Adventist Health’s proposal to absorb the financially strapped Mid-Columbia Medical Center in The Dalles has drawn fierce support and opposition.
Several advocacy groups, including two labor unions, are urging the state to conduct a more extensive and time-consuming review beyond the initial 30-preliminary review the Oregon Health Authority conducts on all large health care company acquisitions or mergers.
Critics say they are nervous that an out-of-state hospital system with a strong religious affiliation – California-based Adventist is tied to the Seventh Day Adventist Church – would assume ownership of secular Mid-Columbia.
“We have received excellent non-judgemental and gender-affirming care at MCMC,” wrote area resident Marisa Cieloha, who described herself as an atheist with a teenager who is transgender. “If this deal goes through, the closest secular hospital option would be over an hour’s drive on a highway that is subject to seasonal road closures.”
Meanwhile, a number of Mid-Columbia employees and other supporters are urging quick approval, saying Mid-Columbia needs the financial stability Adventist would bring. Mid-Columbia leaders have said the hospital needs extensive renovation or a complete rebuild, but that it lacks the reserves or borrowing capacity for that job. Both systems are non-profits.
Mid-Columbia has been wracked by heavy staff turnover and inability to retain doctors, supporters said. Adventist ownership might reverse that, they wrote. Citing an inability to retain oncologists, Mid-Columbia has announced it will close its Celilo Cancer Center “for the time being” at the end of this month. Mid-Columbia employee Annali Cross wrote that new ownership should focus on boosting employment rather than building a new facility.
Oregon Health Authority officials have until late February to decide whether to approve the transaction or require a more extensive review of the possible impacts of the deal, plus hold a public hearing.
Adventist Health, a 23-hospital chain, says it would spend $100 million over the coming 10 years upgrading Mid-Columbia.
State review is required under the state’s new Health Care Market Oversight program.
The proposed deal is noteworthy in part because it is the first hospital acquisition to come up for review since the state launched the oversight program this past spring. Also, Mid-Columbia is one of the few remaining standalone independent hospitals in Oregon.
Plus, while Mid-Columbia is a non-religious institution, Adventist has a religious affiliation.
Out of roughly 45 comments submitted, about a quarter didn’t express an opinion about the proposed deal but generally criticized services at Mid-Columbia. The remaining comments were divided roughly equally between supporters of the deal and those expressing opposition or seeking a more elaborate state review.
In its application, Mid-Columbia said its finances are not strong enough to undertake the costly work of refurbishing or replacing its hospital, portions of which date back to 1959.
Adventist said it did not plan to cut any services at Mid-Columbia.
But critics said the state needs to determine more clearly whether Adventist’s religious policies would restrict care at Mid-Columbia.
The Seventh-day Adventist Church opposes abortion in all but a few instances, such as health-threatening pregnancies and rape or incest, and it opposes same-sex relationships. But Adventist Health said it would not require Mid-Columbia to change any of its current reproductive or other services.
The merger review program was set up by Oregon lawmakers to ensure large health care transactions do not lead to cost increases or reduced services.
Mid-Columbia’s shuttering of the cancer center after Mid-Columbia and Adventist jointly submitted their merger proposal saying there would be no service reductions by Adventist “impugns the integrity of the rest of the application,” wrote Jonathon Baker, president of the Oregon Federation of Nurses and Health Professionals union.
Adventist has a history at some facilities of cutting costs and worsening patient care, Baker wrote. There’s a risk Adventist would repeat that at Mid-Columbia, he wrote.
The Service Employees International Union Local 49 wrote that it feared the deal could increase prices, reduce essential services and lower wages for workers. While Adventist says it does not impose religious-based restrictions on medical services, the system also says it will not take part in death with dignity procedures, SEIU wrote in a joint letter with Cascade Aids Project and Basic Rights Oregon, a group advocating for rights for the disabled. The groups want the state to conduct an in-depth review.
“Any deal to acquire one of our remaining independent hospitals should stand up to scrutiny by industry experts as well as by affected community members,” they wrote.
Other critics didn’t like the idea of losing local control of the hospital. Mid-Columbia has recently cut back on efforts to help Oregon Health Plan members in the Wasco County area because that work is too costly, wrote Dr. Judy Richardson. “I am concerned that a distant governance board may be even more removed from the needs of the most vulnerable and often voiceless in our community,” she wrote.
But having Adventist assume control of Mid-Columbia is essential for Mid-Columbia’s survival, wrote local resident Diana Compton.
Kyna Sears, a registered nurse, agreed. “Please do not delay (the merger) approval,” she wrote.
Local resident Amanda Evans wrote that she feared for Mid-Columbia’s future without Adventist stepping in. “Our local community hospital is failing financially,” she wrote.
About 80 miles east of Portland, Mid-Columbia has struggled financially for years, typically hovering at or below the break-even point on operations. Soaring costs and erratic revenues during the pandemic worsened the situation, leading to an operating loss at the hospital of $3.6 million in 2021, and a loss of $3 million in the first nine months of 2022, according to hospital filings with the state.
In their application, Mid-Columbia and Adventist said most of the $100 million in planned spending would be for facilities improvements, new medical equipment and information technology, as well as expanding Mid-Columbia services.
Mid-Columbia and Adventist said their deal satisfies all of the state’s review criteria.
Adventist said it wants to curb cost increases and improve and expand services to patients.
“No reduction or elimination of health care services is anticipated,” the application states. “Instead, the parties intend to expand existing services and will investigate adding new services.”
“Mid-Columbia will continue to make the full range of reproductive services available to patients, since Adventist Health imposes no religious-based restrictions on medical procedures and services,” the application notes. It was not immediately clear exactly what reproductive care services Mid-Columbia’s obstetrics department currently offers. The department’s website says services include birth control and family planning. It’s unclear whether abortions are performed.
The Adventist system as a whole rarely provides abortions.
The acquisition would entail Adventist taking over all of Mid-Columbia’s assets and liabilities.
In addition to the 49-bed hospital, Mid-Columbia has four federally certified rural health clinics, 18 outpatient clinics and a cancer center. Mid-Columbia would have a local board with some powers, but the entire Adventist system is governed by the Adventist system’s board.
The hospital’s financial condition effectively barred it from securing big loans to build a new campus, Mid-Columbia said in the application.
Mid-Columbia was never able to build up substantial reserves that would have grown with the stock market boom of the past decade. The investment portfolio of Mid-Columbia and its foundation totals only about $19 million, according to the latest figures available.
Adventist, meanwhile, has gone through its own financial turbulence.
The Fitch bond rating service noted that for the first nine months of 2022, the Adventist system recorded a $254 million operating loss on operating revenues of $3.9 billion. “This marks the fourth consecutive year the system will record a loss from operations,” Fitch noted.
But Adventist has a net worth — assets minus liabilities — of $2.5 billion including an investment portfolio of $1.7 billion.
You can reach Christian Wihtol at [email protected]