Low usage and $1.5M deficit lead to closure of four-bed unit after decades of use

By Holly Dillemuth, Ashland.news

The intensive care unit at Asante Ashland Community Hospital is scheduled to close permanently on or before Sunday, Jan. 1, according to Dr. Steven Hersch, administrator and vice president of medical affairs for the hospital, as confirmed in an interview with Ashland.news Wednesday.

Asante’s board of directors voted for the pending closure of the ICU about three months ago, Hersch said, due to a significant decrease in patients in need of critical care at the Ashland hospital but a continued need to staff the unit with nurses. The ICU has been in place at Ashland Asante Community Hospital for at least 30 years, if not longer, Hersch said. Hersch has served in his role since August 2021, but has practiced as a physician in Ashland and/or Medford for 20 years.

“We have a four-bed ICU and we also use that space for intermediate care patients, and during this period of time, we have more of the intermediate patients than the actual critical care patients in that ICU,” Hersch said.  

“We had an annual operating loss of the ICU of $1.5 million so it’s not insubstantial,” Hersch said, saying the closure “will allow the hospital to deploy resources elsewhere for the betterment of the community.”

The financial loss was caused by the requirement to staff the ICU despite low patient volumes, Hersch said, essentially meaning the hospital has had to keep ICU nurses either on site or on call in case the need for critical care arose. In some cases, the ICU would close on and off depending on staffing and patient numbers.

“It was a decision that was not made lightly,” Hersch said. “We understand how the decision impacts our patients, impacts our employees, impacts the community. As we’re moving forward from the pandemic, we see this as a way to optimize our valuable resources, particularly our employees, and get our employees to the best place and get our patients to the best place.”

The ICU’s staff of 12-14 critical care nurses, including traveling nurses, has been offered jobs at Asante Ashland or taken positions at Asante Rogue Regional Medical Center in Medford, according to Staci Sparks, vice president of Nursing and Patient Care Services for all three Asante hospitals

“I think the overall reaction is — grief,” Sparks said. 

Sparks started with Asante in 2006 in Medford and worked her way up from registered nurse, clinical supervisor, and nursing director before taking on her current leadership role, which she started this year.

“Nurses in general, your identity is really tied to your work and they are proud of the work they’ve done and especially through the pandemic,” Sparks said. “The community would’ve suffered without (Asante) Ashland, including Ashland ICU and those nurses who did that work and so there’s a lot of grief with losing what you’re proud (of) and want to do, so I think that’s the overall sentiment that I see from them and from the hospital in general.”

Staff were told in person and by phone, according to Sparks.

“We were able to offer roles internally to all of them who wanted to stay with the (Asante) organization or with Ashland,” Sparks said.

Through the course of the pandemic, especially through some of the COVID-19 surges, Sparks said, Asante Ashland had patient volumes that warranted using Ashland’s ICU.

“They had patients that had higher level respiratory care, patients on a ventilator, that created enough of a volume for us to put them at Ashland and have those nurses be exposed enough to those kinds of patients to maintain that level of competency,” Sparks said.

Sparks said as the pandemic has become more “endemic,” the kinds of patients Ashland has seen has decreased the level of acuity and, mixed in with a shortage of healthcare workers across the board, the volume of critical care patients at Ashland has decreased significantly.

“Even getting nurses who we are able to hire to work in Ashland’s ICU, exposure to enough critical care patients to become competent has become very difficult,” she said. “What we’re facing is difficulty — not just with short staffing, but with exposing them enough to the right kinds of patients to keep their skills up to safely care for those patients. And so, because of that, some of them haven’t been able to get their orientation, or they’re not working in the environment that they thought they would.”

Low volume of incoming ICU patients in Ashland has still meant needing to keep nurses trained in critical care on staff, according to Hersch. 

“These are highly trained nurses who want to keep their skills up and we weren’t able to do that because we’d have one or two critical patients and then we wouldn’t have any for a week or two and it would go back and forth and back and forth and we’d would have to open and close, open and close the unit,” Hersch said. “The low volumes made it difficult for the nurses to retain their required competency for these sickest of sick patients, given that there are many days when there were no critical care patients at Ashland (ICU).”

When asked whether low volume of patients in Ashland could mean more room for patients from other areas to transfer in, Hersch explained that wasn’t happening either.

“We’ve not been on the receiving end of those sorts of transfers,” Hersch said.

During summer 2021, Hersch said Ashland Asante’s ICU did accept patient transfers with COVID-19 from outside Ashland, including from Asante Rogue Regional Medical Center, but the hospital hasn’t received patients strictly needing critical care in an ICU setting from outside Ashland.

“We’re very proud to have provided the level of care that we have over all these years,” he said.

The ICU closure will mean patients in Ashland will be transported elsewhere, to either Asante Rogue Regional Center in Medford or Asante Three Rivers Hospital in Grants Pass.

“We do have capacity in the ICUs at Rogue (Regional Medical Center) and at Three Rivers, where these folks can be well taken care of,” Hersch said. “We have full confidence in the teams there to take care of those patients.”

Brian Almquist, an emeritus board member on the board of the Ashland Community Health Foundation (formerly the Ashland Community Hospital Foundation) and longtime city administrator for the city of Ashland, expressed concern about the impact of the upcoming closure on patients and their families. Almquist started working in Ashland in 1970, when Asante Ashland was still a city hospital, and retired from the city in 1998.

“There were five different administrators at the hospital during that period of time,” Almquist said.

Almquist sees the potential for “personal impacts on families” of patients, who will have to travel to Medford or Grants Pass to be with their loved one. 

“I guess it’s a certain sadness that you feel when those services that we’ve always provided locally are migrating,” Almquist said. 

He said the goal of the foundation has long been to have a full-service hospital.

“Of course what’s happened in the industry is all small hospitals across the country have been struggling, not just because cost increases, because of technology and keeping up with the latest equipment,” Almquist added. “We were kind of the last of the Mohicans when we finally sold to Asante.”

“Realizing that health care is so darned expensive nowadays, you have to consolidate certain things and you have to look at personnel and staffing as well,” he added. “I guess, as you get older … things we were used to, they’re all changing.”

Hersch emphasized Ashland Fire & Rescue and Mercy Flights are working with Asante to streamline transports from Ashland to Asante Rogue Regional and Three Rivers medical centers in Medford and Grants Pass, respectively.  

“We’ve gone to great lengths to set up processes and protocols, such that if we have critically ill patients, they will be automatically transferred out and those facilities will make room for these patients,” Hersch said. “Those agencies have assured us we can work together as a team in a smooth fashion to move people where they need to be.”

Hersch, who operated his own medical practice in Ashland from 2007 to 2017, has been around the Asante system for 20 years prior to starting in his role as administrator in August 2021.

“We’ve learned in the last few years that we need to continue to pivot and evolve and do things differently to be efficient with our resources and to innovate when necessary,” Hersch said. “We did that early in the pandemic establishing one of the first monoclonal antibody infusion clinics at Ashland Hospital … that was one of the first in the country.”

When it became clear that the hospital could give that medication in an injection form instead of the intravenous form, Hersch said Asante set up a clinic in Medford that Hersch believes is the second such clinic in the country.

“Those are both closed now, “ he said. “We no longer need those services. Those are examples of how we’ve been innovative.”

Hersch said the hospital no longer maintains that level of speciality, but noted that, prior to 2017, the hospital also established itself as an Infection Control Assessment and Response (ICAR) hospital, a designation allowing personnel the ability to treat Ebola patients during the Ebola outbreak, though the need luckily never arose.

“Fortunately we didn’t need to do anything with that,” Hersch said. “But the hospital was prepared to serve as an infection outbreak hospital and actually had plans written down to scale up to two to three times our size by optimizing our resources, putting patients at alternative levels, locations of care, and serving as a specialized unit for people with any highly infectious disease. Clearly COVID overwhelmed anyone’s plans.”

The designation, Hersch said, points to how Asante, which has a strategy department that is constantly evaluating community needs, responds to needs as they arise.

“What we’ve had to do more recently is to look at our short-term and long-term changes as necessary and that’s where the ICU closure comes in,” Hersch said. “We’ve had to look at our resources and our challenges recognize that the ICU resource at Ashland is one that is underutilized and those resources could be better utilized and the patients could be treated in a different way to reallocate our resources.”

Sparks emphasizes that Ashland’s ICU doesn’t have a trauma designation, so those who are sent to critical care from motor vehicle accidents, for example, are already sent to Medford’s Asante Rogue Regional Medical Center or elsewhere.

“If there was a case, a trauma that happened, the county EMS protocols direct those ambulances to the closest trauma centers,” Sparks said. 

Asante Ashland’s ICU cares for medical and surgical patients, but not cardiac or neurology services, so many services will continue to stay the same at Asante Ashland.

“What I want to reassure the community of is, we as the healthcare provider will make sure that they get the care they need,” Sparks said. “What I don’t want people to do is worry ….

“If we do have a patient show up at Ashland, we have processes in place that will get them to the right level of care, regardless.”

“Not everybody recognizes our area as rural, but this is a pretty common thing for rural health care centers to able to let the clinical staff do that work up and then … if we decide that the patient is sick enough, that they require services at Rogue, we’ve got a process in place where we will get them to Rogue, if that level of critical care is needed.”

If critical care is not needed, Sparks said Asante Ashland does have the capability to keep medical and surgical patients who don’t need critical care.

“If transfer is still needed, we have the centralized transfer center that will work through transferring those patients where they need to go,” she said.

When asked what will happen with the ICU space after its closure, Hersch said that has not yet been determined, but may be considered through the lens of providing additional geriatric care.

“We will be going through a period of evaluation over the next few months,” he said. “The hospital is establishing an expertise in geriatric care and we’re working on becoming certified as an age-friendly health system.” 

When asked if an ICU could return to the hospital in the future, Hersch said: “I’d say that Asante will evaluate changes when they occur and evaluate the needs of the community and respond appropriately as we’ve done in the past.

“We maintain the ability to pivot if that were to be necessary,” he added.

Hersch said it’s possible that the ICU could close before the week of Jan. 1, pending availability of nursing staff.

All other areas of the hospital, including the emergency room and birth center, will remain open, he said. 

“I want to reassure people that we will continue to be able to provide high quality care for them,” he said.

Reach Ashland.news reporter Holly Dillemuth at hollyd@ashland.news.