Emergency doctors planning to leave PeaceHealth ‘disaster’

Dr. Charlotte Ransom spent 18 years in scrubs on the emergency department floors at PeaceHealth. Many of her shifts were at the health system’s University District hospital — Eugene’s only emergency department until it closed in 2023.

Before it shuttered, Ransom and her colleagues with Eugene Emergency Physicians, the local group contracted to staff the department, asked leaders to delay the move. They asked for changes they believed would make the emergency department at PeaceHealth Sacred Heart Medical Center RiverBend safer for patients.

The boxy design of the RiverBend emergency department at PeaceHealth’s Springfield hospital — five parallel hallways with rooms between them — offered far less line of sight than the University District’s circular layout, where staff could see across much of the department at a glance. 

It’s a less effective design that slows down emergency workers, said Ransom, who worried that issues with RiverBend’s emergency department would only worsen with an increased patient load.  

“And that did happen,” Ransom said.  

She watched average wait times spike at RiverBend, from five hours to seven hours in the following year — a 40% increase — and remain elevated through early 2025, according to Oregon Health Authority data. 

And as the department became more crowded, Ransom no longer felt she could provide appropriate care. She resigned in August. 

“Mostly because of the increasing disaster of RiverBend,” she said. “They’ve put people in closets, and nooks in the hallways, and beds in the middle of the hallways.”

Five other health care workers at PeaceHealth described to Lookout Eugene-Springfield similar conditions inside the emergency department. They said staff treated patients in two administrative offices converted into makeshift exam rooms — with portable sinks in place of built-in plumbing — and a triage station in a cleared-out storage space. 

Now, more doctors, like Ransom, are planning to leave.

PeaceHealth had contracted with Eugene Emergency Physicians for 35 years. That ended this month, for a new contract with a Georgia-based medical group, in what PeaceHealth described as an effort to improve patient flow and reduce wait times in the emergency department.

Hospital leadership said that the company, ApolloMD, intends to retain many, if not all, of the current Eugene Emergency Physicians workers.

But 41 medical professionals — 32 doctors and 9 physician assistants — employed through the local group have signed a pledge not to work with ApolloMD, for at least 90 days. Some plan to never return, citing concerns with physician treatment and patient care.

The severance has triggered an uproar from dozens within PeaceHealth’s medical staff and practitioners throughout Eugene and Springfield. They argue hospital leaders are scapegoating physicians for problems rooted in administrative decisions, such as closing the Eugene emergency department. 

And they say patients, and the broader community, will bear the consequences. 

Lookout Eugene-Springfield interviewed numerous health care workers, both on the record and those who spoke anonymously, who corroborated one another’s accounts. Several didn’t want to use their name, worried about professional repercussions. Lookout also obtained and authenticated two separate audio recordings of heated meetings about the ApolloMD contract between executive leadership and medical staff, attended by nearly 70 clinicians. 

Medical staff ask leadership to reconsider 

Chris Rompala, a registered nurse with RiverBend’s operating room, was talking with caregivers in RiverBend’s emergency department Tuesday, Feb. 3, when an email from Oregon Chief Hospital Officer Jim McGovern announced the switch to ApolloMD. 

“It was like getting the wind knocked out of you,” said Rompala, speaking as a member of his union, the Oregon Nurses Association, and not on behalf of his employer, PeaceHealth.

“People that have been working with us, within this building, for close to 15 years, and then seeing PeaceHealth take this group that we know and love and just tell them, ‘well, sorry,’’ he said.

Rompala was among the staff members who knew such a decision was coming. Eugene Emergency Physicians’ contract would expire June 30, and PeaceHealth had issued a request for proposals, a procurement process inviting groups to submit bids outlining their services.

During the process, the Oregon Nurses Association sent a letter to PeaceHealth in support of keeping Eugene Emergency Physicians, signed by Rompala and others. Twenty-seven other organizations sent letters of support as well, including Eugene Springfield Fire, REACH Air Medical Services, Women’s Care, Oregon Urology Institute and Slocum.

“We didn’t ask for the nurses’ feedback. We didn’t ask for the physicians’ feedback,” PeaceHealth Oregon Chief Medical Officer Kim Ruscher told medical staff in discussion about the contract change during a morning meeting Tuesday, Feb. 10. 

Ruscher and McGovern did not know the meetings were being recorded by attendees. About 20 staff members attended the morning meeting and 50 attended the evening meeting. 

During the meetings, Ruscher said that she read “all those letters” supporting Eugene Emergency Physicians, but the letters could not be considered as part of the official and confidential request-for-proposals process, a procurement process inviting groups to submit bids outlining their services.

Ruscher and McGovern maintained, as PeaceHealth has told the media, the decision was not financially driven or a cost-cutting measure.  

When staff at the meetings pressed for specifics about why ApolloMD was selected, Ruscher and McGovern did not detail how proposals were scored or what metrics guided the decision. Instead, they spoke broadly about improving services and patient satisfaction.

“They just bring a larger wraparound package that we felt could move our emergency department forward. We just needed more than clinical care, right-by-side care, and we believe they will deliver that as well,” McGovern said. 

McGovern and Ruscher pointed to ApolloMD’s track record in the PeaceHealth Ketchikan Medical Center emergency department in Alaska as part of their rationale for selecting the company. ApolloMD also contracts with hospitals in Chicago and in Albuquerque, New Mexico. 

Some staff members expressed bewilderment at the suggestion that Eugene Emergency Physicians has not demonstrated a strong track record, while serving an urban population roughly 12 times larger than Ketchikan’s.

Additionally, they pointed to the three rounds of layoffs at PeaceHealth during the last nine months that cut support staff positions, including people restocking supplies, which she  said slowed down operations.

The layoffs were part of PeaceHealth’s total workforce reductions across hospitals and clinics in Oregon, Washington and Alaska. 

Other staff members at the meetings pleaded with leaders to keep Eugene Emergency Physicians. They warned the transition could endanger critically ill patients as the hospital recruits and trains a new slate of emergency physicians.

Ruscher said she does not expect any of the current physicians to remain and that ApolloMD plans to recruit 30 doctors by its July 1 start date. 

When news broke of the contract switch, Ruscher told Lookout that ApolloMD “stood out” because of “process improvement that really impacts patient flow, leading to things like decreased wait times and decreased offload times for our EMS partners.”

Lookout asked why Eugene Emergency Physicians, sometimes called EEP, was not qualified to offer the same.

“I don’t want to say anything against EEP. We have good doctors,” she said. “We want to move from good care to great care in our emergency departments, and we are investing right now.”

PeaceHealth declined interview requests for this story when Lookout asked for comment about the use of makeshift treatment spaces and specific conditions emergency department staffers said they faced. 

PeaceHealth spokesperson Joe Waltasti emailed the following statements:

“Since the University District ED closure, care teams at RiverBend have taken thoughtful, collaborative steps to safely manage an increase in patient volume. EEP leaders played an integral role in this work, including reviewing and approving the use of all additional spaces, in coordination with the Oregon Health Authority and the Fire Marshal.”  

“EEP leaders have also been deeply engaged in planning for the upcoming RiverBend ED remodel, which will significantly increase patient capacity and improve flow. We look forward to construction beginning shortly. Also, the opening of the PeaceHealth Springfield Rehabilitation Hospital this fall will allow us to convert the existing rehabilitation space on the sixth floor to increase medical bed capacity, further reducing boarding and wait times at RiverBend.”

“In addition to collaborating on the ED remodel, PeaceHealth clinical and administrative leaders meet weekly with EEP leaders to focus on process improvement in the RiverBend emergency department. PeaceHealth has adopted many of EEP’s suggestions. The assertion that EEP input was not acted upon is completely false.”

PeaceHealth has not released a timeline for its emergency department remodel. ApolloMD did not return Lookout’s messages. 

Working with what they have 

During an interview with McGovern last year, Lookout asked about patient overflow from the University District emergency department to RiverBend and data from the Oregon Health Authority showing an increase in wait times that correlated with the closure. 

“At some point in time, we need to move away from the University District conversation,” he first said in response. 

Then he offered context on why the emergency department closed, including that running millions of dollars into the negative was “a luxury that we don’t have in the Eugene-Springfield community.”

In the meantime, emergency doctors, nurses and other health care workers say they are doing the best they can with what they have.

When physician Scott Williams walked through the emergency department doors after the contract announcement, an overwhelming sense of sadness was palpable, he said. 

“It’s the most I’ve ever seen a health care team demoralized,” said Williams, who is employed through Eugene Emergency Physicians. “One of the best parts of practicing emergency medicine is you get to be on a team and work to help people. And it just felt like a gut punch. You no longer had a team.”

Williams has worked with PeaceHealth for 22 years and will continue until Eugene Emergency Physicians’ contract ends. After that, he plans to leave. 

“The patients (at RiverBend) are incredibly complex, and providing them good care takes a lot of time, and it takes a lot of attention to detail, and I don’t have any interest working for a corporate management group that incentivizes me to cut corners or not pay attention to detail; that’s not a structure that I’m willing to participate in,” he said. 

In addition to the University District’s emergency department closure, RiverBend’s strain amplified after corporate consolidation in Eugene, including Optum’s 2020 acquisition of Oregon Medical Group. Optum is a subsidiary of UnitedHealth Group.

In the years since, thousands of people have struggled to find primary care, Oregon Medical Group’s OB-GYN department shuttered, and many patients have scrambled to get their medications.  

The Optum acquisition also drove some physicians out of the region, a pattern doctors fear could repeat with the end of the Eugene Emergency Physicians contract.  

Doctors like Williams said they joined community groups such as Eugene Emergency Physicians for competitive pay, benefits and leave policies — support that allowed him to build a family while practicing at the same hospitals where his children were born. 

“EEP has been such a good job because of the way it treats its physicians,” Williams said. 

‘The Pitt’ in real life 

Michael Barkman and eight other physicians formed Eugene Emergency Physicians in 1990, when the University District hospital was known as Sacred Heart Medical Center. 

“Our first priority was to do what’s best for the patient. We didn’t make money off anybody’s back,” Barkman said.  

“We were equal pay, equal shifts, all the doctors were on an equal basis. And that kind of turned out to be very attractive, as we had hoped and anticipated, very attractive to be able to draw in some of the really good partners to join our group as we grew,” he said. 

As a local group, he said, they controlled some — but not all — operations. They could ensure shifts were covered and set standards for care, but decisions about physical capacity, including how many rooms or beds were available, rested with hospital leadership.

“We, as the emergency physicians, really did not have control over the environment. That’s in the hands of PeaceHealth,” he said. 

“Shame on them, because they are the ones that created the environment,” he said. “If they think they are going to get physicians coming in that aren’t part of this community, managed by somebody that’s going to be taking money off the top of the physician’s pay, that’s probably a pretty shortsighted, foolish decision.” 

Barkman retired in 2020, leaving behind a structure and set of values within Eugene Emergency Physicians for the next generation of doctors in the region. But now, that path has narrowed.

Citlalic Estrada describes herself as “the doctor’s glorified assistant” in the RiverBend emergency department. For three years, she worked as a scribe, wheeling a computer behind physicians to take notes during treatments. She finished her last night shift Thursday and is heading to Portland State University to complete prerequisites for medical school.

She wonders if there will be a place for her at RiverBend when she has her medical license in a few years. 

“I feel very connected and rooted here,” she said. “We have had doctors and physician assistants who have scribed at RiverBend and came back as a provider. To me, that is so inspiring.”

During her heavier shifts, Estrada felt like she was living in an episode of a TV show, like “The Pitt.” The HBO medical drama follows clinicians navigating overcrowded departments with too few beds for critically ill patients.

The episodes tell a story of high patient volume and limited resources that force doctors and nurses into uncomfortable triage decisions — juggling who is sick, who is sicker and who might die without immediate care. It depicts rows of patients on gurneys and in wheelchairs without exam rooms, clinicians improvising in tight quarters and trying to impose order on chaos.

Ransom could only make it through two episodes.

“It was too much, too real,” said Ransom, who still practices emergency medicine in other Oregon hospitals.

“Every once in a while [at the University District] we would have a patient in the hallway bed, when we just became too full, and I think every emergency department does that. That should be used in an event of a unique surge,” she said. “Emergency departments are unpredictable. It should not be a daily event, and if there is a daily event, there needs to be some intervention, right?”