Oncology to close at Celilo Center in TD
Services to stop after Feb. 28, 2023
Chemo patients must find new providers, add 170-mile roundtrip to treatments
By Tom Peterson
Cancer patients receiving chemotherapy and immunotherapy at Mid-Columbia Medical Center will soon be facing an arduous drive to continue their care as The Celilo Center in The Dalles will cease Oncology after February 28, 2023 - 32 days from now.
The closure was announced on Tuesday, Jan. 24.
For more than two decades, The Celilo Center’s oncology service has been a game changer for locals staring down a fight with cancer. Chemotherapy saps patients of their energy after receiving treatment. So, making the trip to Portland and back for chemo adds to the pain for patients already sick from treatments. The Dalles took a collective sigh of relief when the Center opened and eliminated that burden for many who are also elderly and or have mobility issues.
“In response to the many pressures we face as a community health organization, and due to lack of provider coverage, we have made the difficult decision to no longer offer medical oncology services at Celilo Cancer Center effective February 28, 2023, said Travis Dray, MCMC’s Director of Business Development in an Email to CCCNews.
Who this does not affect.
Anyone currently visiting Celilo Center for radiation oncology services, non-chemo infusion services, implanted device maintenance, and surgical cancer care, including breast, colon, access ports, prostate, urological, head, neck and breast cancer navigation.
MCMC has released a statement and FAQ on the closure here.
A fight for life over death
News of the closure first spread last Friday, Jan. 20 when Karen Johnson-Hulit posted a message about it on Facebook on The Dalles Happenings page.
She was diagnosed with stage-3 breast cancer on her birthday in 2022, and her initial chemotherapy treatments did not stop the cancer’s growth from spreading to 8 lymph nodes.
Johnson-Hulit gushes over the incredible care she has received at MCMC’s Celilo in the past year.
But she said the managment of doctors and nurses has led to staffing shortages.
“I am looking at a long road,” she said. The 63-year-old has a degenerative disc disease making the prospect of traveling for treatments stressful.
“I would like to see them do something because I feel they are putting it on a back burner,” she said of getting a medical oncologist hired at MCMC. “Nothing accelerates cancer more than stress. There is nothing more stressful than worrying about your care, and who is going to take care of you, and how you are going to get there and all the particulars.”
“Yes I am frustrated for my own care, but I am much more concerned about others. Elderly people who use walkers and others that do not have family and will have to take a bus.”
Johnson-Hulit chose to speak out on Facebook in hopes of putting light on the situation in an effort to reverse the decision.
“I am hopeful if they receive enough community pressure they will fill the position faster,” Johnson-Hulit said of getting a medical oncologist hired to oversee the treatments.
“If there was enough of a community response, it might make them realize how important this oncology center is to people and keep the department going. It is just necessary. Too many people need that care.”
“They have a constant full flow of patients right now…,” she said. “I fear people are not going to be able to find care even if they can commute. I don’t know how they (other hospitals) can take on a full load of patients on top of their existing ones. It will just be overwhelming.”
Going Deeper on Why?
Eiko Klimant, M.D., is set to leave the cancer care team at Celilo Cancer Center. Klimant is a board-certified medical oncologist, which is necessary to keep the oncology program in good standing.
He started with MCMC in February 2022 after the departure of medical oncologist Xinyu Steve Fu in 2021 who is now at Providence in Hood River.
In recent months, MCMC was unable to recruit another board-certified medical oncologist to take his place, according to Dray.
“MCMC is facing the same critical staffing shortage as other hospitals and health systems in Oregon and across the country, particularly in specialty areas like medical oncology, Dray said. Only 3% of medical oncologists practice in rural areas, and 70% of counties in the U.S. do not have medical oncologists at all.”
“Over the past few months, we have worked hard to recruit additional providers, introduce temporary and contract providers and consolidate where necessary, but these short-term measures have become unsustainable,” the hospital posted on its website.
Johnson-Hulit said the closure was do to staff resigning or quitting which in turn made it more difficult for those that remained.
She said Dr. Klimant came to The Dalles a year ago in a part-time position when two full-time oncologists were still at Celilo, and then those doctors eventually left.
“Dr. Klimant and (Family Nurse Practitioner) Robin Seuse, they both put in resignations at the same time at Thanksgiving, she said. “My oncologist Dr. Erokhina left in mid-September. She left on a Friday and never came back. No notice.”
“She was gone, all those months we started getting a visiting oncologist and Dr. Klimant was supposed to be part-time.”
During the past few months, Johnson-Hulit said nurses were getting really worried that they were not going to fix it (getting a medical oncologist hired),” she said. “They are not going to do anything about this.”
High Cost of Temporary Doctors
The Hospital has relied, in part, on temporary oncologists to fill the gaps after staff departed.
Temporary doctors or “locum tenens” can cost up to $440 per day according to Ayalocums.com
Johnson-Hulit said she had heard it cost up to $5,000 a day to cover the cost of an oncology locum.
“I get that,” she said. “It is a lot of money.”
MCMC’s CEO Dennis Knox said exactly that in his “Note from Dennis Knox” in December.
“Nearly 95% of organizations have turned to travel nurses and temporary providers to fill gaps in their workforce. This contract labor is exceptionally costly, with travel nurses costing on average $5,000 per week and temporary providers as high as $5,000 per day,” Knox wrote.
This is happening at the same time that MCMC is facing tight budgets, according to a story in the Lund Report, a nonprofit, non-partisan news site.
MCMC had operating losses of $20 million in seven of the last 10 years, according to the story written by Christian Whitol and published in September 2022. And Its first-quarter losses in 2022 were $4 million.
Money’s tight.
“The trend in medical oncology is it is more lucrative to be locum (Temporary Physician),” MCMC’s Dray said. “They can demand greater money and they’re not employees of the hospital, and they can put a cap on the number of patients they see per day.”
“They also direct their own schedule. They can say they want to work six days in two weeks and take the next two weeks off. That’s the going trend in the industry,” he said. “Physicians make more money and are not obligated to a community.”
Dray said the average age of medical oncologists has risen to about 55 years old, and they are concerned about making more time for themselves after spending 25-plus years focused solely on their profession.
Could you get locum if you had money, CCCNews asked.
“Yeah, we could get a locum, but they are being very selective. And It does not provide the greatest care for our community needs.”
Market Conditions Blamed
MCMC officials point to the ravages of COVID-19 which severely reduced budgets by limiting hospital services and led to an exodus of burned-out providers nationally, a cause they say has also affected MCMC.
“It’s hard to believe that it has been almost three years since the start of the COVID-19 pandemic, which was an extraordinarily difficult time for healthcare organizations. The stressors of the pandemic have since given way to skyrocketing costs, major gaps in staffing, the end of government aid and sicker patients than we have ever seen before,” wrote MCMC CEO Dennis Knox in December. “As is often the case, rural hospitals like MCMC feel the effects of these conditions more severely than larger health systems.”
Some Local Care Providers disagree
However, multiple seasoned providers have come to CCCNews in anonymity in the past 2 years stating that it has been management at MCMC that led them to their decision to leave. Their grievances ranged from lack of support to lack of transparency.
MCMC had lost 14 clinicians from the primary care group as of March 2022.
They include Jon Soffer, Judy Richardson, Carrie Vieira, Maile Anslinger, Jordan Nagle, Pema Bhutia, Emma Pieirrs, Rebecca Coombs, Kim Whitaker, Colin McInnes, Jessie Radley, Sara McCaffrey and Margaret Haupt.
Help from Adventist for oncology?
MCMC has recently signed agreements to partner with Adventist Health. However, that agreement has not been approved by the Oregon Health Authority or the Department of Justice, Dray said when asked if Adventist could assist in providing a replacement oncologist.
“We are talking to every organization provider with medical oncology care,” Dray said. “Those conversations take time to put together.”
What about OHSU?
Dray said the past OHSU agreement which was terminated in December 2021 had no bearing on the situation as the Hospital did not have agreements with MCMC for oncology services.
How many people will lose oncology services?
Dray would not say how many oncology patients at Celilo Center will be affected by the closure.
“I will not be able to provide you with the information requested until all patient plans have been navigated by the Celilo Clinic Team with each patient,” he said in an email.
Johnson-Hulit estimated there were around 12 or more people receiving treatments on a single day when she received chemotherapy.
“They have a constant full flow of patients right now…,” she said. “I fear people are not going to be able to find care even if they can commute. I don’t know how other hospitals can take on a full load of patients on top of their existing ones. It will just be overwhelming.”
Where will MCMC cancer patients go for treatment?
CCCNews called multiple oncology centers in the region on Jan. 25 and found that oncology centers at OHSU and Legacy Memorial in Portland were accepting patients. Providence in Hood River is not. Peace Health in Vancouver, Wash., had appointments, but they were available a month out. St. Charles in Bend and Legacy Medical have yet to return calls.
IN the MCMC transition plan, it lists the following “may be available for new patient appointments”
• Adventist Health Campus – Portland, OR
• Astria Cancer Center – Sunnyside, WA
• Compass Oncology – Portland, OR & Vancouver, WA
• Legacy – Mt. Hood & Good Samaritan, OR, Salmon Creek, WA Locations
• OHSU Knight Cancer Institute – Gresham & Portland, OR
• PeaceHealth Cancer Services – Vancouver, WA
• Providence Cancer Center – Hood River, OR
• Providence Cancer Institute – Portland, OR
• St. Charles Cancer Center – Bend & Redmond, OR
• Tri-Cities Cancer Center – Kennewick, WA
• Yakima Valley Memorial (North
Carrying a Heavy Load
“Our patients’ health and well-being remain our highest priority,” said Dray. “We are working through the options available to ensure their care continues with other providers.”
Johnson-Hulit said she was concerned patients much older than herself with mobility issues will fall through the cracks.
“That’s my biggest fear - people not surviving - it terrorizes me,” she said.
“This is taking its toll,” Dray said in a phone interview on Jan. 25. “No one wants to see this. It’s hard on staff and leadership. It has been hard. But it is what we have to do to provide the best care right now and continue to work to bring that care back home.”
Dray, while unable to say when, said the Hospital intends to bring oncology back as soon as it can hire a medical oncologist willing to take the permanent job.
Dray was adamant that the administration and staff were doing everything they could, pointing to recent hiring of care providers outside of oncology.
CEO Knox reported in December that “fourteen OHSU providers in primary care, general surgery and orthopedic surgery have chosen to transition to MCMC… In addition, four new clinicians have joined primary care, four more have committed to join MCMC in the coming months and we are thrilled to have three providers join our behavioral health team.”
We have hired new physicians to join our existing teams in ear, nose and throat, urology and general surgery. We know that, despite the industry challenges, it is possible to make progress, and I feel we are doing so. However, there is still work to be done, and we are committed to improving access and providing quality care.”
“There are a lot of wins here,” Dray said of recent recruitments. “People here are busting their ass. We are serving this community the best we can, and health care is very hard right now.”
Looking to the Future
In the Lund Report article, it states that MCMC had scant surplus cash, and the hospital has been unable to build up a big investment portfolio, so it has largely missed out on the stock market boom of the past decade that has fueled a meteoric rise in the portfolios of so many large and wealthy hospitals systems.
MCMC is looking to remedy that problem with a partnership with Adventist Health, which has a $2 billion investment portfolio. Adventist has promised MCMC a $100 million for “investments in physician and (advanced practitioner) recruitment, service line development and healthcare campus improvements,”
With a $2 billion investment portfolio, Adventist is raring to grow. It says it wants to double in size by 2030, to $10 billion in annual revenues, and become a streamlined West Coast powerhouse that achieves close to 10% annual profit margins, Whitol reported. Adventist already owns two other hospitals in Oregon: the 302-bed Adventist in Portland, the 25-bed Tillamook hospital.
CCCNews reached out to MCMC Board of Trustee Chair Robb Van Cleave for comment on Monday, Jan. 23. He did not respond.
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