The local board that oversees Pen Bay Medical Center, Waldo County General Hospital, the Knox Center, Quarry Hill and nearly all local physician practices gave its approval Tuesday night, Dec. 5, on merging with Portland-based MaineHealth.

The vote by the Coastal Healthcare Alliance Board was 13-6, said Board President Lee Woodward Jr. of Belfast.

Woodward said he voted against the unification of the boards out of concern about self-governance of the local health care facilities.

Woodward has been on the Waldo County General Hospital Board and its successors, including now Coastal Health Care Alliance, for 31 years.

Now that the vote has been taken, however, he said the board is pledged to move ahead and finalize the unification so that it will take effect in January 2019. He said there is no government approval needed for the unification.

MaineHealth issued a news release Dec. 6.

"Currently, each MaineHealth member must financially stand on its own, generating the revenue necessary to pay for the services in that particular local community. In recent years, however, many community hospitals have come under mounting financial pressure. This has been caused in part by the migration of more complex procedures to major medical centers, which are able to leverage new technologies employed by highly specialized providers," according to the news release. "Across the MaineHealth system this has created uneven financial performance among member hospitals, threatening the ability of some community hospitals to continue to deliver needed care. Meanwhile, Maine Medical Center in Portland, the system’s tertiary-care hospital, has seen growth in volume and in its bottom line, as complex procedures have migrated there. A unified governance model would allow resources to flow across the system, better supporting the delivery of care in local communities."

Pen Bay Medical Center has been one of the members that has experienced significant financial losses during the past few years. Waldo County has remained financially strong.

Pen Bay had an operating loss of $7.4 million for the fiscal year that ended Sept. 30, 2016. The hospital also lost $3.5 million in 2015. And it has accumulated debt of about $20 million since 2012 to MaineHealth, the parent corporation of which PBMC is an affiliate.

Woodward said even those board members who voted against the unification were in agreement that MaineHealth is the best for all measures of health care, including quality and efficiency.

Under the unification proposal, Pen Bay and Waldo County would each have one member on a 26-member MaineHealth Board for the first five years. After the five-year mark, the MaineHealth Board would decide whether to reduce its size, perhaps to 15 to 20 members.

MaineHealth Systems Director for Marketing and Communication John Porter has said a patient service could not be eliminated at a hospital within the MaineHealth system during the first five years of unification without approval of the local board. After that point, the elimination of a service would require support from two thirds of the combined system board.

Voting across the system is expected to be concluded during the first week of December.

Physicians at Pen Bay voiced concern last year about the unification proposal, but at a public forum in August, Board Vice President Carole Brand said they were coming around to recognizing its benefits.

Brand said in August, however, that doctors at Waldo County General continued to struggle with the unification proposal. Both groups of physicians were concerned about loss of local control.

Waldo County became an affiliate member of MaineHealth in 2009 and Pen Bay became an affiliate member at the end of 2010. Pen Bay and Waldo County's boards of directors merged into a single board, named Coastal Healthcare Alliance, in 2015 which is an affiliate of MaineHealth.

MaineHealth oversees hospitals and other health care facilities in the state, with its flagship being Maine Medical Center in Portland. In addition to Pen Bay and Waldo County, the hospitals include Franklin Memorial Hospital in Farmington, Stephens Memorial Hospital in Norway, Miles Campus and Hospital in Damariscotta, St. Andrews in Boothbay Harbor, Southern Maine Healthcare in Biddeford and Sanford, and Memorial Hospital in North Conway, N.H. Maine Behavioral Health is also a member of MaineHealth, as is the clinical laboratory NorDx in Scarborough.