This article is the product on an independent journalism project by the author. Due to their paper closing between the start and end of the story project, they've allowed us to highlight and share the article in its entirety to add to the discussion about the University District closure. 

By John Ofstedal

 A dozen workers put up fences and covered all signs indicating an emergency department at PeaceHealth Sacred Heart Medical Center University District at 7 a.m. Friday, December 1. Signage indicating available medical care was flipped and taped over. The Vancouver-based nonprofit’s shuttering of this vital recourse for the community, preceding the complete closure of the University District Hospital leaves Eugene, a city of 175,000, without an emergency department.

The closure was announced in a press release August 22, citing declining patient volume and revenues. However, advocacy groups have disputed its reasons for closing, citing PeaceHealth’s own evaluation of the hospital from under a year ago.

"It's plain they feel it will be more profitable to provide services at Riverbend and to shutter University District," said Kevin Mealy, a spokesperson for the Oregon Nurses Association which represents more than 1,500 registered nurses at both hospitals. PeaceHealth announced they would be closing the University District hospital which opened in 1936, starting with the emergency department.

The third page of PeaceHealth's 2022-2025 Community Health Needs Assessment of the University District hospital, titled A Vital Bridge with the Community, refers to the now-shuttered ER as "heavily utilized" and emphasizes its strong ties to community partners like CAHOOTS, which provides mobile mental health care and transport.

The shock of PeaceHealth’s closure announcement on August 22 reverberated through Eugene's medical community. Kevyn Paul, a local ONA leader and charge nurse with decades of service at the University District hospital said, "It's frustrating because we could have made this a lot closer to a seamless transition than what it's going to be.”

Paul worries the vulnerable patients University District has built trust with will not want to go all the way to the PeaceHealth's Riverbend hospital in north Springfield and will not receive the care they are used to. "Are the people that they're taking there actually going to get the care that they need? Or are they just going to get frustrated and leave?" Paul asked. It will take ambulances and transports from Eugene an extra 15 minutes to reach Riverbend, and patients will have to arrange their own transportation back upon discharge.

To address the emergency department's closure, PeaceHealth has relocated its West Eugene urgent care facility across the street, resulting in one less medical resource for the area. The urgent care will not offer MRI or CT scans, nor will they offer care for problems “of life and limb,” as Paul put it.

The University District ED saw more unhoused and mentally ill people than Riverbend. "It's difficult for them to negotiate the system to get any kind of insurance or really any kind of care except in the moment in the E.R.” Paul said.

A press release from PeaceHealth on October 9 details how students and others without access to vehicles will benefit from the closure. “Moving the urgent care clinic to a more central Eugene location helps us better serve those patients and many others,” said Dr. James McGovern in the press release. He is the interim chief executive, and chief medical officer for PeaceHealth Oregon network.

Chelsea Swift, a CAHOOTS EMT and crisis worker, said that CAHOOTS has always explored other resources before turning people over to a hospital, jail, or involuntary psychiatric care, but since COVID there have been fewer alternatives than ever. "Everything has kind of always felt like a Band-Aid. I feel like we're going to be giving out smaller Band-Aids," Swift said.

Swift added that CAHOOTS has consistently bypassed urgent care facilities in the past because they are ill-prepared to deal with people experiencing mental health crises, but they may have to start relying on it in cases where there are no better alternatives.

During her eight years with CAHOOTS, Swift has always been able to rely on the strong familiarity and trust the University District ED holds in the community. “University District is very much a community hospital,” Swift said. “Losing those relationships that we have with hospital staff is one of my biggest fears.” Swift was often able to use the proximity and reliable care of the University District ED to coax reluctant people to seek help.

The University District ED had 12 secure, lockable private rooms, a resource vital for treating a constant stream of mental health patients, Paul said. In contrast, Riverbend has only two such rooms, with planned additional rooms that have yet to begin construction.

In the case that the secure rooms are full, ambulance crews with acute mental health patients will often hold the patient until a room opens up, or hospital staff would put them in a regular hospital room with one or more attendants present, said Paul.

The lack of properly outfitted rooms for psychiatric patients at Riverbend paired with their already long ED wait times will only exacerbate their ambulance patient offload times (APOT) or "wall time," as medical personnel call it. "Wall time" is when ambulances are not able to leave because there is no room for their transported patients.

"The closure of University District has not created the APOT problem, but it certainly won't improve it." said Deputy Chief Heppel, who is responsible for EMS in Eugene Springfield Fire.

In the case that all ambulances, CAHOOTS vans, and alternative transports are tied up, a fire engine crew is taken offline to man an ambulance. Heppel said that this happens multiple times a month, highlighting the strain on EMS and crisis responders even before they lost one of three area hospitals.

Crow Bolt, an ONA leader and nurse at a local hospital which is affected by University Districts closure says his hospital has rearranged the structure of their emergency room to handle the new influx of patients being delivered by EMS, but it is often still not enough.

"By the end of the night we could be down to one bed, or even no beds for emergency patients because we're seeing so many inpatients," Bolt said. He is concerned for Oregon, which is already tied for dead last in hospital beds per thousand residents of any state in the United States, a country with considerably less hospitals per capita than other developed countries.

On Monday afternoon during her first shift since CAHOOTS stopped making drop offs at University District, Swift had to leave a patient experiencing a mental health crisis in a packed Riverbend E.D. waiting room. "I left someone in that really busy lobby not knowing when someone would check in with them again, whether they would get a room in an hour or six hours," Swift said, "It felt unsustainable.”

Swift avoided Riverbend for the rest of the day by bringing patients to White Bird Clinic, which is currently undergoing interior renovations. "There's not even a place indoors for people to hang out and stabilize, but it was at least like a place I knew where I can trust that staff were equipped to deal with those behaviors, even if they don't have a lot to offer," Swift said.

Swift sees PeaceHealth’s divestment from services like the hospital as indicative of a greater divestment from health and social services beyond lane county.

"The whole community will be impacted by a decreased availability of ambulances," Deputy Chief Heppel said. There is not a shortage of ambulances, but a challenge in getting them back on the road after a drop off. EMS has adjusted their dispatch according to past data, but as Heppel said, “we really won’t know the impact until we have some lived experience.”

Eugene Springfield Fire has added a unit focusing on evaluating non-emergent calls in the downtown and highway 99 corridor, and an advanced life support ambulance in response to the greater call response time resulting from University Districts closure. The impact of these new units will be evaluated after 30 days.

“Really often all public safety entities, whether it's CAHOOTS, whether it's police, whether it's fire. We end up on calls where it's very clear to everyone that someone just needs to go somewhere,” Swift said, “I foresee a lot of that 'Someone just needs to go somewhere' ending up in jail that would otherwise not go there right now."