Moving to close the gap in Island medical care

She is a frail Shelter Island senior who needed care for a wound but had to go off-Island to get treatment because no doctor was available here.

That may seem a minor inconvenience to some. But to the frail elderly among us, not having a doctor they know and can reach when there’s a medical problem that doesn’t rise to the emergency room level can be alarming.

In addition, with the seriousness of this year’s flu epidemic, an elderly resident should be able to know if she/he has just a cold or something more serious without travelling off-Island for a diagnosis.

What Senior Services Director Laurie Fanelli hears from elderly people when it comes to medical issues is the worrisome question “What if?” — wondering what will happen if they need medical care when the Island’s two medical practices aren’t staffed, “This is not a good situation,” Ms. Fanelli said.

Not good, and not uncommon, she added.

Shelter Island has the highest ratio of seniors to the rest of its population of any municipality statewide, according to Barbara Silverstone, president of the Senior Citizens Foundation, and often there is no doctor available for elderly residents here.

Supervisor Gary Gerth became aware of the issue when residents contacted him, he said, and to improve the situation, he has taken steps to close gaps in coverage. He spoke to an NYU-Winthrop Hospital official who moved quickly to provide coverage this week while Island physician Dr. Peter Kelt is away, Mr. Gerth said.

The town has a contract with Winthrop that ensures coverage five days per week by two doctors, according to Town Attorney Bob DeStefano Jr.

Dr. Kelt works Mondays, Tuesdays, Wednesdays and Fridays between 8 a.m. and 4 p.m., but the contract was not “activated” in the past to ensure coverage on a fifth day, Mr. Gerth said. It is now, he added.

Winthrop spokeswoman Anne Kazel-Wilcox said the hospital was able to assign a doctor Tuesday and that by April, a new physician’s assistant will be assigned so Dr. Kelt’s office is staffed five days a week.

In recent years, Dr. Barbara Phillips-Cole worked with Dr. Kelt, but left the practice suddenly this year. Drs. Nathanael and Anthonette Desire, who work independently of any hospital medical group, staff the other office at the medical center.

Mr. Gerth and Mr. DeStefano plan to meet with Dr. Desire later this week about the possibility of extending coverage beyond the two days a week — Mondays and Fridays — when that office is open for patients during the off season. On the two days when Dr. Nathanael Desire opens the office at 10 a.m., he continues to schedule patients until about 4 p.m. depending on appointments.

Ms. Silverstone said Dr. Desire “really looks after his patents” and returns calls during off hours.
When Dr. Kelt returns next week, Mr. Gerth plans to schedule a meeting with him to talk about hours.

URGENT CARE
The many urgent care centers on the North and South forks demonstrate the need for care outside regular office hours, Ms. Fanelli said. She said more Island residents need to speak up for a facility here so it’s not just the occasional “squeaky wheel” that gets attention.

The Foundation is concerned, Ms. Silverstone said, and has made extended care a top priority and is prepared to put money into an effort to focus attention on the problem.

A volunteer driver who also serves on the Foundation Board, but asked that her name not be used, said many elderly on the Island don’t have family members living nearby and have to depend on friends and neighbors. What can start out as an hour’s round trip to an off-Island urgent care center or doctor can turn in four or five hours if a patient needs X-rays or other prolonged treatment that day, she said.

“You’re more than just a driver,” the woman said, explaining that people she drives want continuity and assurance she will always be their driver. There are just too many elderly patients in need and too few volunteer drivers to fill the void, she said.

Finances also are an issue, she said, explaining that when a patient in need of something like care for a wound has to resort to an emergency room, bills can mount and result in difficulties for some on a tight fixed income.

“The problems are so many. What do we have the right to expect from our local government?” she asked.