How the closure of Eugene’s only hospital is impacting emergency services

It’s been just over three months since the only hospital in Eugene closed, leaving Oregon’s second-largest city without a dedicated emergency department. PeaceHealth announced the closure of its University District hospital last August and ceased most operations at the facility in December. Since then, emergency patients have been transported to the McKenzie-Willamette Medical Center or PeaceHealth’s RiverBend hospital, both located in Springfield.

Deputy Chief Chris Heppel oversees emergency medical services at Eugene Springfield Fire. He joins us to talk about how the University District closure has impacted EMS in Eugene, along with Rep. Nancy Nathanson, D-Eugene, who joins us with more details about a possible legislative solution to some of those issues.

Editor’s note: HB 4136 passed the state House on Monday and the Senate on Wednesday. It now goes to Gov. Tina Kotek’s desk.

The following transcript was created by a computer and edited by a volunteer:

Dave Miller: From the Gert Boyle Studio at OPB, this is Think Out Loud. I’m Dave Miller. What happens when the only emergency department in the second largest city in the state closes down? Eugene is finding out right now. PeaceHealth Sacred Heart Medical Center shut down its University District Hospital in December. Since then, public health officials, first responders, and elected leaders have all been scrambling to figure out what to do next. We got two perspectives on this yesterday, including from a Lane County lawmaker who has introduced a bill intended to address the situation. Chris Heppel joined us first, he is the deputy chief at Eugene Springfield Fire where he oversees emergency medical services. I asked him what went through his mind when he heard that PeaceHealth was going to close its hospital.

Chris Heppel: For us, it was just simply a surprise. Our healthcare system as a whole is challenged and stressed right now. For many years we’ve experienced decreasing resources in our area and across the state of Oregon. What we’re experiencing in Eugene is not unrepresentative of what we’re experiencing across the state with the smaller hospitals able to stay open, the reduction of services and outlying areas requiring us to colocate or centralize services in larger metropolitan areas, which really reduce access across the state of Oregon.

But really what we were surprised about was the timeline. We literally had about three months notice that we’re shutting this facility down and we’ll no longer have access to it, which then subsequently, literally drives us to take all of our patients over to Springfield.

Miller: I want to hear about what that drive has meant and what happens when you actually arrive in Springfield. But can you just tell us what role the University District emergency department was playing? Because I’ve read that it was already seeing fewer patients since PeaceHealth opened up a new hospital in Springfield 15 years ago or so. So what role had it been serving?

Heppel: So in that community, you’re correct in the sense of the disproportionate amount of services shifted to the RiverBend complex in Springfield around 2008. But they left the emergency room open there. We also had the ACE unit for senior folks there. We also had some behavioral health capacity there as well. What we had was a capable emergency room. Patients who generated within the Eugene area, we could simply take a mile or two or three to that facility where they didn’t require higher levels of care which would be provided at RiverBend. It just gave us another avenue or facility in which we could take folks. And we were in double digit patients that we were taking there daily. I’d say about 20% of our call volume was going to that facility on a regular basis.

Miller: What does it mean in terms of outcomes? What does it mean to now be going to a hospital in Springfield that is six miles away for Eugene patients?

Heppel: I think the piece to look at is it’s not the distance or the time. We need to step up a few thousand feet, look at it from a bigger picture. And it’s about availability of resources and access to care in the end. Our critical patients were already going to RiverBend. This is folks who were requiring a lower level of care. They also may be in a lower socio-economic status and literally walked to that facility. And so that’s where our biggest challenge was.

The other big challenge we have is what we call ambulance patient offload time, or the ability to get our patients off the gurneys and into hospital beds so we can put our ambulances back in service. So now we’ve got this little trifecta event to where I’ve closed a facility, I now have to take them further. I already have challenges getting patients off my gurneys. That problem is now increased because I’ve got fewer facilities to take them to. And then to top it off, it takes even longer for our units to get back into service back in Eugene. And so when you add up all those times, basically it comes out to those patients we would have taken to University District adds about 27 to 30 minutes per patient total unit time. Over a year, is about 2,000 unit hours we lost just simply because we’re going further and having to wait longer with fewer resources to take patients to.

Miller: I think we are really used to on this show, and society-wide, hearing about 911 wait times. But that is somebody has called 911, they talk to a dispatcher, and then they count the seconds or count the minutes before an ambulance comes. What you’re talking about there at the end is actually really different. You’re saying that the time from when the ambulance actually arrives outside the emergency room, before the patient can enter into the hospital and be a patient in the hospital, why is that time increasing?

Heppel: Really probably need to ask those questions to the hospital system. Our lens is gonna be from that of the emergency medical services system. But they’re struggling from the same challenges we are. Patient throughput, fewer resources to discharge patients to such as long-term care facilities, rehab facilities, abilities to get patients home, etc. And I use that from the sense of they’ve got to send patients out the front door to make room at the end so we can bring them in the back door. And so they’re struggling with those types of resources as well in the stressed healthcare system that we’re in. We don’t lay blame, if you will, on that piece. It’s an entire system challenge that we’re trying to establish. But when we don’t have room at the end, it really backs up things at the back door, which really backs up our whole 911 system and even our non-emergency response system.

Miller: You mentioned staffing challenges. What has the closure of the emergency department at the University District Hospital meant for your staff?

Heppel: For our staff, it’s a reduction in destinations that we can use. So that’s probably one of the biggest stresses. I think the other part is just more windshield time, spending more time in the unit, spending more time standing in the emergency room waiting for a nurse to take the patient. And so from a job satisfaction perspective, a patient satisfaction perspective, all have tremendous impact long-term. Our folks love to go out and do their work. But I didn’t come to Fire and EMS to stand in an emergency room.

Miller: In a few minutes, we’re going to be talking about a bill in the legislature that among other things would provide funding to staff one additional ambulance in the region. How much difference do you think an ambulance would make, one more ambulance?

Heppel: For us, it’s really to help blunt the impact of PeaceHealth closing in our hospital. I mentioned approximately 2,000 unit hours a year, that’s really what it’s blunting, is helping us to absorb the impact of the decision the health care system made. They made the decision which they needed to, and we totally understand that.

Miller: I just to remind folks the reason is that as an entire system, they’re losing hundreds of millions of dollars over the last couple of years.

Heppel: And so for us, we weren’t prepared to absorb that cost. That cost was passed on to, disappointingly, the taxpayers. We were happy that we were able to partner with Representative Nathanson, as well as Lane County Public Health, and ask for what we call some bridge funding to help us get through this period of time while we reconfigure our system to help accommodate the reduced resources available to us in Eugene.

Miller: Let’s say the bill were to pass. How quickly could you actually get another ambulance with staff inside it on the street?

Heppel: In a couple of weeks. We’ve gone to the legislators and just asked for funding for staffing. We will utilize one of our reserve ambulances, and we’ll bring folks in on extra hours to help cover those shifts, is our game plan.

Miller: Chris Heppel, thanks very much.

Heppel: Thank you.

Miller: Chris Heppel is the deputy chief of Eugene Springfield Fire.

Nancy Nathanson joins us now. She is a Democratic state representative from North Eugene. Representative Nathanson, welcome to the show.

Nancy Nathanson: I’m so glad to be here.

Miller: What were your biggest concerns when you heard, with something like three months warning, that the University District Hospital was closing?

Nathanson: I knew right away there would be an immediate and serious impact. And I knew it was way more than what I could figure out on my own. So I quickly pulled together a wide-ranging group of stakeholders to help us think through what this would mean, not only in the short-term but in the middle range and long-term. I knew it was big.

We just heard Chief Heppel talking about the bridge funding. I’m really excited that the proposal that we’re working on, that has already passed the House on an overwhelmingly positive vote just yesterday, very glad it’s moving on to the Senate now, it’s about bridge funding. But even more important and more exciting, it’s about how we can reshape the future of delivering immediate or urgent health care.

Miller: What exactly would the bill do to address the immediate needs of emergency services providers? We just heard about staffing for one more ambulance. What else is your intent in terms of the immediate needs? And then we can talk about the experimentation element that’s a little bit more in the medium- or long-term.

Nathanson: The simplest thing we could do immediately was make sure that Fire EMS had that additional ambulance crew. We need to make sure that’s available to them because that’s about the patient experience. We need to be able to have an ambulance available to get people in an emergency and take them to a hospital. And when you close one out of three emergency departments, of course people are gonna be waiting longer times in the emergency department. And we’re concerned about the strain on hospitals and the strain on all of the health care providers in those hospitals, as well as the ambulance crews.

So the one immediate thing is that additional ambulance crew. But rather quickly we’re gonna be able to put in place, I hope, some of this innovation fund, new program models. And also one of the things we’re talking about is how can we help people get to the care they need? Lane Transit District, which operates RideSource, they’re already helping people get to medical appointments. We’re already talking with Lane Transit District about what role they can play in helping people get to the care they need. We need to find new ways of helping people get the care, whether it’s helping them get a ride to where they need to go, or taking the care to them right at their own home.

Miller: Back to the idea of the ambulance, if the biggest problem right now stemming from the closure of one of the three emergency departments is just that there aren’t enough places for people after they’ve been brought there by an ambulance, what difference would an extra ambulance make? This gets to sort of the front door and the back door that Deputy Chief Heppel was talking about. If there aren’t enough emergency beds or stalls, how big a difference would it make to have another van to take you to the already jammed emergency room?

Nathanson: It’s gonna make a difference to someone who’s called 911 and they’re waiting for someone to get them. We really need to make sure that as long as someone has called 911 and the emergency crew is able to get to them, at least they are in the care of a highly skilled trained professional. When you have EMTs, emergency medical technicians and paramedics, able to get to people quickly, that can save lives, and save pain and suffering. And I think it’s important to make sure that we have this additional crew available because as the chief explained, when the crew is taking longer to just get someone to a hospital that’s even farther away, and then they’re having to wait with someone to offload them into the emergency department, that crew isn’t able to then respond to another call that came into 911. We wanna make sure that when that call comes, there’s someone to go take care of someone who needs the help right away.

Miller: So that is the funding in the bill for another ambulance crew. The other big part of state money that you want your fellow lawmakers to approve would be for an innovation fund. What would that support? What are examples of what that money, if it were to pass, might be used for?

Nathanson: I’m gonna start with just a real brief explanation of the kind of medical situations that show up at an emergency department. It includes things like someone who needs just two or three stitches for a small uncomplicated laceration, or a sprained ankle, or a sinus infection. People show up at the emergency department just to get a prescription refill.

What if people didn’t have to wait for three or four or more hours in an emergency department, and they could get the care they needed the same day in a compassionate professional way, but have it be done quicker, and better and we could even reduce overall system cost?

Some of the examples are we could do a better job of triage, a better more thorough interview. When someone calls 911 and it turns out it’s not an immediate life threatening situation, what if someone could help evaluate that person’s situation, and maybe we could send a mobile nurse practitioner to the home, or we could send a different type of transport vehicle to take them to an urgent care facility, or take them to a doctor’s office.

Or what if we had flexible EMS community response units, so instead of an ambulance taking someone to a hospital, a really well equipped medical vehicle shows up and can take care of the person. Similarly, a mobile nurse practitioner is able to prescribe medication. We think that we can come up with some really good plans to help people. We’ve also heard ideas about a nurse call service linked to the 911 system. Or even what if there was a 24/7 nurse advice line available for everybody. Some of us with a health insurance plan might have access to some people call it “Ask a Nurse.” but not everyone has that op option. What if we could make that available to everybody?

There are just lots of really good ideas out there. And we’d like to put two or three of them into practice as quickly as possible.

Miller: It seems like what you’re describing, there are at least two really major components that would have to be in place for the system broadly that you’re describing to work. One of them is that the ultimate service providers have to be in place, there has to be a nurse who could go to someone’s home to help with the laceration. There has to be an urgent care center that is up and running, etc.

The other though is before that, there has to be the right system that can funnel people in the right ways. Meaning, if someone calls 911, but it turns out they don’t need the full suite of 911 services, the dispatcher has to be able to actually push people into the right place. Is the money that you hope to get lawmakers to approve in the Senate, would that also go towards dispatch, so the more sort of supple system that you’re describing could actually be in place?

Nathanson: That’s exactly right. We will have the ability for Lane County Health and Human Services to be able to review proposals for programs such as you just explained. They’re going to review proposals and identify the ones that have the best opportunity for making real change, and getting help to people, reducing overall system cost, being the smartest solutions possible. We’re also really counting on our coordinated care organizations and other interested parties, other stakeholders in the medical community, to step up. I’ve already heard interest from several groups that they would like to help participate in designing something new.

Another piece of the bill that we’re really proud to have included is some streamlining in licensing for nurses. In the past, it has taken a long time, more than weeks, sometimes counted in months, for a nurse moving to the State of Oregon to be licensed and practice in the state of Oregon. We’re cutting through the red tape in this bill. We’ve brought some streamlining to that so that a nurse with an active license in good standing, practicing in another state, can come to Oregon and work more or less immediately. We really need to be able to do this. Of course, we have shortages in many of the health care occupations. But this is one we’re also going to address right away in this bill.

Miller: Representative Nathanson, thanks very much.

Nathanson: You’re welcome.

Miller: Nancy Nathanson is the Democratic State Representative for North Eugene. We talked yesterday. A little under an hour ago, House Bill 4136, the bill Representative Nathanson was just talking about passed the State Senate. It now goes to Governor Tina Kotek’s desk.

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