St. Mary’s Regional Medical Center and Central Maine Medical Center have been treating Lewiston and surrounding communities’ health care needs since the late 1800s, initially as competitors but more recently working together to lessen some duplication and strengthen specific areas of care. Staff photos

LEWISTON — Retired general surgeon Greg D’Augustine’s Maine Medical Center colleagues were “shocked” when he told them in 1982 that he wanted to practice medicine in Lewiston, working out of Central Maine Medical Center and St. Mary’s Regional Medical Center, he said.

Lewiston was no different than other large Maine municipality at the time, with one large secular hospital and another slightly smaller Catholic hospital. But the city’s two hospitals had a reputation of being “at each other’s throats,” making it unappealing to some doctors, he said. Despite this, he wanted to go somewhere he felt there was need.

At that time, doctors were not usually employed by hospitals. Rather they worked in hospitals, which gave them a place to care for patients, he said. What D’Augustine found when he got to Lewiston was two feuding hospitals but a community of doctors who managed to work well together despite the competition.

“When I arrived in ’82 there was a sense of conflict between the two administrations but somewhat less conflict between the two medical staffs.”

There was even a serious effort made to create one local medical doctor staff to cover services in both hospitals, but it never came to fruition, he said. He recalls the effort failing largely due to the administration at both hospitals.

Now, some community members have questioned why the two hospitals don’t merge as both face financial struggles that have required them to cut services and staff in the last few years.

Merging hospitals

St. Mary’s Regional Medical Center was founded by the Sisters of Charity of St. Hyacinthe in 1888. Starting out in a house on Sabattus Street, it was the first hospital in Lewiston and Auburn, according to the  St. Mary’s website. It was taken over by Covenant Health in 1990, according to a 1990 edition of the Sun Journal.

Central Maine General Hospital, which opened its doors in 1891, was renamed Central Maine Medical Center in 1976, according to a news article published in the Sun Journal that same year.

D’Augustine, who retired a few years ago and still lives in the area, wonders how useful two general hospitals providing similar care is to a community the size of Lewiston-Auburn and the surrounding area, he said.

“It hasn’t always served the population best to have two,” he said.

The three primary ways hospitals and systems are acquired or merge:

— Vertical mergers, when a health system or hospital acquires another health system or hospital offering different services;

— Horizontal mergers, when a hospital system acquires another hospital or system within the same market;

— Cross-market mergers, when a hospital system merges with another system or hospital in a different market.

If California-based Prime Healthcare Foundation takes over Central Maine Healthcare, as is currently planned, it would be a cross-market merger, because the two systems are in different markets. If Central Maine Healthcare and St. Mary’s were to merge or one takes over the other it would be considered a horizontal merger, because both systems offer similar services in the same market.

However, antitrust laws make it difficult for two hospital systems in the same market offering similar services to merge or for one to take over the other, with the Federal Trade Commission overseeing any hospital system merger or acquisition to ensure the health care market remains competitive.

The health systems also would need to get state approval. The process is meant to ensure that an acquisition or merger would, among a list of criteria, mean continued access to cost-effective services for consumers, “reasonable choice” of services while avoiding excessive duplication, the prudent use of state funds, access to health care services regardless of a consumer’s ability to pay, and a balance … between competition and regulation in providing health care, according to information on the Maine Department of Health and Human Service’s website.

There is also the Catholic Church to consider. It owns St. Mary’s parent company, Massachusetts-based Covenant Health. Services offered at Central Maine, such as abortion care, could complicate a possible merger or acquisition of one with the other.

Prime Healthcare Foundation’s proposed acquisition of Central Maine Healthcare is in a more poised position to get state and federal approval as there is likely no perceived competition in the local community between Prime and Central Maine, given Prime currently owns no hospitals in Maine.

Central Maine officials are adamant that the acquisition be approved in part because Prime has promised to invest $150 million in Central Maine Healthcare over a five-year period — much needed capital to help offset financial deficits, provide upgrades to its facilities and invest in its staff.

Unnecessary duplication

Retired Dr. Louis Talarico was born at St. Mary’s Regional Medical Center in a maternity and women’s health unit that the hospital closed in 2022 as births in the area declined. Many of St. Mary’s patients shifted to Central Maine Medical Center.

Talarico worked as an orthopedic doctor who bounced between Lewiston and California through the ’70s and ’80s before settling in Lewiston in the ’90s, he said. He recalls the hospitals being competitive, to the point where at times some physicians would get iced out of one hospital if they had privileges at another.

A lot has changed since he retired in 1999. Now, hospitals hire doctors onto their staffs, and hospitals are operated by administrators with little to no medical background, he said. He wonders if hospitals’ financial struggles are at least in part due to that.

From 2012 to 2022, the number of physicians working in private practices nationally decreased by 13%, going from 60% of physicians working in private practices to 47%, according to information on the American Medical Association’s website.

Both Lewiston hospital systems have cut staff and programs in recent years.

For instance, St. Mary’s ended its maternity services and closed its intensive care unit, services also offered by CMMC. Meanwhile, St. Mary’s has worked to strengthen its comprehensive mental health services, which is something CMMC doesn’t provide.

In the last few years, much of the cuts and changes the two hospital systems have had to make seem to be fueled by steep funding deficits, with Central Maine Medical Center sustaining more than a $19 million funding deficit for fiscal year 2023 and St. Mary’s sustaining a nearly $30 million deficit the same year, according to the two nonprofits’ tax filings.

The result is that the hospitals appear more than ever to be working around each other, rather than as competitors of old. But D’Augustine said he started noticing each hospital offering more specialized care as far back as the ’80s.

St. Mary’s began leaning toward expanding its behavioral health service, while Central Maine began leaning away from those services, he said, the first division of labor between the two hospitals that he observed.

Then, Central Maine started embracing more acute care services, like intensive and trauma care, he said. While St. Mary’s maintained an intensive care unit and certain trauma capabilities, Central Maine was a higher-level trauma center.

He believes the division of labor stemmed from the competition between the two hospitals, both trying to offer more or better services than the other, he said. When Central Maine rolled out its heart and vascular program in 2003 that was a big deal, D’Augustine said, because St. Mary’s did not have a program like that at the time.

St. Mary’s prioritizes collaboration with “community health care partners” rather than focusing on competition, according to a spokesperson. It allows St. Mary’s to avoid unnecessary duplication to provide more comprehensive care and best use its resources for the Lewiston-Auburn community.

“Emphasizing primary care, outpatient services, emergency and urgent care, outpatient surgery, behavioral health and elder care allows us to address critical health needs while supporting our most vulnerable population,” the spokesperson said. “… Our goal is to provide strong, high-quality care that enhances healthcare access for the entire community.”

One way the two hospital systems have been able to successfully collaborate is through United Ambulance, which is owned equally by both Central Maine Healthcare and St. Mary’s Health System. For decades now the two hospital systems have met monthly with ambulance management to oversee the operation.

Officials with St. Mary’s did not respond to specific questions about the two hospitals’ rivalry and officials at Central Maine declined to comment at all for the story.