Enduring Institution: Saint Alphonsus Medical Center to celebrate 125 years in Baker City

Oct. 5—To Dina Ellwanger, COVID-19 puts into perspective the legacy of Saint Alphonsus Medical Center in Baker City.

This isn't the first pandemic the hospital has endured.

Then known as Saint Elizabeth, the hospital had already been serving the community for more than two decades when the influenza pandemic swept across the U.S. in 1918 and 1919.

And now, as the institution prepares to celebrate its 125th birthday, Ellwanger, the hospital's president, is reflecting on its role.

"To know that I've been part of it, to represent this institution as the local president, it's a great honor," Ellwanger said. "My goal is to make sure we're going to be there for the next 125 years, whatever the name."

St. Elizabeth was founded in Baker City in 1897 by five sisters of Saint Francis of Philadelphia. The hospital's first location was at Second and Church streets.

In 1915 the hospital moved into a new cut stone building at 2365 Fourth St., where it remained for more than half a century.

The current 25-bed critical access hospital, at 3325 Pocahontas Road, opened in October 1970.

In 2010, after the hospital was bought by Trinity Health, a national Catholic health care system, it was renamed Saint Alphonsus Medical Center, part of the Saint Alphonsus Health Alliance, which includes hospitals in Ontario, Nampa and Boise.

Ellwanger, who is also president of Saint Alphonsus Medical Center in Ontario, added the Baker City hospital to her duties on May 4 of this year.

She replaced Priscilla Lynn, who had served as president and chief nursing officer for four years.

Saint Alphonsus Medical Center-Baker City was named one of the nation's top 100 critical access hospitals for five straight years, 2017-21.

Ellwanger is not a newcomer to the Baker City hospital — she was chief nursing officer here from 2010-14.

Ellwanger said the hospital's consistent presence over a century and a quarter is, more than anything, a testament to Baker City residents.

"Community support is what kept that facility there," she said. "Without that community support it would not be here."

The current building has undergone renovations over the decades, most recently, in 2019, a remodel of the emergency department and moving the physical therapy/occupational therapy department to the former site of the nursing home dining room and nurses station.

(The nursing home was closed in 2014.)

Ellwanger said that although the current building "meets the needs, it is 52 years old."

She said Saint Alphonsus has contracted with an architectural firm to come up with options for either a significant renovation or possibly new construction over the next couple years.

Although details haven't been determined, Ellwanger said she believes the hospital, in whatever form, will remain at its Pocahontas Road location.

She said people tend to equate a hospital's quality of care with its appearance, even though the two aren't necessarily linked.

Nonetheless, Ellwanger said she understands that the perception is important, and she said Trinity Health's goal is to ensure that its hospitals are attractive.

"We want people to feel comfortable," she said. "We want to be competitive."

Progressing through the pandemic

The prospect of refreshing the hospital is especially welcome at a time when the effects of the pandemic continue.

Although those effects have largely diminished elsewhere, with none of the restrictions or requirements that dominated much of 2020 and 2021, the hospital is among the few locations where face masks are still mandated.

Ellwanger said she doubts many people, herself included, would have predicted, in the spring of 2020, that the pandemic would continue to be an issue well over two years later.

Having to wear a mask for a 12-hour shift can be challenging for hospital employees, she said.

"It's hard," she said. "People don't see you smile, and you don't have that connection with the patient."

But mask mandates, though an obvious effect of the pandemic, aren't the most significant from Ellwanger's standpoint.

A combination of other factors have combined to create what Ellwanger called the most daunting environment for recruiting employees in her 30 years in health care, including 17 years as an executive.

"I have never faced a challenge like we're facing now," Ellwanger said.

From employees concerned about being exposed to COVID-19, to burnout from extended shifts, to nurses attracted by the higher wages if they travel to other areas for short-term assignments, Ellwanger said it has been a constant challenge over the past two years to fill vacancies.

The issue isn't just recruiting doctors and nurses, but all employees, including maintenance and support staff, she said.

This has forced Saint Alphonsus to take advantage of technology, including virtual medicine, where distant providers can meet with patients.

The hospital has made progress recently with its workforce, Ellwanger said.

The obstetrics department and respiratory department are fully staffed.

The hospital recently welcomed a new orthopedic surgeon, Dr. Samuel Capra, to the Baker City hospital.

Ellwanger said the hospital is recruiting a general surgeon, and she hopes to have general surgeons from elsewhere in the Saint Alphonsus system available to work in Baker City as well.

The most pressing local need is registered nurses — there are openings for nurses on the medical floor and in intensive care and the emergency department, Ellwanger said.

The hospital is also recruiting radiology technicians, she said.

Besides the issues related to the pandemic, the shortage of workers has boosted average salaries, something hospitals can't easily adjust to, Ellwanger said.

Unlike many businesses, which can cover higher personnel costs by raising their prices, hospitals, which receive much of their revenue from insurance companies, can't simply charge them more to raise revenue and make it possible to offer more attractive salaries to prospective employees, she said.

Financial challenges

The pandemic resulted in extended cancellations for surgeries, and it discouraged some people from having surgery or other treatments even when those were available, Ellwanger said.

"There was a financial loss, and we're certainly trying to make up for that," she said.

Data from the Oregon Health Authority illustrate the challenge.

Gross revenue from patients at the Baker City hospital dropped by 4.8% in 2021 compared with 2020, from $62,773,848 to $59,749,203.

Net revenue dipped by 1.9%, from $35,327,907 to $34,672,768.

The number of outpatient surgeries plunged from 1,224 in 2019 to 618 in 2020 and to 214 in 2021.

Emergency department visits dipped from 7,334 in 2019 to 6,216 in 2020, but rebounded slightly in 2021, to 6,434.

The hospital's operating margin — the difference between revenue and expenses — dropped from $3,920,000 in 2020 to $2,830,000 in 2021.

The increase in expenses, from $35,375,000 in 2020 to $36,719,000 in 2021, was driven in part by the higher wages for "travelers" — employees, such as nurses, who work temporarily in the hospital, Ellwanger said.

The Baker City hospital has also employed travelers in other areas, such as radiology, patient services and registration, she said.

Some larger hospitals even had to hire traveling employees for duties such as housekeeping, but that hasn't been necessary in either the Baker City or Ontario hospital, Ellwanger said.

Saint Alphonsus Health Alliance has partially offset the cost of travelers by setting up its own program employing travelers, which eliminated the additional expense of a third-party company that connects travelers with hospitals, Ellwanger said.

Prior to the pandemic, she said the Baker City hospital generally had one or two traveling employees at any time.

But during the pandemic, the percentage of travelers at the hospital peaked at around 20% of the workforce. That has dropped this year to about 10% to 15%, and Ellwanger said her goal is to have no traveling employees in the hospital by the end of 2022.

She said at least two hospital employees who became traveling workers during the pandemic have returned as full-time staff at the Baker City hospital since May of this year.

Although recent trends are positive, Ellwanger said the financial challenges the pandemic created remain.

"How do we rebound," she said. "That's the million-dollar question. And nobody has that answer."