A monthslong state review of one of northern New Hampshire’s most important hospital systems has landed with a clear finding: North Country Healthcare breached its fiduciary duties when it fired Weeks Medical Center President Michael Lee, and it now must accept a set of corrective steps designed to win back the trust of the communities it serves. The conclusion comes from the Charitable Trusts Unit, the arm of the Attorney General’s Office that oversees nonprofit hospitals and hospital mergers, and it caps a tense stretch in which patients, physicians, and residents across rural Coos County openly questioned where their health system was heading. As the New Hampshire Bulletin reported, the unit determined that while most of the complaints it examined did not rise to the level of legal violations, the handling of Lee’s termination did.

What the Charitable Trusts Unit found

North Country Healthcare operates three hospitals across the rural northern reaches of the state, making it a backbone of care in a region where the next provider can be a long drive away. That scale is exactly why the Attorney General’s Office took the complaints seriously. After reviewing what amounted to a laundry list of allegations gathered from an organized group of concerned patients, the Charitable Trusts Unit reached a narrow but pointed conclusion. It cited the system specifically for failing to recruit and appoint a full-time, permanent replacement for Lee after his firing.

The unit went further, lamenting that the move set off a cascade of resignations that, in its words, called “into question the validity of a WMC board affirmative vote to substantially alter NCH’s governance structure.” In plain terms, the state worried that a board weakened by departures may have pushed through significant governance changes without the legitimacy such decisions require. On the rest of the complaints, the unit was measured. It stated plainly that “CTU did not find legal violations as to the other issues reviewed.” Even so, it knocked North Country Healthcare for a series of communication failures that allowed tensions with the community to fester over recent months.

The agreement North Country Healthcare must follow

Rather than litigate, the Charitable Trusts Unit announced a negotiated agreement that requires North Country Healthcare to take several concrete actions. The system must cooperate with, and pay for, an independent board governance consultant chosen by the attorney general to make sure it is following the governing documents it adopted in 2016. It must provide every board member with annual training on their duties. It must hold listening sessions with the community at least once per quarter going forward. It must hold off on any board governance restructuring plans for the time being. And it must reimburse the Charitable Trusts Unit $75,000 for the cost of conducting the review.

Taken together, those terms read as a roadmap back toward accountability: outside expertise, board education, regular public engagement, a pause on the contested restructuring, and a financial penalty that signals the state’s seriousness. North Country Healthcare CEO Tom Mee struck a cooperative tone in response. “We appreciate the thorough process undertaken by the New Hampshire Charitable Trust Unit, and for their findings in several key areas that our leadership team acted reasonably and appropriately on behalf of NCH and the communities we gratefully serve,” he said in a statement, adding that the system is “prepared to work diligently and collaboratively to pursue CTU’s recommended steps to address areas requiring attention.”

How the conflict started

The friction did not begin with Lee. It began with the firing of Dr. Elizabeth Cooley, a well-known physician at Weeks Medical Center, the system’s Lancaster location, which traces its roots to the original Weeks Memorial Hospital. Her departure struck a nerve. A group of area residents, including at least three former Weeks physicians, wrote letters urging North Country Healthcare to reinstate her. Out of that frustration grew the Concerned Patients Group, which began holding public meetings to air broader worries about the direction the health system was taking.

That grassroots organizing is what ultimately drew the attention of state regulators. When patients in a rural region feel they are losing trusted doctors and a responsive local hospital, the consequences are not abstract. In communities where Weeks and its sister hospitals are often the only realistic option for care, governance disputes at the top can quickly become questions of access at the bedside. Lee, for his part, declined to speak about the matter because he signed a non-disclosure agreement when he left the system, a detail that itself underscores how guarded the situation has been.

Why this matters for rural New Hampshire

Rural hospitals across New Hampshire are operating under enormous financial and demographic pressure, and the North Country is among the most exposed. When the Attorney General’s Office steps in to police the governance of a nonprofit hospital system, it is enforcing the basic bargain behind charitable healthcare: these institutions hold their assets in trust for the public, and their boards owe a duty to the communities they serve, not to any individual executive or faction. The finding against North Country Healthcare is a reminder that the duty is enforceable.

For residents of Coos County, the practical question now is whether the agreed reforms translate into a hospital system that listens better and governs more transparently. Quarterly listening sessions and an outside governance consultant will only matter if they change behavior. The Concerned Patients Group has already shown it can organize and command a state response, which raises the bar for North Country Healthcare to follow through. The coming months, and the consultant’s review, will reveal whether this is a turning point or merely a pause in a longer struggle over the future of care in the North Country.

For related coverage, see our reporting on Retired Judge David King Named to Oversee North Country Healthcare Governance….

What did the Charitable Trusts Unit conclude about North Country Healthcare? It concluded that North Country Healthcare breached its fiduciary duties when it fired Weeks Medical Center President Michael Lee, particularly by failing to recruit a full-time permanent replacement. It did not find legal violations on the other issues it reviewed.
What corrective actions must North Country Healthcare take? The system must hire and pay for an independent governance consultant selected by the attorney general, provide annual board training, hold quarterly community listening sessions, pause any board restructuring, and reimburse the Charitable Trusts Unit $75,000 for the review.
How did the dispute begin? The conflict started with the firing of Dr. Elizabeth Cooley, a well-known physician at Weeks Medical Center in Lancaster, which prompted letters from residents and former physicians and led to the formation of the Concerned Patients Group.
Why is this significant for rural New Hampshire? North Country Healthcare operates three hospitals serving a rural region where access to care is limited. State enforcement of fiduciary duties protects the public interest in nonprofit hospitals and underscores how governance disputes can affect community access to care.

The North Country case is part of a wider strain on rural health care across the state. For more on the financial pressures facing northern providers, see our coverage of Dartmouth Health’s $500 million rural grant amid Medicaid cuts and the Go North rural health initiative. For another example of community concern over a hospital’s direction, read our report on the Exeter Hospital merger and worries about care.