A patient-care ombudsman watching over Astria Health’s bankruptcy has noticed growing demands on the organization’s nurses, she said during a status conference Friday in court.
The ombudsman, Susan Goodman, visited Astria Regional Medical Center in Yakima on Thursday, where she met a nurse who ended up working a 16-hour-shift, rather than the standard 12-hour-shift, to ensure there was enough patient coverage.
There have been other instances of nurses having to work longer hours to ensure sufficient patient coverage, said Goodman, an Arizona attorney appointed by the court to monitor patient care at Astria Health’s facilities while it undergoes Chapter 11 bankruptcy protection.
“There’s very little bench in terms of extra people,” she said.
Astria operates hospitals in Yakima, Sunnyside and Toppenish, along with a network of clinics.
Goodman’s comments mirrored the ones she made in a report she filed with the court earlier this week. The report covers recent visits to all three hospitals and several clinics but focused primarily on Astria Regional, where she stated most of the unofficial staff departures and reductions were occurring.
In that report, she notes that during recent visits she observed patients were being held in Astria Regional’s emergency department because nurses weren’t available in the intensive or acute care departments.
This was especially noticeable with the hospital seeing an increase in its daily census due to the cold and flu season. That increase resulted in “nursing staff functioning at maximum staffing assignments, leaving no one to take a new admission,” Goodman wrote.
The nursing staff issues also were causing delays and cancellations in elective surgical procedures, Goodman said.
In an email response, John Gallagher, CEO of Astria Health, said the staffing issues raised by Goodman are not unique to Astria Regional.
He said Astria Health has worked on recruiting staff and has hired for 437 open positions so far this year. Astria Health also has used more travel nursing staff.
“First, hospitals throughout the country actively manage patient care demands and available resources in terms of emergency room admissions, patient flow and patient staffing,” he wrote.
Goodman said she was concerned about the impact of staffing and other issues on patient care but emphasized that Astria Regional was still ultimately meeting patient ratios.
“(But) we certainly don’t want to wait until there is a patient safety issue,” she said.
She also expressed concern that Astria Regional is diverting patients to other medical facilities due to staffing issues.
“You can’t constantly go and divert because you’re challenged from a nursing perspective in terms of patient ratios,” she said.
Gallagher said diverting patients is not a common practice with Astria Regional Medical Center but said diversions occur for “limited periods of time” to clear patient backlogs. He said that is a practice common in other hospital emergency rooms.
Nurse staffing was the main issue that Goodman addressed in her report, but she took note of other potential concerns:
• Goodman observed the impact of recent layoffs and consolidation by Astria Health on its services. For example, the layoff of some Astria Regional social work team members led to the shift of discharge planning follow-up to nursing supervisors and clinicians.
She also noted the elimination of a lab technician at one of Astria Health’s clinics in Yakima that led to a temporary halt of lab draws at that location.
“Given the volume of lab draws previously performed at this clinic and the abruptness of the service elimination, (I) expressed some concern surrounding both the patient notification process and the development of quality auditing to ensure that important lab monitoring is not missed.”
In his response, Gallagher said Astria Health avoided layoffs in areas “that affected direct patient care.” He notes that the lab manager is still an Astria employee and that lab draws are now done at the hospitals rather than at the clinics. Doing so “allows for more efficient delivery of care, and seeking more efficient care delivery is a necessity being experienced nationally throughout the industry and is not unique to Astria Health facilities.”
He adds that Astria Health decided to consolidate its social worker positions at Astria Regional after examining industry productivity standards.
• In a footnote in her report, Goodman noted the recent closure of Astria Regional’s oncology clinic and chemotherapy unit, which had only been open for a handful of months. “Certainly this change can be attributed to the bankruptcy and any care gaps resulting from it would represent significant and material patient care impacts.”
Astria Health has decided to focus its oncology services at its cancer center location in Sunnyside, Gallagher wrote. Patients who were being treated in Yakima will now be treated at the Sunnyside cancer center. Ultimately, the organization decided it was best for Astria Regional to focus on core services, such as open-heart surgery, neurosurgery, emergency services and trauma care.
The decision was made “due to the high costs associated with opening new service lines and running duplicate programs,” he wrote. Astria Health is evaluating whether oncology services could again be offered in Yakima, he wrote.
WASHINGTON — In chilling detail, ousted U.S. Ambassador to the Ukraine Marie Yovanovitch described to Trump impeachment investigators Friday how she felt threatened upon learning that President Donald Trump had promised Ukraine’s leader she was “going to go through some things.”
Trump was unwilling to stay silent during Yovanovitch’s testimony, focusing even greater national attention on the House hearing by becoming a participant. He tweeted fresh criticism of her, saying that things “turned bad” everywhere she served before he fired her — a comment that quickly was displayed on a video screen in the hearing room.
Rather than distract from the career diplomat’s testimony, Trump’s interference could provide more evidence against him in the probe. Democrat Adam Schiff, chairman of the House Intelligence Committee, said Trump’s attacks were intimidation, “part of a pattern to obstruct justice.” Others said they could be part of an article of impeachment.
The former ambassador was testifying on the second day of public impeachment hearings, just the fourth time in American history that the House of Representatives has launched such proceedings. The investigation centers on whether Trump’s push for Ukrainian officials to investigate his political rivals amounted to an abuse of power, a charge he and Republicans vigorously deny.
Yovanovitch, asked about the potential effect of a presidential threat on other officials or witnesses, replied, “Well, it’s very intimidating.”
When she saw in print what the president had said about her, she said, a friend told her all the color drained from her face. She was “shocked, appalled, devastated” at what was happening after a distinguished 30-year career in the U.S. Foreign Service.
Unabashed, Trump said when asked about it later: “I have the right to speak. I have freedom of speech.”
But not all Republicans thought it was wise. Rep. Liz Cheney of Wyoming said Trump’s live tweeting at the ambassador was wrong, saying, “I don’t think the president should have done that.”
More hearings are coming, with back-to-back sessions next week and lawmakers interviewing new witnesses behind closed doors.
Yovanovitch, a career diplomat who served for decades under both Republican and Democratic presidents and was first appointed by Ronald Reagan, was pushed from her post in Kyiv earlier this year amid intense criticism from Trump allies.
During a long day of testimony, she relayed her striking story of being “kneecapped,” recalled from Kyiv by Trump in a swiftly developing series of events that sounded alarms about a White House shadow foreign policy.
She described a “smear campaign” against her by Trump’s personal lawyer, Rudy Giuliani, and others, including the president’s son, Donald Trump Jr., before her firing.
The daughter of immigrants who fled the former Soviet Union and Nazi Germany, her career included three tours as an ambassador to some of the world’s tougher postings before arriving in Ukraine in 2016. She was forced out last May.
In particular, Yovanovitch described Giuliani, Trump’s lawyer, as leading what William Taylor, now the top diplomat in Ukraine who testified earlier in the inquiry, called an “irregular channel” outside the diplomatic mainstream of U.S.-Ukraine relations.
“These events should concern everyone in this room,” Yovanovitch testified in opening remarks.
She said her sudden removal had played into the hands of “shady interests the world over” with dangerous intentions toward the United States. They have learned, she said, “how little it takes to remove an American ambassador who does not give them what they want.”
After Trump’s tweets pulled attention away from her, Schiff read the president’s comments aloud, saying that “as we sit here testifying, the president is attacking you on Twitter,” and asked if that was a tactic to intimidate.
“I can’t speak to what the president is trying to do, but I think the effect is to be intimidated,” she said.
Said Schiff, “Well, I want to let you know, ambassador, that some of us here take witness intimidation very, very seriously.”
In a closed-door session later Friday, the panel heard from David Holmes, a State Department official in Kyiv who overheard Trump asking about investigations into his political rivals the day after Trump’s July 25 phone conversation with new Ukrainian President Volodymyr Zelenskiy. Holmes was at lunch in Kyiv with Gordon Sondland, the ambassador to the European Union, when Sondland called Trump. The conversation was loud enough to be overheard.
Rep. Ted Lieu, D-Calif., said two other people heard the call as well and there were four people at the lunch. The Associated Press has already identified one of the other people who heard the call as Suriya Jayanti, a foreign service officer based in Kyiv.
In Trump’s phone call with Zelenskiy the previous day, he asked for a “favor,” according to an account provided by the White House. He wanted an investigation of Democrats and 2020 rival Joe Biden. Later it was revealed that the administration was withholding military aid from Ukraine at the time.
Democrats are relying on the testimony of officials close to the Ukraine matter to make their case as they consider whether the president’s behavior was impeachable.
Yovanovitch provides a key element, Schiff said, as someone whom Trump and Giuliani wanted out of the way to make room for others more favorable to their interests in Ukraine, an energy-rich country that has long struggled with corruption.
It became clear, he said, “President Trump wanted her gone.”
The top Republican on the panel, Rep. Devin Nunes of California, bemoaned the hearings as a “daylong TV spectacle.”
Republicans complained that the ambassador, like other witnesses, can offer only hearsay testimony and only knows of Trump’s actions secondhand. They note that Yovanovitch had left her position before the July phone call.
Nunes also pressed to hear from the still anonymous government whistleblower who first alerted officials about Trump’s phone call with Ukraine that is in question. “These hearings should not be occurring at all,” he said.
Just as the hearing was opening, the White House released its rough transcript of a still-earlier Trump call with Zelenskiy that was largely congratulatory.
Nunes read that transcript aloud. In it, Trump mentioned his experience with the Miss Universe pageant in Ukraine and invited Zelenskiy to the White House. He closed with, “See you very soon.”
Under questioning from Republicans, Yovanovitch acknowledged that Joe Biden’s son, Hunter, serving on the board of a gas company in Ukraine could have created the appearance of a conflict of interest. But she testified the former vice president acted in accordance with official U.S. policy.
She denied allegations against her, including that she favored Democrat Hillary Clinton over Trump in the 2016 election, and she rejected the notion that Ukraine tried to interfere in the election, as Trump has claimed counter to mainstream U.S. intelligence findings that it was Russia.
The White House has instructed officials not to comply with the probe, and most have been issued subpoenas to appear.
An administration budget official will meet privately with the panel Saturday. Part of the impeachment inquiry concerns the contention that military aid for Ukraine, which borders a hostile Russia, was being withheld through the White House budget office, pending Ukrainian agreement to investigate Biden and the 2016 U.S. election.
TJ Martin and her husband, David, had kept watch on 9-year-old Valee since her birth. They had taken in her older brother, Drake, then 7, as a foster child.
The children’s mother died when Valee was 4, and their fathers have not been involved in their lives, TJ said, adding: “We knew we were getting her someday.”
In January, Valee was placed with the Martins as a foster child. On Friday, they formally adopted her.
Valee was among more than 20 adoptions in Yakima County Juvenile Court on National Adoption Day. The courthouse was abuzz with families eager to provide foster children a permanent home.
Valee beamed glowing smiles as family greeted her with hugs in the hallway before the courtroom doors opened.
Her story began with the Martins at the time of her birth. The Martins had just taken in Drake as a foster child.
Dave and TJ were both emergency medical technicians with Yakima County Fire District 5 at the time. Neither had intentions of adopting, Dave said.
“We just wanted to provide a safe and secure home with good structure to help them become adults and that was it,” he said.
Two years later, they were asked if they wanted to adopt Drake.
“My wife said: ‘Where do I sign?’” Dave said.
Drake is now 15 with a healthy sense of humor. In the hallway of the courthouse, he snuggled up against TJ and said: “I tolerate you,” in a fun-loving tone.
He then turned to a news reporter and said: “When you’re young, you love them. When you’re older, you tolerate them.”
Valee wasn’t the only one the Martins adopted Friday. They also adopted 27-year-old Melissa Stark, who now lives in Iowa with her husband.
The adoption was handled over the phone.
Stark was just 6 when Dave dated her mother more than two decades ago. Things didn’t work out, and Dave and Stark’s mother parted ways.
A few years ago, Stark contacted Dave on Facebook. She was in the hospital and needed information about an injury she suffered as a child.
“We were talking on the phone and TJ just burst out: ‘Tell her she can come live with us,’” Dave said.
So Stark did. Last year, Dave walked her down the aisle at her wedding.
TJ said Washington is one of the few states a family can legally adopt an adult who doesn’t have a disability.
“She doesn’t have any family — we’re it,” TJ said.
There were many other heartwarming stories that flooded the courtroom on Friday, including that of Sherri Ramirez. She adopted three children in a single proceeding.
That brings the number of children she’s adopted to six. She asked they not be identified.
On National Adoption Day in 2016, she adopted her twin niece and nephew, who are now 8.
In March, she adopted a 4-year-old girl she was fostering, and on Friday she adopted three more girls, ages 6, 3 and 1.
The five girls were clad in matching yellow dresses and the boy donned a gray herringbone hat. They all sat together before presiding court Commissioner Shane Silverthorn. They all applauded when Silverthorn declared the adoption final.
“It’s beautiful,” Ramirez said of her adopted children. “The more the merrier, because they all have the heart to love.”
In early March 1934, a community leader said he would donate $80,000 to build a home for the Yakima Young Women’s Christian Association. From comments Alexander Miller made years later, he never regretted it.
Miller and others appreciated the impact the Yakima YWCA had made for women and girls. His gift funded construction of a red brick Colonial Revival-style structure at 15 N. Naches Ave. and paid off what members owed for the land.
The building, now the Le Château event venue, for decades provided physical, social and cultural activities for the region’s young women. It was an employment agency, offered social services and temporarily housed homeless, transient and working women. The YWCA moved to a new location on Yakima Avenue in 2008.
Cheri Kilty, executive director of YWCA Yakima, and Lisa Kapuza, its development director, are familiar with the organization’s impact in the Yakima Valley since it was founded on Nov. 17, 1909. But in preparing for a 110th birthday celebration set for Sunday, they’ve learned much more.
“I feel like there’s a lot of history out there we don’t know,” Kapuza said.
The celebration will take place from 1-3 p.m. at the YWCA, 818 W. Yakima Ave. It will feature refreshments and a short program at 1:30 p.m. in which guests will learn about YWCA Yakima’s past and plans for its future. Tours and a display of historic documents are planned.
“We really want to encourage past board members to come, but this is open to anybody that the YWCA has touched,” Kapuza said. Those attending may share their stories related to the YWCA and add their names to a timeline.
“It’s going to be fun to see who comes,” Kilty said.
In preparing for Sunday’s event, she and Kapuza have pored over stacks of old scrapbooks, historic photos and other items brought out from storage.
“There’s going to be all kinds of historical artifacts” on display Sunday, Kapuza said.
They include a time capsule added to the former YWCA Yakima building on Naches Avenue. Along with newspaper articles about Alexander’s $80,000 donation, early bylaws and a list of original members, the small metal box contained a two-page handwritten history of the organization by Mary Remy.
An early YWCA Yakima leader and its board president for 10 years, Remy helped design that building with well-known Yakima architect John Maloney.
For years its board presidents used their husband’s names in meeting minutes and other documents; that ended in the early 1970s, a photo composite shows. Fundraisers have included bingo, which ended awhile ago. YWCA Yakima members played on its sports teams, and its offices were an early home for the League of Women Voters. For years, the Working Woman’s Wardrobe has helped low-income women who need clothing to enter or re-enter the work place.
While the YWCA’s mission of eliminating racism and empowering women is the same for all of its local associations, how they serve their communities varies and has changed over the years.
In 1978, YWCA Yakima opened a shelter and offered support services for women and children impacted by domestic violence, a pressing issue in the city and throughout Yakima County for decades.
Along with its West Yakima Avenue offices, the organization runs a 14-room emergency shelter with 44 beds for domestic violence victims and their children and 16 transitional housing units.
Housing is often at capacity, YWCA Yakima’s website notes, and there is a waiting list.
“A lot of YWCAs reflect the needs of their community,” Kilty said. “Some do not have a domestic violence shelter.”
Domestic violence affects all communities. One in four women will experience domestic violence in her lifetime regardless of socio-economic background or ethnicity — more than breast, ovarian and lung cancer combined, YWCA officials have noted.
Some 6,632 individuals involved in domestic violence incidents received services through YWCA Yakima in 2018, according to the organization.
As that work continues, it expands. YWCA Yakima is spreading the message to students that abuse of any kind is not healthy, nor should it be tolerated in any form.
“Because our main service is domestic violence, our main goal is to educate people,” Kilty said. “We’re slowly increasing our prevention work with middle school girls (on) healthy relationships.”
The future also includes YWCA Yakima’s Persimmon Boutique, where it sells new and gently used items. It opened in 2016 and not only provides clothing to domestic violence survivors who are entering or returning to the workplace, it provides job training for them.
With all its history to choose from, YWCA Yakima leaders hope to keep highlighting some of it beyond Sunday’s event. Those efforts will include the 52 Women, 52 Weeks campaign on Facebook, which honors women making a difference in the Yakima Valley.
“We’re going to celebrate all year long,” Kilty said.