RiverBend’s fines near $500,000 for breaking Oregon’s nurse staffing law

Alyssa Foshee changes out bags of fluids running through patients’ IV lines at PeaceHealth Sacred Heart Medical Center at RiverBend. 

But her patients are smaller than those treated by most nurses at the hospital, sometimes weighing just 1 to 2 pounds.

“I call them our tiny humans,” said Foshee, who spoke to Lookout Eugene-Springfield on behalf of her union, the Oregon Nurses Association, and not her employer, PeaceHealth. 

The neonatal intensive care unit averages about 30 babies daily, she estimates, tiny humans too small to survive outside their mothers’ wombs. 

“They have things that need to be handled immediately after birth, for surgeries, in order for them to survive,” she said. “(We have) levels of what we call acuity, and that is just how bad off they are versus some baby that’s fairly stable that’s getting close to going home versus a baby that was just born really early.”

That acuity level of patients determines how many nurses are assigned to their care, known as the patient-to-nurse ratio — thresholds documented in a staffing plan and protected by state law. Typically, the higher the acuity, the fewer patients a nurse can care for. 

But the Oregon Health Authority found that in the NICU at PeaceHealth, staffing is not always meeting those mandated ratios. In early June last year, over two night shifts, six nurse assignments involved more patients than nurses could safely care for, as determined by RN-to-patient ratios under the staffing plan.

It’s among the 438 hospital-wide staffing complaints filed against RiverBend with the Oregon Health Authority, whose regulators found violations of Oregon’s hospital staffing law in 93% of those complaints. That led the health authority to cite a consolidated total of 278 violations, including instances in which the hospital failed to finalize staffing plans for multiple departments. 

Those violations have led the health authority to propose $497, 250 in civil penalties as of June 4, following the enforcement of fines last year.

PeaceHealth is contesting many of the fines and has requested hearings for the vast majority of the investigations and penalties, according to the hospital and state records.

The dispute has become part of a broader debate across Oregon, with nurses arguing stronger enforcement is needed to protect patient care and hospitals warning that financial penalties could further strain an already challenged health care system.

An impasse  

Oregon’s hospital staffing law dates back nearly 25 years, with lawmakers building on and strengthening it through a series of revisions. 

Since its inception, the law has required hospitals to maintain committees — made up of direct-care nurses, managers and union representatives — to arrange staffing. 

In 2023, legislation signed by Gov. Tina Kotek established minimum staffing ratios for nurses and certified nursing assistants — baseline standards for hospitals and staffing committees.

However, staffing committees can determine that additional nurses or support staff are needed to reflect the specific needs of individual hospitals and units. Once those staffing plans are approved by the committee, adopted by the hospital and submitted to the state, they become binding.

As of last year, more than 80% of hospital units had approved staffing plans, but collaborations stalled on five units, according to Matt Calzia, Oregon Nurses Association co-chair of the Sacred Heart Medical Center at RiverBend staffing committee.

That includes neurology, cardiac surgery, cardiology, and orthopedic medicine, according to the Oregon Health Authority. 

In an October meeting, the committee met with leadership, including former Chief Hospital Executive Dr. Jim McGovern, to ask about who is making decisions on staffing plans. 

“He (McGovern) was dismissive of our concerns. He made (a) statement about not being ‘leveraged’ by direct care nurses, and would rather pay the fines, and really he was just, he had this arrogance about him, it was again very demoralizing,” said Calzia, who spoke with Lookout on behalf of his union, not his employer. 

McGovern departed PeaceHealth in May following months of turmoil over RiverBend’s emergency department staffing and allegations that he worked outside the scope of his administrative license and was trying to intervene in patient care decisions. 

“McGovern is a disgraced health care executive, and the people who are in power enabled him,” Calzia said. “They all enabled him and they perpetuated his toxicity. He came to that staff meeting, and the interim (chief hospital executive) was sitting right next to him.” 

Heather Wall, vice president of patient care operations and chief nursing officer, has served as interim chief hospital executive for PeaceHealth’s Oregon region since McGovern went on leave. 

PeaceHealth declined Lookout Eugene-Springfield’s request for an interview with Wall. In an email, spokesperson Joe Waltasti said that Wall and RiverBend nursing leaders will “continue to collaborate” with the nurse staffing committee.

“PeaceHealth’s priority is always high-quality patient care, and we are committed to continued staffing compliance. Current nurse-to-patient ratios at RiverBend are among the best in the nation,” he said in a statement. 

PeaceHealth has paid the Oregon Health Authority $16,000 in civil penalties for violating staffing plans, including the nursing shift in the NICU, according to Waltasti.   

“Like many hospitals around the state, PeaceHealth seeks additional guidance, clarity and interpretation on this new law,” he said. 

Lookout Eugene-Springfield reached out to the Hospital Association of Oregon, requesting an interview about the statewide struggle and solutions for hospitals to meet staffing ratios. They declined. Spokesperson Lisa Goodman sent the statement:

“The Hospital Association of Oregon continues to disagree with how the Oregon Health Authority is interpreting and implementing the hospital staffing law. This is a problem of the OHA’s own making. At a time when Oregon hospitals are struggling to keep their doors open, OHA’s decision to enforce the law differently than expected in fundamental ways and impose an overly burdensome complaint process is draining resources and creating a serious threat to jobs and services Oregon communities rely on.”

It’s an argument that has caught the attention of Rep. Rob Nosse, chair of the House Health Care Committee.

Nosse said he is considering legislation in 2027 to address some of the challenges surrounding how hospitals and staffing committees reach agreement on staffing plans.

From his perspective, hospitals generally believe that when a staffing committee reaches an impasse, the minimum staffing ratios established in state law should serve as the default, Nosse said. Nurses, however, often argue that meeting those minimums does not always provide enough staff to safely care for patients.

“That’s the tension,” said Nosse, who worked at the Oregon Nurses Association for almost 20 years. 

“What do you do? When the hospital is like ‘the ratio is good enough’ and the nurses are like ‘well, no, we should bring an extra certified nursing assistant,’ or in this situation, another RN on board, and the parties can’t resolve it?” he said. “That’s what I have to try to work out.”

“Most of the hospitals have figured this out across the state, but there’s like 10 that haven’t, and they tend to be the bigger ones,” Nosse said. 

McKenzie-Willamette Medical Center, the other hospital in Springfield, has also failed to adopt staffing plans in some units, according to nearly 50 complaints aggregated in Oregon Health Authority investigation reports since last year.

Both hospitals serve the larger urban area, as Eugene no longer has a general hospital after PeaceHealth closed most of its departments at its University District location in 2023.

‘We’re being taken advantage of’ 

Defaulting to the minimum staffing ratios is frustrating for nurses like Calzia, who works in the catheterization lab, where he treats conditions affecting the heart and blood vessels, and Chris Rompala, a registered nurse who works in the operating room at RiverBend. 

“What often happens is we drop it down to safety … the administration will say it’s safe. So, I didn’t go to nursing school to provide safe care,” said Calzia, underscoring that “safe” is just the minimum. “I want to provide quality.”

“That’s the biggest thing for us, is making sure that we provide our patients the care that they deserve,” Rompala said. “The level of staffing directly affects patient care and patient outcomes. Mortality is directly affected by how many patients each nurse has. We’re talking about people’s lives.” 

Calzia and Rompala haven’t seen many staffing violations when on shift, which they attribute to their departments being “revenue centers” for the hospitals. Meanwhile, other units, like the NICU, bear the brunt of staffing shortages. 

And so, nurses like Foshee find themselves rotating into the unit. Foshee’s primary assignment is caring for postpartum patients in the hospital’s Birthing Center. But she often works in the NICU when staffing is short because she has the specialized training needed to care for newborns in intensive care.

“A lot of our nurses will go handle that emergency situation leaving patients basically with no one really to watch over them, which can also be unsafe,” said Foshee. “They’re typically getting pulled from their designated role to plug a hole where patients need a nurse.” 

Many nurses will put in 16-hour days, “a recipe for mistakes to happen,” Foshee said. She has worked those long shifts herself, but has since tried to set firmer boundaries. The problem, she said, is that keeping boundaries is hard to do in practice when coworkers and patients still need help. 

“I feel like sometimes hospitals prey on the compassion of the nurses, because we love our coworkers. We love our patients,” she said. “We always want to do what’s best for them, and yet a lot of times it feels like we’re being taken advantage of.”