Things you have a right to know.
The history of health care in Curry County is long and complicated, especially in South Curry (97415). I’ve been working on trying to improve our inadequate health care services for years, and it’s still confusing. But, before you accept the emergency room-only proposition being pushed, there are things you have a right to know.
Whether or not other elected officials and/or public employees believed that a stand-alone emergency room (ER) was the best or only option for South Curry, they have known for over one and one-half years that is not true.
We can’t have an Asante or Providence hospital in 97415 as long as the Curry Health Network maintains its Critical Access Hospital (CAH) designation. There’s a lot included in that designation: significantly increased patient service reimbursements; much fewer reporting requirements; limits on hospital beds and length of stay; as well as distance from other hospital facilities. Because the CHN’s Fifth Street clinic is designated under their CAH license, all of the same benefits and restrictions do apply.
Starting around 2014, Brookings city officials, CHN’s board and administration, as well as a former county commissioner somehow decided that a stand-alone ER was what South Curry could and should have. Unfortunately, they evidently believed the citizens didn’t have a right, or need to know. They spent tens of thousands of taxpayer dollars to change the Oregon state regulations by way of a new Oregon Administrative Rule (OAR) to allow a stand-alone ER. This was never allowed before. The City of Brookings paid more than $108,000 alone to a Portland law firm for lobbying and attorney services.
Additional tens of thousands were spent on meetings, travel, advertising and a ballot measure to annex South Curry into the Curry Health special tax district. The Curry Health special tax district overwhelmingly approved 97415’s annexation. It would cut the amount of their special district tax and bond assessments in half. However, 97415 overwhelmingly rejected annexation. The defeat of annexation was based on many issues. Some didn’t want more taxes. Some didn’t want anything to do with Curry Health. Some didn’t want to be paying off a very large debt when they had no say, or vote in the matter. Some realized that a stand-alone ER would eliminate options and choices we currently have.
The laws of Oregon require ambulances to bring patients to the closest ER. That means that our current option of being brought to Sutter Coast would be eliminated.
A stand-alone ER also significantly increases risks and costs to patients. The majority of patients arriving at an ER need to be hospitalized. A stand-alone ER means double transport, at least. It also means significantly delayed care, depending on distance and road safety. Remember, even if you have insurance, when costs go up, so do premiums, co-pays, and deductibles.
The federal regulating agency, CMS (Centers for Medicare/Medicaid Services) has stated that they “frown on” stand-alone ER’s for those very reasons. However, our state regulator, OHA (Oregon Health Authority), evidently seems to support such licensing: whether it’s in the best interests of patients, or not.
The federal regulating agency has indicated that needs assessments and feasibility studies should be conducted to ensure that the CAH designation is appropriate and sustainable. That designation was specifically intended for areas like ours which are rural and remote, have a lot of poverty, and where a majority of residents rely on Medicare and/or Medicaid (OHP in Oregon).
It seems our state regulating agency has far fewer concerns in these regards.
I have met personally with representatives at all levels. What I’ve found is that as soon as our state and local officials were presented with the fact that CMS allows satellite CAH hospitals, delaying tactics were employed, and multiple hurdles presented. To be perfectly clear, what that means is we could have a hospital, with an ER right here in Brookings, as long as it was under the CAH license.
As examples: the construction of the Fifth Street Clinic as well as the new Curry General Hospital (both of which are more than double the size of the former facilities) were not required to have feasibility studies or needs assessments in order to be licensed by OHA, which is designated by the federal authorities to ensure compliance. These same authorities, along with our local officials, were presented with documentation from CMS in August 2017 that a satellite hospital is an option.
Yet, there have been delayed responses, total lack of responses, resistance to the concept of a hospital (with an ER) versus an ER alone, and statements indicating feasibility studies, needs assessments, potential legislation, etc., etc., would have to be completed prior to consideration. The authorities have been repeatedly requested to delay licensing a stand-alone ER until any requirements, including studies, could be completed. Those requests have, apparently, been ignored.
The primary reason I have been working on this issue is because our very lives are dependent on these decisions.
South Curry constitutes more than two-thirds of our total county population. It also contributes over 53 percent of patient care revenue to the CHN. The CHN cannot survive without us and our revenue. All that is being asked is that we have the same, or more similar level of care available to us as those in proximity to Gold Beach.
Ginny Razo the CEO of the network has now indicated that the emergency closure of U.S. 101 at Hooskanaden is a good reason to apply for federal funds (Office of Emergency Management) to open the stand-alone ER in Brookings, promised in 2015. She has clearly stated that transport to Curry General would be provided at no cost, but an ambulance to Sutter (as an example) would be the patient’s financial responsibility.
Now, in addition, Razo has stated that a patient in their Brookings ER would have to sign documents Against Medical Advice (AMA) in order to be transported to Sutter. She hasn’t made it clear if that would apply to patients requiring transport to Medford or Portland.
Please remember, most of us are either not able, or would find such medical/legal issues too complicated, to make an informed choice while in an emergency situation. We also don’t know if any ambulance would transfer a patient who has signed out AMA.
I’m asking that you email me, the Brookings City Council, state officials, including our governor, and let them know your thoughts and opinions on these issues.
Your life matters.
Sue Gold is a Curry County Commissioner.