Samaritan will keep birth centers in Lebanon and Lincoln City open for now

Samaritan Health Services considered closing the birth centers at its hospitals in Lebanon and Lincoln City earlier this year.

The move drew pushback from nurses, community members and lawmakers. The health system recently announced it would keep the centers open for at least another year — but not without some changes.

Lesley Ogden is the CEO of both Samaritan’s North Lincoln Hospital in Lincoln City and Pacific Communities Hospital in Newport. She joins us to talk about what it takes to keep maternity services running amid rising health care costs, decreasing revenue and staffing challenges.

Note: The following transcript was transcribed digitally and validated for accuracy, readability and formatting by an OPB volunteer.

Dave Miller: From the Gert Boyle Studio at OPB, this is Think Out Loud. I’m Dave Miller. It has been a challenging few years for birthing centers in Oregon. One in Gresham was closed two years ago before state regulators ordered it to be reopened. A maternity ward at the Saint Alphonsus Hospital in Baker City closed in 2023. And the maternity unit at the Providence Hospital in Seaside will close in October.

It seemed that Samaritan would follow suit. The health system said in the spring that it was considering closing their birthing centers at hospitals in Lebanon and Lincoln City. Then, after holding dozens of meetings and hearing pushback from nurses, community members and lawmakers, the health system announced a few weeks ago that it would be keeping those centers open for another year before reassessing their viability.

Lesley Ogden is a CEO of Samaritan’s North Lincoln Hospital in Lincoln City and its Pacific Communities Hospital in Newport. She joins us now. It’s great to have you on Think Out Loud.

Lesley Ogden: Thank you, Dave. Great to be here.

Miller: Why was Samaritan looking at closing birthing centers in both Lincoln City – one of your hospitals – and in Lebanon?

Ogden: Well, it’s really multifactorial. As your listeners may be aware, we are looking at declining birth rates across Oregon in particular, but even across the nation. We’re looking at unprecedented workforce shortages, particularly affecting our specialists in OBGYN, simply not able to recruit those people who need to do the work, as well as labor and delivery nurses who are specialized and hard to find sometimes.

We are looking at payments to hospitals that do not cover the cost of providing care, and then on the other hand, steeply rising costs of providing that care, as well as regulatory and specialty requirements driving our staffing. So all of these things work together to create, increasingly, a very hard environment to continue to deliver the care that we all want to continue to deliver.

Miller: We could spend a chunk of time on any one of those different factors, but let’s dig into a couple of them so we can really understand what you’re facing. You mentioned regulatory requirements. What are they, in terms of what the state or feds say you have to have on hand in terms of people for a birthing center?

Ogden: Yes, it’s a very good question because it’s very different than it used to be. I think a lot of people will remember the times when you maybe went to the hospital to give birth and you checked in with one nurse, and then your doctor was called, and it was probably the same doctor as your family medicine, who took care of the whole family and then facilitated that birth. And things are very different now.

For example, you have a minimum of two, ideally three nurses that are all specialty trained on at the exact same time, so that you can handle whatever might come through the door, as well as meal and rest breaks that have to happen for all of them. You have an OBGYN specialist that takes care of the mother, plus a pediatric or family medicine physician that takes care of the infant or baby. You have as well, an anesthesia provider that has to be on call all the time, as well as an OR crew, in case what is planned to be natural childbirth moves to a surgical solution.

And, in some cases, we also have neonatology backup through robots and other technology to help us in the event that something does go wrong and we need their expertise. So it is just an entirely different type of environment than we’ve seen even 20 years ago.

Miller: Do you think that all of this is necessary? I mean, I don’t think it’s hard to understand why these different providers, specialists need to be on hand. In case something goes wrong, they’re there to save the day. Do you think it’s all necessary?

Ogden: Really, with our increased specialization within medicine, as we get better and better at what we do, in order to maintain that level of patient safety and those amazing outcomes, despite what the world may bring us on any given day, it really is necessary to maintain a lot of this.

I think you could argue, could you make a tweak here, could you make a tweak there? Absolutely. Could you substitute some other specialist in this particular case? We could all come up with some different models, but overall we are not getting less specialized in medicine. We are only getting more specialized. That does mean better outcomes and increased safety for our patients. So yes, I think we are at that time where we don’t want to go backwards, but the sacrifice may be less places in which to give birth, in this particular case.

Miller: Right. I mean, it seems like a devilish trade-off question. Do you want more places, so a patient who’s going into labor, they only have to travel, say, 20 minutes or 25 minutes, but when they get to that place, there are fewer resources? Or they have to travel 45 minutes or an hour, but when they get to that place, there’s the full suite of services you just mentioned. How do you think about those two scenarios?

Ogden: Well, I think you have to balance that with patient safety, number one, always. And many patients do successfully go many miles in order to deliver. I think what our studies show us is that once you get above about an hour of travel time, that’s when patient safety is sacrificed. So we rely on experts in the field and those types of studies to help inform what is safest for our patients.

Miller: Can you tell us about your Lincoln City Hospital in particular? That’s one of the two that had been proposed as one of the possible closures for maternity services. As I mentioned in my intro, there’s been a one year reprieve, and we’ll talk about the changes that you plan to put in place over the coming year. But what has labor and delivery looked like at Lincoln City over the last year?

Ogden: It actually looked very similar to what it has looked like before. We’ve just been navigating services with one less OBGYN physician. We did have one leave us to move her family to Montana. So we’ve been working with two out of three, which is ideal for us for a call scenario, meaning the times that they have to be available at the drop of a hat to come in. Ideally, it’s three of those providers sharing that call burden, but we’ve been dealing with two instead and supplementing with some temporary workers to fill in those gaps. We’ve been quite successful with it, actually.

Miller: I’ve read that there were 260 days last year – significantly more than half the year – at your hospital, when there was no birth. Those days, do you still have to have all those people on hand just in case?

Ogden: Yes, that is the crux of the situation. Although we’re getting better and better at predicting when someone might have a due date and and might give birth – we also have ways to induce births and make those happen at the safest periods of time – but it all comes down to, sometimes people just have babies when they have babies. And we have to be prepared at all times to be ready for that.

Miller: Did any of the fear, frustration or pushback from either health care providers or outsiders – say, lawmakers or community members – play into your decision to continue services for at least another year?

Ogden: Certainly, it helped us understand how important so many people thought these services were. Certainly, if we had gotten a mediocre response from anyone, that may have led us down a different path. But this is something that everyone is united on, including myself, that we’d like to, if at all possible, continue services to our community and have the safest places available for these births. So yes, I think everything played into our decision.

Miller: What kinds of compromises or changes are you going to have to make as a health system in order to keep these particular birthing centers open for the next year?

Ogden: We’re coming at it with a lens of innovation, thoughtfulness and collaboration. We don’t purport to have all the answers, but what we hope is [to pull] together and establish a systemwide OBGYN practice so that our services are more coordinated across our hospitals and providers. If we approach with that lens of innovation, to encourage and support our teams to do things like cross-train team members for broader support roles where appropriate; if we look at our staffing with new lenses, focus on reducing that reliance on temporary agency providers, and really be thoughtful and look for solutions as much within ourselves as outside of ourselves, what we hope is that we can come up with ways, differently than we’ve ever done in the past, but to continue forward and get to some solutions that will allow us to be sustainable for much longer than that.

We’re also looking towards some solutions coming from those very legislators who have said, “We feel strongly that you should continue these services.” Well, they are looking at ways that perhaps those payments to hospitals change to support our efforts. So it really is everyone within our OB-GYN and labor and delivery community as well as outside, everyone who wants this to happen, coming together and figuring out, what does it take and how can we get there?

Miller: Back in the spring, obstetrics wasn’t the only specialty that was in conversations about either closure or major changes. General surgery, orthopedics and neurology were all mentioned as well. How broad are the conversations that you’re having right now about rethinking the way so many services are being delivered?

Ogden: Well, you just identified some of those areas that we took a look at very closely, because all of those things that I outlined at the beginning that are affecting our ability to deliver those labor and delivery birthing center services also, to some degree, affect other service lines. But in some cases, maybe we saw ways to actually, instead of contract, expand. So, in the case with urology and orthopedic services, we actually saw opportunities to expand those services. And in fact, [we] are getting to the nuts and bolts of identifying what those expansion opportunities are, and outlining where we want to be with that.

However, with general surgery, we looked at ourselves and said, wow, we’re a system covering roughly 280,000 people over a tri-county area. If we had to build this service from scratch, would we build it like it is right now – and I’m talking general surgery services – would we have five different hospitals with five different general surgeons on call, 24/7, 365? Or could we come up with some innovative ways to continue to staff, continue to provide those services but not with redundancies that don’t make sense? So this is one question that we’ve been asking ourselves and bringing together people across the general surgery specialty to help answer for us.

Miller: You’re going to be doing quarterly monitoring over the next year and then a full reassessment a year from now, in summer or fall of 2026. How are you going to decide whether or not these changes were enough?

Ogden: Certainly, we’ll be looking at our bottom line and looking to see, have any or all of these changes really made something more sustainable, that perhaps a year in the past was not? And certainly, that would be the happiest moment, when you say, “Wow, we came together, we came up with a lot of innovative ideas and a lot of collaboration, and it really worked. And then our legislators were able to get additional funding to support, for example, maternity services and this really changed our trajectory.” That’s our fondest hope, but certainly, we’ll look at each of these areas as we continue to reimagine how to design care.

And the biggest thing when we think about all of this is, we know we’re not in this alone. These are really existential questions for anyone who is in the hospital industry and providing health care now. How do you continue to provide robust services and the safest patient care you can, in a setting where things are increasingly not sustainable? Meaning you’re not meeting your financial bottom lines, where all of your costs are rising and your reimbursement is either stagnant or declining.

So we’re looking at ourselves, we’re looking to others, and we’re hoping against hope that all of this introspection and partnership really pay off in the end and that we’re able to still be everything we have been for our communities and for our patients.

Miller: Lesley Ogden, thanks very much.

Ogden: Thank you.

Miller: Lesley Ogden is the CEO of Samaritan’s North Lincoln Hospital in Lincoln City and Pacific Communities Hospital in Newport.

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