For the first time in more than a century, women will not have a maternity center available in the Baker City hospital.

Saint Alphonsus Health System, which owns and operates the hospital that celebrated its 125th birthday in October 2022, announced on Thursday, June 22 that the birthing center will close in a little more than a month, on July 30.

Neil Carroll, a physician at St. Luke’s Clinic/Eastern Oregon Medical Associates (EOMA) in Baker City, said hospital officials told doctors and nurses on Wednesday about the pending closure of the birthing center.

Carroll is among the four local doctors, all of whom work at EOMA, who deliver babies and provide other obstetric care.

“I have full confidence in the high quality of obstetric care and the nursing staff in Baker City,” Carroll said on Thursday afternoon. “I think this is a financial decision being made by Saint Alphonsus administration in Boise, and the physicians at EOMA are devastated at what this means for maternal and newborn health in our community.”

The nearest hospital with a maternity department will be Grande Ronde Hospital in La Grande, about 43 miles away.

In October 2022, just before the hospital’s 125th birthday celebration, its president, Dina Ellwanger, said that after struggling to find employees during the pandemic, the hospital’s obstetrics department was one of the bright spots, as it was fully staffed.

But that’s not the case now, according to the press release Saint Alphonsus issued just before 12:30 p.m. on Thursday announcing the pending closure of the birthing center. The release stated:

“Over the last four years, deliveries at SAMC – Baker City have declined at a record rate. Since fiscal year 2020, deliveries have declined from 128 deliveries per year to a projected 75 deliveries in fiscal year 2023. In addition to the four-year trending decline, we have an increasingly unsustainable crisis in our ability to staff the Obstetrics Department adequately with temporary or permanent staff to meet staffing requirements — even with significantly high agency compensation rates. The urgency of the situation has escalated due to recent staff resignations and changes. With this developing situation and Safety as one of Saint Alphonsus Health System’s Core Values, the difficult but necessary decision has been made to close the Obstetrics Program.”

Ellwanger was not available for an interview on Thursday or Friday.

Shelly Cutler, Eastern Oregon senior specialist for marketing and communications for Saint Alphonsus, said on Friday that “staffing is a dynamic situation that is always changing,” and that although the obstetrics department was fully staffed last fall, subsequent resignations created vacancies.

The press release stated that “We understand this incredibly difficult decision will impact our patients, community, colleagues, and physicians. SAMC – Baker City is committed to continuing to be a transforming healing presence in our community and continuing our 126-year legacy of compassionate service to the residents of Baker County.”

The press release stated that employees in the birth center will be encouraged to apply for jobs elsewhere in the Baker City hospital or the other Saint Alphonsus hospitals in Ontario, Nampa and Boise, or at the health system’s clinics.

The closure of the birth center will affect 12 current employees, Cutler said — four full-time, four part-time and four who work as needed.

There are four current vacancies for full-time nurses in the birth center, she said.

State doesn’t require hospital to offer maternity services

In a recent case in Gresham, the Oregon Health Authority (OHA) denied a request by Legacy Mount Hood Hospital to close its birthing center in March.

That hospital, which is larger than Saint Alphonsus-Baker City, is required by state law to to provide maternity care and thus must request a waiver from the state to close a birthing center.

Saint Alphonsus-Baker City, however, is in a different category due in part to its size and patient load, and it is not required to maintain a birthing center, said Jonathan Modie, a spokesman for the OHA.

The Baker City hospital is classified as a low occupancy acute care hospital by state standards, and a critical access hospital by federal standards.

“This kind of hospital is not required to provide maternity services; therefore, the hospital would not need to submit a waiver request prior to closing the service and (OHA) has no further role through hospital licensing,” Modie wrote in an email to the Herald on Thursday.

Intensive care unit closed earlier this year

The intensive care unit at the Baker City hospital closed early in 2023.

Saint Alphonsus attributed the closure, which had been intermittent over the previous several months, to “difficulty recruiting permanent and temporary staff and a consistently low number of patients requiring this level of medical service.”

The ICU will remain closed, Cutler said, although some patients who formerly would have been admitted to the ICU are now monitored on the medical/surgical floor by local staff and remotely by staff at other Saint Alphonsus hospitals

Financial trends

The hospital’s total revenue dipped by 12.7% in 2022 compared to the previous year, from $40,832,000 in 2021 to $35,632,000 in 2022, according to date from the Oregon Health Authority.

The 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.

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.

Cutler said several factors contributed to the hospital’s downward financial trend, including federal COVID aid the hospital received in 2021 but not in 2022.

The hospital’s net patient revenue declined in 2022 due to fewer surgical procedures as well as the decline in deliveries at the birth center, she said.

Higher costs for labor and materials also contributed to the negative operating margin, Cutler said.

Trends in patients, procedures

The number of outpatient surgeries at Saint Alphonsus plunged from 1,224 in 2019 to 618 in 2020 and to 214 in 2021. That trend continued in 2022, when there were 92 such surgeries, the fewest in at least 15 years.

The annual average for the decade prior to the pandemic, 2010-19, was 1,111 outpatient surgeries.

The number of outpatient visits also declined, although not as dramatically as outpatient surgeries.

Outpatient visits dropped from 29,891 in 2020 to 24,723 in 2021 and to 23,415 in 2022. That’s a three-year decline of 21.7%.

By contrast, emergency department visits rose in 2022 to 7,719, an increase of 20% from 2021 and the highest one-year total since 7,846 in 2007.

St. Elizabeth Hospital was founded in Baker City in 1897 by five sisters of Saint Francis of Philadelphia. The hospital’s first location was at Second and Church streets.

In 1915 the hospital moved into a new cut stone building at 2365 Fourth St., where it remained for more than half a century.

The current 25-bed critical access hospital, at 3325 Pocahontas Road, opened in October 1970.

In 2010, after the hospital was bought by Trinity Health, a national Catholic health care system, it was renamed Saint Alphonsus Medical Center, part of the Saint Alphonsus Health Alliance, which includes hospitals in Ontario, Nampa and Boise.

Saint Alphonsus Medical Center-Baker City was named one of the nation’s top 100 critical access hospitals for five straight years, 2017-21.

The current building has undergone renovations over the decades, most recently, in 2019, a remodel of the emergency department and moving the physical therapy/occupational therapy department to the former site of the nursing home dining room and nurses station.

(The nursing home was closed in 2014.)

Just before the hospital celebrated its 125th birthday with an event at Quail Ridge Golf Course, Dina Ellwanger, the hospital’s president, said that although the current building on Pocahontas Road “meets the needs, it is 52 years old.”

She said Saint Alphonsus had contracted with an architectural firm to come up with options for either a significant renovation or possibly new construction over the next couple years.

Although details haven’t been determined, Ellwanger said she believes the hospital, in whatever form, will remain at its Pocahontas Road location.

Ellwanger said then that during the pandemic, a combination of factors created what Ellwanger called the most daunting environment for recruiting employees in her 30 years in health care, including 17 years as an executive.

“I have never faced a challenge like we’re facing now,” Ellwanger said.

From employees concerned about being exposed to COVID-19, to burnout from extended shifts, to nurses attracted by the higher wages if they travel to other areas for short-term assignments, Ellwanger said it had been a constant challenge over the previous two years to fill vacancies.

The issue isn’t just recruiting doctors and nurses, but all employees, including maintenance and support staff, she said.

This has forced Saint Alphonsus to take advantage of technology, including virtual medicine, where distant providers can meet with patients.

Unlike many businesses, which can cover higher personnel costs by raising their prices, hospitals, which receive much of their revenue from insurance companies, can’t simply charge them more to raise revenue and make it possible to offer more attractive salaries to prospective employees, she said.