RiverBend bottleneck is tying up ambulances for thousands of hours

Paramedics call it “the wall.”

They hit it after rolling patients on gurneys from their ambulances into emergency departments where beds are full and no nurses are available to take over care.

Chris Paskett, Eugene Springfield Fire’s assistant chief of emergency operations, has walked through the emergency department of PeaceHealth Sacred Heart Medical Center at RiverBend to find a line of his crews — sometimes five deep, down the wall, treating patients on the hospital floor. 

“We’ve had critical patients crash in the hallway while our paramedics are still trying to take care of them with our equipment and limited resources,” Paskett said. “It just puts us in a really tough spot.” 

Emergency department delays took paramedics and emergency medicine technicians off the streets for a record 4,621 hours last year, with nearly 80 percent of that time at RiverBend, according to Eugene Springfield Fire data. That’s nearly $500,000 in employee pay spent while “on the wall.”

Paskett worries the problem will only get worse as PeaceHealth goes forward with a new emergency provider to replace Eugene Emergency Physicians, which employs 41 local doctors and physician assistants to work there.

“This is a structural problem,” Paskett said. “It really is not an issue with the nurses or the people that work in the ER. Everyone is trying to do the right thing, and they’re trying to move patients through with the resources they have.”

Paskett’s concerns were underscored this week in a flurry of letters to PeaceHealth signed by elected officials in Lane County following outcry from their constituents.

In one of the letters, local leaders — state Reps. Julie Fahey and Lisa Fragala, state Sen. James Manning, Eugene Mayor Kaarin Knudson, Springfield Mayor Sean VanGordon, and Lane County commissioners Heather Buch and Laurie Trieger — urged hospital leadership to reconsider its July 1 transition to Atlanta-based ApolloMD.

They wrote that turnover and recent layoffs undermine “care coordination” — a term that describes collaboration and processes between medical partners outside of PeaceHealth and those who work inside the hospital.

Think of care coordination as a relay race that helps ensure smooth transitions for a patient every step of the way. The transfer from the ambulance to the emergency department is sometimes the first step.

Improving coordination is a goal cited by hospital leadership, including Jim McGovern, PeaceHealth Oregon’s chief hospital executive. But current emergency doctors say they have pushed those efforts as far as they can go in their constrained environment. They, alongside the elected leaders, warn that system-level decisions have created conditions that will make it difficult for any physician group to reduce RiverBend’s soaring wait times.

And they warn, as the letter stated, the emergency department switch threatens to increase “EMS wall times — delaying first responders’ ability to return to the field to serve our broader community.” 

‘Care coordination’ from the field to the ER 

Last year, Eugene Springfield Fire paramedics and emergency medicine technicians responded to nearly 700 cardiac arrest calls.

When a person goes into cardiac arrest, their heart stops beating, and with each passing minute, their survival rate drops. That’s why crews arrive on-scene, giving high-quality chest compressions on the spot and continuing in the ambulance. 

It’s the first lap in a race against time that demands care coordination, which applies to other life-threatening situations like a heart attack, where blood flow to the heart is blocked. 

“So, a patient comes in with a heart attack, from the minute they hit the door, there is a stopwatch that’s going,” said Dr. Matthew Trojan — a heart failure specialist at Oregon Heart & Vascular Institute, which has a location at RiverBend. He spoke to Lookout Eugene-Springfield on his own behalf, not that of his employer or colleagues.

“Because the faster you can open the artery, the better the outcomes are. And right now, we exceed [are better than] every national standard,” he said.

Trojan estimates about 40% of the patients treated at his institute come through the emergency department. And he is among medical staff who have worked with Eugene Emergency Physicians over the years on clear pathways for cardiac patients. 

Pathways are apart of care coordination — structured clinical guides that map where the sickest patients go and what they need. The planning for those pathways happens in committee meetings and conference rooms, long before a doctor sees the patient. And people who serve on those committees bring institutional knowledge to the table, he said. 

“It’s the people who have been here five to 10 years and have an understanding of how all these things work together,” Trojan said.

Those are people like Dr. Sarah Coleman, who is with Eugene Emergency Physicians and works at RiverBend. 

Care coordination isn’t just for the most dramatic cases. It also covers patients with broken bones, chest pain and other urgent but not life-threatening conditions — many of whom end up waiting on the wall with ambulance crews for a handoff. 

Coleman adapted a rapid medical evaluation model from Legacy Mount Hood in Gresham. It moves stable patients to lobby or fast-track areas — where those who can sit upright receive expedited care — and keeps bed space open for sicker patients.

She said the change helped the emergency department to handle about 20,000 additional visits a year without increasing how long patients stay.

Average wait times at RiverBend jumped to seven hours in 2024 after the University District emergency department closed and have stayed near that level through 2025, according to Oregon Health Authority data.

A leadership board at PeaceHealth recently asked Coleman to present on the success. During the meeting, she said, the board gave her two Touchstone Awards, recognizing exceptional patient care. 

“At the same time having been fired the week before,” she said, referring to PeaceHealth’s decision to end its contract with Eugene Emergency Physicians.

Doctors and physician assistants within the group have welcomed a path forward to work with PeaceHealth, provided it can remain a locally based team. But they won’t do so for at least 90 days under ApolloMD, according to a pledge they signed. 

“[We’re] rearranging the deck chairs on the Titanic as best we can, but at some point we need a functioning ship.” Dr. Sarah Coleman

They, along with the larger medical staff across the hospital, don’t understand how ApolloMD can manage and maintain its current care coordination — let alone improve it — safely in a transition four months away.

They also question why leadership is investing in staffing that already exists rather than in improving physical elements of the emergency department itself.

“We are at the limits of the meaningful change that we can make without PeaceHealth making investments in a bigger department,” Coleman said. “[We’re] rearranging the deck chairs on the Titanic as best we can, but at some point we need a functioning ship.”

Over the last week, medical staff voted 345-25 that they do not have confidence in two hospital leaders, McGovern and Oregon Chief Medical Officer Kim Ruscher, nor their decision on the contract.

McGovern discusses staffing change 

In an interview Friday with Lookout Eugene-Springfield, McGovern acknowledged the limitations of space at RiverBend. And he said that a $6 million renovation kicked off this week will add seven more fast-track bays and four exam rooms.

That is estimated to be completed in July, the same month ApolloMD takes over emergency departments in RiverBend, Cottage Grove and in Florence.

McGovern said that ApolloMD has “40-plus” doctors and physician assistants in a “credentialing pipeline,” which he said “means they’ve signed contracts and committed to come” work at PeaceHealth. Credentialing for new emergency physicians in Oregon can take two to three months.

He reiterated, as he wrote in a recent public letter, why ApolloMD stood out: its ability to improve processes. But when asked which specific processes he wants to fix, such as reducing how long ambulances are held at RiverBend, he did not identify a specific problem.

“Part of their [ApolloMD’s] expertise in large busy EDs is helping us to see those steps in the process and identify where the gaps are. They haven’t gotten to that point. It’s been four weeks,” he said.

Lookout asked multiple times what ApolloMD’s staffing would provide that Eugene Emergency Physicians does not.

“It’s not just the staffing, it’s not just the volumes, it’s not just the physical space. There’s something else. And so if the physicians say, ‘we’ve done everything we can,’ I don’t accept that. We have to look at how we do our work differently, and ApolloMD will help us do that,” he said. 

When asked why a consultant could not work with Eugene Emergency Physicians, he pointed to implementation. Pressed on whether that meant Eugene Emergency Physicians had not followed through on solutions, he said no. 

“It’s an evaluation of the EEP [Eugene Emergency Physicians] as a management company. I think Apollo is going to do better implementing and sustaining improvements over time,” McGovern said.

And in regards to wall times, he said, “We have the same goals as the [fire] chiefs do, which is to get ambulances back into the community.”

Getting back to the streets 

Eugene Springfield Fire ambulances spend up to two hours a day on the wall. Paskett said he has never seen or heard of a process issue with Eugene Emergency Physicians that would account for the delays.

He, along with fire Chief Mike Caven, have worked with hospital administrators to reduce the time their crews spend at the emergency department. 

The issue dates to late 2017, when both Paskett and Caven were battalion chiefs in Springfield. The department had just secured a $3 million investment to add ambulances to a strained system, yet crews were still going out of service. That’s when Paskett and Caven began noticing the backups in emergency departments.

“Patients parked in the ER with no beds or nurses to care for them, and at the time, it seemed like a weird anomaly,” Caven said. “We’ve recommended options to help alleviate some of the pressure and get our ambulances back into the street, but to no avail.” 

The hours on the wall have nearly doubled since 2019. In 2024, the fire department experienced limited progress with hospital administrators, Paskett said, but it didn’t turn out to be a long-term solution.

Wall times at RiverBend are among the department’s biggest challenges, Paskett said. 

It takes a toll on his budget, built on taxpayer dollars in Eugene and Springfield that are already stretched thin. 

Eugene Springfield Fire runs a network of seven advanced life support vehicles, ambulances and between two to four life support ambulances, depending on staffing. The department also contracts with Mid-Valley Ambulance on low severity cases if needed. 

When their fleet is tied up at hospitals, emergency calls stack up and fire crews rotate into ambulance runs.

That widens coverage gaps when fires break out. Last summer in Springfield, flames burned along a fence to a house, causing significant damage. Firefighters did not have a water engine for 11 minutes, because its crew was on an ambulance.

Safeguarding the appropriate use of public resources is top of mind for Paskett, along with the legal implications of his staff continuing to treat patients inside the hospital. 

“When we arrive with the patient, it becomes their patient,” said Paskett, citing the Emergency Medical Treatment and Labor Act, a federal law with wide-ranging hospital regulations, including rules governing when and how patient care is transferred. 

But crews are left with no options when staff isn’t available to take over care. 

“It puts us in a really gray area,” Paskett said. “We feel a little taken advantage of, as far as resources that we can all agree, even when talking to the hospital, they can agree these resources need to be on the street. That’s where the taxpayers are paying for them to be. That’s where our people do their best work — is out on the street.”

This story was updated to clarify that cardiac response times are better than the national standard as well as the recognition associated with the Touchstone Awards.