SPECIAL REPORT: ‘Nail in the coffin’, hospital project collapses | Exclusives
Editor’s note: In our first special report published last week, we laid out the questions The Chronicle would answer raised by our investigation into the Columbia Health District (CHD) hospital project.
The following report explains the creation of the CHD, the feasibility study that led to the hospital project proposal, and the process of obtaining state approval to build the hospital.
Warren resident Thelma Bonar thinks it’s time for a hospital in Columbia County. But it has to be done “in a good way”, she said.
The Chronicle spoke with the woman behind Measure 5-209, an initiative to repeal the CHD hospital tax, at her home on Monday, April 25.
At home, Bonar pointed The Chronicle to a box of records, thousands of pages on the CHD from start to finish, piled haphazardly against her living room wall.
“My husband, he was sick,” she said. “At that time, he had cancer. And I was guilty because I put all my time into it. People came home. It was busy.
According to CHD records obtained by The Chronicle, the Hospital District of Columbia was formed with five members to oversee operations at a hospital on 4th Street in St. Helens.
In 1954, this facility was sold. In 1955, another hospital was built along Pittsburg Road in St. Helens.
The new hospital was sold to the Sisters of St. Joseph and closed in 1990 due to financial losses.
At the end of this period, the district council was renamed Columbia Health District.
In 2003, the CHD board commissioned a study to determine if a 12-bed critical access hospital was financially feasible in St. Helens.
A year later, the results of the feasibility study led the Council to pass a resolution to dissolve and liquidate the Columbia Health District subject to the formation of a new district. New members of the district council offered voters Ballot Measure 5-123, which would raise a tax of $0.38 per $1,000 of assessed land value to support construction of a critical access hospital.
The permanent tax rate would affect taxpayers in St. Helens, Scapoose, Columbia City and nearby areas, according to a description of the 2004 ballot measures.
Although the initiative was finally adopted with 9,275 votes in favor and 6,763 votes against, measure 5-123 was not without reproach.
On October 18, 2004, Christopher Armstrong-Stevenson, a former Oregon Public Health (OPH) employee and Certificate of Need (CN) coordinator in Oregon, called the measure “premature”.
“Seeking the permanent tax levy before the proposal is approved by the state is unfair and inappropriate,” he wrote.
Armstrong-Stevenson argued that the results of the feasibility study revealed three concerns: the proposal had not been “analyzed or critically reviewed”, “had substantial flaws in its conclusions”, and was adopted by the CHD “without sufficient knowledge of hospital administration. .”
Based on the results of the feasibility study, Armstrong-Stevenson added that the state would likely deny the project a CN.
CN’s programs are regulatory programs designed to discourage wasteful investments in health care facilities, technology and services, according to Jonathan Modie, communications manager for the Oregon Health Authority.
Thirty-six other states in addition to Oregon, Puerto Rico, the U.S. Virgin Islands and the District of Columbia have adopted CN programs to avoid duplication of hospital services, which would ultimately result in “higher costs and disruption to the healthcare system,” Modie told The Chronicle.
One of the more specific issues with the study that Armstrong-Stevenson mentioned in his online letter was an overreliance on swivel beds, or beds used interchangeably for acute or post-hospital care. acute, per the 2020 CMS Interpretive Guidelines for Swing Beds in Critical Access Hospitals (CAH).
“The use of the ‘swivel bed’ theory today, in this case, is simply flawed planning theory and appears to ignore the fact that private licensees already in the service area are providing nursing care beds. long term (SLD),” he wrote. “(The) St. Helens Hospital would therefore be in competition with the livelihoods of the owners of these private nursing homes.”
Armstrong-Stevenson was also skeptical that St. Helens Hospital (renamed Columbia River Community Hospital) would attract doctors from other service areas.
When the old CHD disbanded and reformed in 2004, five new members were elected to serve on the board: Jay Tappan, Paul Becks, Gary Heide, Karen Punch and Laura Tomanka.
Despite fears that the state would not grant CN, in 2008 the new board submitted a state application to build a new hospital.
In October 2009, the Oregon Department of Human Services (ODHS), which oversees OPH, denied CHD’s CN application, saying the board had failed to adequately substantiate the viability and need for a hospital.
CHD responded by submitting an amended application to fill in the gaps in the original document and to make arrangements for a rural health clinic.
The state remained unconvinced that the CHD sufficiently substantiated the need for a hospital in St. Helens, and for the second time denied the board a CN on September 20, 2010.
“State review of this project found it to be financially marginal,” ODHS spokesman Grant Higginson said. “The district has failed to establish the need for this facility or to show that it is the most effective and least expensive alternative.”
In response to the CHD Board’s appeal, OPH held a hearing on August 25, 2010.
“We [The Columbia Health District] proven that we are financially viable and a necessary service to this community in every way we can, two or three times over,” said Pam Powell, Hospital Coalition Coordinator for CHD. “We are devastated.”
With Order CN #658a, OPH denied Columbia River Community Hospital for the final time, for the following reasons:
“(OPH) found that the proposed facility would have replaced some of the current spectrum of inpatient care that was served outside of Columbia County and that the proposal would have duplicated the services that were being offered.”
Columbia County Commissioner Henry Heimuller was one of three county commissioners overseeing the CHD’s disbandment after it failed.
Looking back, Heimuller told The Chronicle in a one-on-one interview that what really killed the hospital project was when the feds changed the definition of critical access in November 2005. .
“Once the CAH designation changed, (that) was just the nail in the coffin,” he said. “It happened where there was no possible way for the hospital to survive financially,” he said.
Per Section 485.610(c) of the Centers for Medicare and Medicaid Services (CMS) guidelines, CAHs must be located more than 35 miles away (or, in the case of mountainous terrain or in areas where only secondary roads are available, a 15 mile drive) from a hospital or other CAH.
Prior to the critical access rule change coming into effect on January 1, 2006, rural hospitals designated by their state as a “necessary provider” could be exempt from distancing requirements.
The Chronicle also spoke with former CHD president Gary Heide, who conceded during this interview that the hospital project should have stopped immediately.
“Looking back on it now, I think it probably would have been better if we had just trashed the thing when they changed the rules,” Heide said.
Our third investigative report will cover the citizens’ initiative to repeal the hospital tax, the steps taken to dissolve the hospital district, and the internal emails exchanged between board members during the period of dissolution – the fundamental evidence and the basis of two lawsuits against the former CHD board.
Look for the report in the July 20 edition of The Chronicle.
Read our previous investigative report attached.
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