Physicians at Ashland Community Hospital are urging the City Council to approve a merger with San Francisco-based Dignity Health, saying without it the hospital could close within a year.
The vast majority of the medical staff at ACH is in support of the merger, said Dr. Miriam Soriano, chief of medical staff.
"Dignity is vital to having a hospital here," said Soriano, who has worked at ACH for 23 years and has been involved in a yearlong series of meetings on a possible merger. "I definitely feel like this is something we must do." (Correction: See below.)
The financial outlook has worsened for ACH after reporting a loss of about $2.5 million last fiscal year because of unreimbursed costs associated with Medicare and Medicaid patients, other unpaid medical bills and charity care.
The loss is now closer to $3.3 million, Chief Executive Officer Mark Marchetti said, after reviewing an official, ongoing audit of the budget.
Without a partnership, closure within a year is a "serious possibility," Marchetti said.
"If not total closure, certainly a significant reduction in services that clearly are not financially sustainable," he said.
Ashland residents have expressed concerns over Dignity Health's stance against the Oregon Death with Dignity Act, its banning of direct abortions, and the loss of local control if a partnership is formed.
"As far as the community being concerned about abortion and Death with Dignity, neither of those things pertain to the hospital," said Dr. Jani Rollins, a family practice physician who works at ACH. "Abortion is a total non-issue for us here, and as far as Death with Dignity, you can't do it in the hospital, it's built into the law."
If the merger is approved, ACH's doctors would be barred from writing prescriptions for patients who qualify under the Death with Dignity Act, but only while they are working at the hospital or one of its clinics.
Currently ACH doesn't perform direct abortions, but it has in the past. Dignity Health does not allow abortions unless the mother's life is at stake.
Dr. Pam Ator, an internal medicine physician at ACH, said she wouldn't feel limited by the changes a Dignity Health merger would bring.
"I'm interested in the hospital being able to provide a range of services that can meet the community's needs, and being able to maintain a range of services broad enough for the hospital to remain relevant," Ator said.
"I don't feel like it limits my ability to fully palliate people's symptoms — if I have a patient at the very end of their life on a morphine drip, in constant pain, shortness of breath "… (Dignity Health) would have no objection with me using whatever dosage of that medicine I need to treat that patient."
Ator said she believes there is no other option for ACH but to merge with Dignity Health.
"If people kill this affiliation, I think that there is a real risk that the hospital may not continue to exist," Ator said. "The hospital needs to do something now. They don't really have another six to 12 months to fiddle around."
Residents have voiced concerns that Dignity Health's polices on abortion and physician-assisted suicide are not in line with the community's values. They also have questioned what the new board of directors would look like and how much independence ACH would retain.
"We want our rights, even though we are all aware that Death with Dignity is not done in the hospital, and most abortions are not done in hospitals," said Diana Spade, a retired anesthesiologist who lives in Ashland. "We don't know what will happen in the future, and we are totally losing the control to make those choices as a community."
If the merger is approved, ACH's current board of directors would likely remain unchanged pending the approval of Dignity Health's primary board, said Carol Bayley, Dignity Health's vice president for ethics and justice education. After that, the local board would pick and approve its new members.
Currently, the Ashland City Council appoints ACH's board members after they are nominated by other members.
The alliance requires the city's approval because when the city turned the hospital over to the not-for-profit Ashland Community Healthcare Services in 1996, it retained sole corporate membership, according to city documents. Before 1996, the hospital was a department of the city.
The agreement gave the city the power to approve sale, sublease, merger or consolidation of ACH assets with any affiliation partner. The city also retained ownership of the property, buildings, improvements and fixed equipment.
Pauline Black, 55, of Ashland, said, last month's forums gave the community too little time for input.
"First and foremost, for me, is the idea that a religious organization that I don't belong to is going to make decisions about what kind of health care I can receive is wrong," Black said. "The option they've given us has some serious issues."
Dignity Health was formerly known as Catholic Health Care West until Jan. 23, when it changed its name and its affiliation with the Catholic Church. Since the change, the hospital system is no longer a sponsored ministry of the church, but a self-governing, nonprofit health care system.
However, because 25 of Dignity's 40 hospitals remain Catholic-affiliated, its non-Catholic hospitals are still barred from performing direct abortions, in vitro fertilization or physician-assisted suicide. They are not, however, required to force lifesaving treatment on a patient who does not want it.
"It's very clear what (Dignity Health's) background is, and what they are bringing in," said Valerie Muroki, 71, of Ashland. "There was such a shock wave that went through town after the forums."
Spade, who attended last night's City Council meeting with others who wanted to voice their opposition to the merger, said, "It feels like the deal is already done, but we need more community discussion."
More than 50 people opposing Ashland Community Hospital’s merger with Dignity Health attended a Tuesday meeting of the Ashland City Council and 15 signed up to speak. Because of time limitations, only nine were allowed to speak on the issue and all nine spoke in opposition to the merger. (Correction: See below.)
Reach reporter Sam Wheeler at 541-499-1470 or email firstname.lastname@example.org.
Correction: This story has been updated to include correct information about meeting attendance and Miriam Soriano's length of employment.