Expansion of Columbia Memorial Hospital in Astoria proceeds despite loss of federal grant

Columbia Memorial Hospital in Astoria is currently undergoing a $300 million expansion. The new facility will include a more secure foundation, a vertical tsunami evacuation staircase and other features meant to make it more resilient during a potential earthquake.

That work was supposed to be covered by a $20 million grant from the federal Building Resilient Infrastructure and Communities program. But the Trump administration cancelled the program this spring, leaving projects across the country and state stranded.

On Thursday, a federal judge in Massachusetts ruled that the cancellation was unlawful. That’s after a group of states, including Oregon, sued to block the termination of the grants.

Meanwhile, expansion work on the hospital is moving forward. Columbia Memorial CEO Erik Thorsen joins us to talk about where the project stands.

Note: This story has been updated to reflect the federal ruling against the termination of the BRIC program, which was announced after this conversation on “Think Out Loud” first aired.

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

Dave Miller: This is Think Out Loud on OPB. I’m Dave Miller. Columbia Memorial Hospital in Astoria is currently undergoing a $300 million expansion. The new facility will include a more secure foundation, a vertical tsunami evacuation staircase and other features meant to make it more resilient during an earthquake. That work was supposed to be covered by a $20 million grant from FEMA, the Federal Emergency Management Agency, but the Trump administration canceled the FEMA program this spring, leaving projects across Oregon and the entire country with major funding gaps. Erik Thorsen is the CEO of Columbia Memorial. He joins us now to talk about the hospital’s renovation and the challenges ahead. Welcome to Think Out Loud.

Erik Thorsen: Thanks Dave, I’m really happy to be here with you today.

Miller: What are the main reasons that Columbia Memorial needs to expand?

Thorsen: Primarily two. Our current facility is about 50 years old. While it’s really served our community well during its lifespan, it’s really at the end of its useful life. We have numerous infrastructure systems that need to be replaced. And unfortunately, it was designed in an era where resiliency was not a theme, and it is a facility that today is constructed on a great deal of fill. It doesn’t have any sort of foundation structure that makes it safe if we were to experience a natural disaster. It’s also a wood-framed one-story building that just is not conducive to any form of retrofitting to make it safe if there ever was a Cascadia subduction zone earthquake that impacted our region.

The second reason is CMH has grown significantly over the past decade. Simply put, we are out of space. We have no room to grow in the future, and we still believe there are many services that we can offer to this community if we had additional space. So those are really the two primary reasons for our expansion.

Miller: So let’s zero into that first one. What have you heard from engineers about what would happen to the current facility in the event of a major earthquake?

Thorsen: We haven’t heard a lot of positive news from the engineers that have reviewed our current facility. I think they basically believe evacuation is our only way to care for patients if we were subjected to a significant Cascadia earthquake. Our facility would be prone to failure. We have evacuation plans and procedures developed and in place that would require us to move all of our patients, all of our staff, basically up the hill to our local community college and school district and set up makeshift, almost like field hospital structures.

Miller: Including, you’re talking about the entire hospital, including places like a cardiac unit and the ICU. How do you do that?

Thorsen: That’s the challenge, right? We’re talking about the most vulnerable patients that we care for, our inpatient populations or patients that are potentially in our ICU. It will be incredibly difficult to do that, which is why we’re on this journey of replacement, because kind of that magic window of 30 minutes of time, if we even get that much notice, it will be an incredible challenge for us to do that.

Miller: The 30 minutes, that’s a tsunami warning, right, as opposed to the earthquake itself?

Thorsen: That’s exactly right. If we withstood the earthquake and there was a potential threat for a tsunami, indications are you get that 20 to 30 minutes of time to evacuate and prepare.

Miller: Can you give us a sense for the kinds of drills that you’ve been doing as a community in preparation for the worst case scenarios now – before we get to the hopes for the future with the renovation – but what are you doing now, just so staff has a plan?

Thorsen: That’s a great question and I’ll tell you that ultimately, we probably don’t do enough, but we do participate almost every year in a kind of a countywide mass casualty and evacuation drill that’s usually coordinated with other community members and county agencies in our community. We do tabletop exercises in our facility that take us through each procedure that we have around evacuation or around needing to transport patients up to our evacuation site.

But I can tell you, no amount of drills will really ever prepare you for that stress, and I’ll use the word chaos, that comes if you’re right in the heart of that disaster. Everyone’s aware of what they need to do and we do devote time to talking about it, but I still think it will be an incredible challenge when and if we’re ever faced with that.

Miller: How many people in the community might be relying on you after an event like the major earthquake?

Thorsen: That’s a question that’s hard to quantify. The city of Astoria is roughly 10,000 people. When we applied for the BRIC grant, we used the calculation of the number of residents that could reach our facility within that 20 to 30 minute time horizon. We roughly estimated and planned for up to basically 2,000 people could reach us and ultimately take safe refuge in a resilient structure if we had one. That was the number for the BRIC grant, but it’s gonna be heavily dependent on the roadways and access to this area that will really tell how many people will rely on us during that event.

Miller: When you say BRIC, that’s the Building Resilient Infrastructure and Communities Program that had been run by FEMA. So let’s turn to that now. What did you say you would do with this BRIC grant that you did get money for?

Thorsen: We said that at the end of the day, we would be the first hospital in the nation that has embedded a vertical tsunami evacuation staircase and a tsunami-safe refuge area into a hospital design, or into a hospital structure. So the elements of that included, you start at the bottom, a foundation system that anchors the building deep into the bedrock, and then has columns that are encased in concrete, so that debris can’t wash onto the site, and ultimately knock the building off its foundation. As you elevate up the building, we put all of our inpatient beds, those most vulnerable patients up on the third floor of our building, so that they would be safe and well above the height of any expected tsunami wave.

As you go further up the building, on the fourth floor, the top floor, we put all of our electrical systems, generators, IT equipment, telecommunications equipment, all of those components that are necessary to run a building, we elevate it off of the ground level and put on our rooftop. We put a helipad on our rooftop, so that if we did need to ultimately evacuate people, we could do it in a safe and orderly manner. We build, on the fourth floor as well, a county-wide emergency command center, so that we could be the command center for our entire region if necessary.

All of those elements added somewhere in the neighborhood of $20 million of premium onto our construction cost, and those were the elements that $20 million was our request through the BRIC grant program that was ultimately awarded in 2023.

Miller: As I understand the timeline here, the first phase of work for this project started in 2024, about 14 months ago, and then another one started this year. When did you first realize that federal funding, that $20 million through this FEMA program, was at risk?

Thorsen: We learned in April of 2024. We were about 3 months away from breaking ground, as you indicated, on the first phase of work.

Miller: So you learned this in April 2024 before President Trump took office?

Thorsen: Oh I’m sorry, I misspoke the year. It’s 2025.

Miller: It’s been a long year.

Thorsen: I’m sorry.

Miller: No, that’s fine.

Thorsen: I’m sorry, that’s my mistake. We learned in April of 2025.

Miller: OK.

Thorsen: Yes.

Miller: How did you learn? What kind of communication did you get?

Thorsen: I believe we got notice through email and through papers and news sources that the program was canceled. We got no pre phone calls, no indication directly from FEMA it was coming. We learned, I think at the same time the nation learned, that the BRIC grant program was canceled.

Miller: And I should say, according to various reporting and investigations by the Urban Institute, the cuts mean communities all across the country are losing more than $3 billion that they were counting on to prepare for things like earthquakes or tsunamis, as in the case of your hospital, or wildfire or floods or other natural disasters.

I have to say that when I heard that this program was being canceled, I assumed that it was a Biden era infrastructure package or program. But it was actually established under the first Trump administration to fortify American communities. Has the current administration explained why they canceled a Trump One era program?

Thorsen: I agree with you. It was under the Trump era that the BRIC grant program was stood up, and no, I have not heard any good, solid rationale for why it was discontinued in the manner it was, other than it was in that same time period of DOGE and cost cutting and evaluation of programs that do or do not add benefit, but there’s nothing political about this project in our community. This is about saving and protecting lives, which I think was at the core of the BRIC grant program.

Miller: What kind of conversations have you had with state partners since then?

Thorsen: A lot of conversations, and I have to give a big shout out to our state legislature. We went and communicated during the last legislative session with them about the BRIC grant, about the cancellation, and they stepped up. They understood what we were trying to accomplish in Astoria, and they funded $6 million through the Ways and Means Committee for this project at the end of the session. So we did get $6 million back of the $20 million BRIC grant. I have a deep gratitude to our state legislatures for working with us to restore at least some of the funding.

Then our federal legislature, our elected officials have been deeply involved as well. They visited our site. They’ve reached out, they understand the project, and they have been doing everything they can to get some bipartisan support. Many letters have gone to try to restore the BRIC grant program, but they have been incredibly helpful and engaged as well.

Miller: 20 states led by Democrats, including Oregon, have sued to prevent FEMA from ending this programming and redirecting more than $4 billion of its funding. Where does that suit stand right now?

Thorsen: In the early stages, I don’t have a lot of information about the details of the lawsuit. We’re obviously tracking it, but there has not been anything significant yet out of that suit.

Miller: You mentioned that from the legislature, they gave you money to make up $6 of the $20 million shortfall caused by the cancellation of this grant, but at this point, how are you thinking about backfilling the rest of that money?

Thorsen: That’s a question that I don’t have a complete answer to yet. We sit today roughly 96 to 97% funded with our project. We had a complete budget with the BRIC grant dollars. We’re out talking to other foundations, looking for other grant sources that might be out there and applying for those grants. We have a major capital campaign running through our foundation, so we are talking to other potential donors about filling this void that the BRIC grant left us with.

Worst-case scenario for us is that we have to use more resources from Columbia Memorial Hospital, which would in turn delay other capital purchases that are necessary to continue to provide the type of care that we do out here. That is really not the path that we want to go down, but if we have to, we will have to delay some projects to make up the funding gap.

Miller: Just a question or two about bigger picture issues facing hospitals right now, because hospitals are in a really interesting and tenuous position it seems, especially more rural ones, because huge Medicaid cuts are coming which will affect, at base, how many people are eligible for Medicaid. It’s not gonna change how many people get sick, how many people need to go to hospitals, how many people go to emergency departments, but it’ll affect how the care that they get is paid for or reimbursed. How are you thinking about what’s coming?

Thorsen: We’re worried. We’re worried like every other healthcare facility is right now, especially in the rural communities. We’re trying to estimate the impact, but all the factors aren’t there to do that analysis, because as you point out, this is all around eligibility and how many people ultimately lose coverage. We don’t know specifically how many people that is in Clatsop County or how that rolls out to our individual hospitals.

So we are definitely looking at some belt tightening. We have seen in our community, services cut. We had a hospital located about 17 miles away from us cut their maternity services. So we now are the only hospital remaining in our community that is offering maternity services. While I don’t have the true impact, we are looking at our budget. We’re trying to look for kind of that path that we would take if we have to make significant changes to our budget, but it won’t be known until we truly understand how many people lose their eligibility.

Miller: Erik Thorsen, thanks very much.

Thorsen: Thank you, Dave.

Miller: Erik Thorsen is the CEO of Columbia Memorial Hospital in Astoria. The hospital is going forward with a major expansion despite the cancellation of a $20 million federal grant.

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