Saint Alphonsus Medical Center-Baker City has been at its current location, 3325 Pocahontas Road, since 1970.

The Baker County Board of Commissioners is urging Saint Alphonsus Health System to keep the birth center open at the Baker City hospital for at least one year.

Commission Chairman Shane Alderson said on Friday morning, July 14 that he met Thursday with hospital president Dina Ellwanger and discussed ways the county, working with state and federal officials, could potentially help the hospital find more nurses to work in the birth center.

Hospital officials have cited a nursing shortage as the main reason for their June 22 announcement that the birth center would close July 30.

Alderson said that although Thursday’s meeting didn’t yield a commitment from hospital officials to keep the center open beyond that date, he felt the conversation was “positive.”

“We can find solutions here,” he said.

In a July 12 letter to Ellwanger, Alderson wrote that the hospital’s July 30 closure date, little more than a month after the announcement, “is not enough time for families to plan for a change of this magnitude.”

“We are greatly concerned about the impacts on Baker County’s birthing mothers having to travel 45 miles to La Grande or 72 miles to Ontario for maternal care,” Alderson wrote in the letter on behalf of himself and the two other commissioners, Christina Witham and Bruce Nichols. “This is alarming and presents a preventable risk to the lives and health of the patients in your care.”

Alderson noted in the letter that inclement weather occasionally closes Interstate 84 from Baker City to La Grande and Ontario.

He wrote that the birth center closure would have a disproportionate effect on low-income families because they couldn’t afford to stay in another city in the final stages of pregnancy to ensure the mother was close to the hospital.

Alderson also urged Ellwanger to “consider all resources offered to you through federal, state, and local agencies” to keep the birth center open for a year “in order to allow us all to plan for a long-term solution for hospital care in Baker County.”

In a July 10 letter to Odette Bolano, president and CEO of Saint Alphonsus Health Systems, which includes hospitals in Baker City, Ontario, Nampa and Idaho, Oregon’s U.S. senators, Ron Wyden and Jeff Merkley, called for keeping the birth center open for at least six months.

The senators also offered to help the hospital find nurses to work in the birth center. Saint Alphonsus officials have said a shortage of nurses is the main reason they announced the birth center closure.

Alderson said one of those options, through the United States Public Health Service Commissioned Corps, could potentially supply nurses at no cost to the hospital.

Other options could require financial assistance, but Alderson said he believes that the county could qualify for state or federal aid to help deal with the nursing shortage.

Alderson said county commissioners and officials are considering declaring a public health emergency due to the pending closure of the birth center. He said that declaration could potentially qualify the county for financial and other aid that could help alleviate the nursing shortage.

Although hospital officials haven’t cited financial losses as a reason for closing the birth center, the hospital’s operating margin — revenue minus expenses — went from a surplus of $2,832,000 in 2021 to a negative $1,660,000 in 2022. That’s the biggest deficit since 2016, when it was $1,200,000, and the biggest in at least 15 years, according to Oregon Health Authority (OHA) data.

The hospital’s “bad debt” — money that patients were billed but did not pay — was the highest in nearly a decade in 2022, at $1,217,000. That was the biggest amount of bad debt since 2013, when it was $1,413,000. The highest annual figure in the past 15 years was $2,603,000, in 2009.

Saint Alphonsus is a 25-bed critical access hospital. Its intensive care unit closed in January of this year, something Ellwanger attributed to a lack of patients who needed that level of care.

Ellwanger told the Herald that “for decades, obstetrics services in many hospitals, both urban and rural, have incurred financial losses due to low reimbursement from insurance companies, Medicaid, and in some cases, lack of insurance.”

Alderson said that based on his conversation with hospital officials, the annual loss from the birth center in Baker City is $900,000 to $1 million.

He said the Oregon Health Plan pays about $7,000 for a routine birth, less than half the actual cost of about $16,000.

According to OHA reports, from 2015-17, the most recent period for which statistics are available, 57% of mothers who delivered babies in Baker County were covered by Medicaid or the Oregon Health Plan, compared with a state average of 45%.

In Baker County, 40% of mothers had either private insurance or paid their bills themselves, compared with a state average of 57%.

Alderson said lawmakers at the federal and state level need to increase the reimbursement for maternity services, at least for small, rural hospitals such as Saint Alphonsus in Baker City.

Letter to Gov. Tina Kotek

Alderson was one of three county officials to sign a letter to Oregon Gov. Tina Kotek, also dated July 12 and also related to the pending birth center closure.

The co-signers are Dr. Eric Lamb, the county’s public health officer, and Meghan Chancey, director of the county health department.

The letter reiterated some of the concerns in the letter to Ellwanger, noting that “we feel that we have a pending public healthcare crisis on our hands.”

The letter pointed out that Saint Alphonsus is a critical access hospital, a designation “designed to help rural hospitals stay open despite low patient volumes and poor reimbursement.”

“We believe this is an issue of equity in access to basic health care for rural Oregonians,” the letter states. “Baker County children experience a higher rate of child poverty and food insecurity than in other parts of Oregon. In 2022, the percentage of infants born at low birth weights was more than double the statewide average.”

Although the letter to Kotek reiterated the goal of keeping the birth center open for at least one year, the county officials also asked for state help, if necessary, to help pregnant women and their families travel to and pay for lodging in other communities to be closer to hospitals.

If the birth center doesn’t stay open, Alderson said the alternatives for a local replacement facility are possible but difficult and expensive.

Any birth center would have to be close to the hospital, he said, because mothers must have access to an operating room in case a Caesarian section is required.

Ellwanger said hospital officials have not considered selling the facility.

The four doctors who deliver babies in Baker County, all of whom work at St. Luke’s Clinic/Eastern Oregon Medical Associates in Baker City, said last month that a possible option is forming a publicly funded district to operate the hospital. Hospitals in John Day and Enterprise operate under that model.

“We are greatly concerned about the impacts on Baker County’s birthing mothers having to travel 45 miles to La Grande or 72 miles to Ontario for maternal care. This is alarming and presents a preventable risk to the lives and health of the patients in your care.”

— Letter from Baker County commissioners to Dina Ellwanger, president of Saint Alphonsus Medical Center-Baker City