‘I didn’t get into healthcare to watch it disappear’: Tensions boil over Eastern Oregon hospital cutbacks

For nurse Doris Harper the Blue Mountain Hospital in John Day is more than a workplace. It’s also where she gave birth decades ago, 90 rugged miles from the next nearest hospital in rural Oregon.

Harper’s daughter, Jessie Saul, grew up in their Grant County community. She too became a nurse, working alongside her mom. When the doctor who delivered Saul entered hospice care in recent years, she helped take care of him.

Both women say that when it comes to staffing a rural hospital system, a tight-knit community can make the difference for patients with nowhere else to turn. But recent staffing cuts and departures are making them question whether there will be enough people, and enough time, to respond to emergencies.

It’s gotten to the point, Harper said, “where the staff will come back from time off and ask what cuts have been done this week.”

This year the hospital has weathered layoffs, resignations of longtime doctors and financial losses likely to worsen when federal cuts to Medicaid roll out next year. Concerns about working conditions sparked a unionization effort by employees in April.

Tensions came to a head during a tense meeting of the Blue Mountain Hospital District board in John Day on Aug. 26. Nearly 40 employees and residents packed the room or overflowed into the hallway. They wanted to know why caregivers were being let go and who was to blame for a vital institution shrinking.

Related: A rural Oregon town lost its maternity ward. As Trump’s Medicaid cuts loom, other hospitals may be next

District officials say the hospital is trying to survive financial hardships while meeting state staffing guidelines, pressures that are not unique to the county of roughly 7,000 residents.

One in five rural hospitals in Oregon are at risk of closing, according to an analysis this year by the Center for Healthcare Quality and Payment Reform. The policy advocacy group tracks distress at rural medical centers nationwide. It found more than 40% of Oregon’s rural hospitals have cut back services to make ends meet.

Meanwhile, Republican-backed cuts to Medicaid take effect Jan. 1. Some 200,000 Oregonians could lose their health insurance. The Oregon Health Authority has projected Oregon will lose $9.4 billion total as a result.

In their “One Big Beautiful Bill,” GOP lawmakers set aside a different funding source for hard-hit rural hospitals, but in Oregon, the money makes up only a fraction – roughly 4% — of cuts to the state’s Medicaid plan.

At Blue Mountain Health District, austerity measures are already well underway.

The district operates a 25-bed hospital in John Day, a 40-bed elder-care center in Prairie City, two clinics and a hospice.

Without this safety net, locals would need to drive at least an hour and a half for care. But in emergencies like heart attacks, Harper said, minutes matter.

“I didn’t get into healthcare to watch it disappear. I became a nurse to help care for our community,” she said.

A rural hospital under pressure

Soon after Blue Mountain Hospital District hired Misty Robertson as its CEO last year, nine employees were let go. At the time, Robertson cited financial pressures and anticipated Medicaid cuts.

She told OPB this week the district lost $1.6 million last fiscal year, and has lost another $818,000 this fiscal year. She described the financial situation as an “unsustainable trajectory that required us to make difficult changes and find new solutions for the future.”

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State records show that since Robertson took over, regulators from Oregon Department of Human Services raised red flags over staffing levels at the hospital.

They documented nights when there were no nurses working last year. Other times, the state found the hospital did not have adequate Certified Nursing Assistant staffing. In October 2025, the state fined the hospital $9,750 over its staffing report.

Robertson said the district is following Oregon staffing guidelines. She blamed a broader shortage of nurses and nursing assistants.

“This is not an isolated experience specific to BMHD but a nationwide systemic issue that needs to be addressed at the local, state and federal levels,” she said.

Cutbacks fuel union organizing

Harper, the longtime nurse, agreed staffing has always been a struggle in a remote part of the state.

“We’re pretty secluded. Not everybody wants to live in Grant County,” she said.

Between January and June, three longtime doctors resigned. Their departures left the hospital with just one doctor on staff and another traveling physician.

Meanwhile, employees are unionizing in the hopes of stabilizing pay and staffing.

Earlier this year they learned the usual cost-of-living increases aren’t happening. Employee health insurance costs increased. In response, 120 healthcare workers in the district organized a vote to join the Oregon Nurses Association. The effort is pending state verification.

ONA spokesperson Kevin Mealy said the April employee vote was essential for making sure healthcare workers can speak freely.

“We can’t improve healthcare or working conditions if we’re pushing problems under the rug,” Mealy said.

Criticism of the hospital district’s leadership and concerns about staffing levels have been aired on local Facebook groups for months, often anonymously.

At the district’s Aug. 26 meeting, the conflict spilled into the standing-room-only boardroom when BMHD board member Shawna Clark put her online critics on notice, saying she intended to hire a lawyer and track them down.

“You’re not going to hide behind these anonymous names because your IP address can be traced and they will be traced,” Clark said, before name-checking several people in the crowd.

After the meeting Clark told OPB in an email that her reference to litigation stemmed from “the slanderous and defamatory statements that are being stated and misrepresented online.”