have to practically look at ways to address that change — not only to survive, but to thrive as an organization," he said.
Local business leaders have also raised objections. The head of Dixon Valve & Coupling Co., one of the largest local employers, said not having a hospital hurts the business climate and makes it hard to attract workers.
County and economic development officials wondered how they could attract businesses and young families without a place for them to get good medical care. An official from Washington College said families want students to be close to a hospital in case they get sick.
"When we admit them, we not only want to educate them," said Xavier Cole, senior vice president of student affairs. "We want to take care of them."
O'Connor, who has been at the hospital since 1984, has organized much of the opposition. He said the Chestertown hospital has steadily become more of a feeder to the Easton hospital in Talbot County. He said Shore Regional Health system has not aggressively tried to recruit new doctors and improve the hospital.
"My feeling is if they wanted to make it work, they could make it work," O'Connor said. He said keeping even some inpatient beds would be better than eliminating them all.
The number of hospital beds nationwide has declined in the face of changing economic trends in the health care industry.
The average hospital occupancy rate dropped from 64 percent in 2006 to 60 percent nationwide in 2013, according to the Medicare Payment Advisory Commission. Fifteen hospitals opened and 25 closed nationwide in 2013, resulting in a net loss of 1,000 hospital beds.
The decline is likely to continue as more treatment shifts to outpatient settings, the commission said.
Maryland has seen three hospitals close in the last 16 years. In Laurel, residents are fighting a plan by Dimensions Health to turn that hospital into an ambulatory care center to make room for a regional hospital in another part of Prince George's County.
Inpatient hospital admissions have declined by 100,000, or 15 percent, in the past decade, according to the Maryland Hospital Association. The association is lobbying for legislation to make it easier to create free-standing medical facilities that would not provide inpatient care.
"To keep care available and affordable, hospitals need to provide local access to services like emergency care, medical observation, outpatient surgery and diagnostics, and get rid of unneeded inpatients beds," the association said in a recent position paper.
Chestertown residents have vowed to keep up the pressure on Shore Regional Health. There are plans to organize a letter-writing campaign and perhaps seek legal action.
"We have to keep it up," O'Connor said. "This is just the beginning."