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Yakima’s Astria Regional Medical Center.

Late last month, Astria Health confirmed it had laid off employees as part of an effort to consolidate management of its three hospitals — Astria Regional Medical Center, Astria Sunnyside Hospital and Astria Toppenish Hospital — and to provide a means to better staff those working directly with patients.

The layoffs came several weeks after Arizona attorney Susan N. Goodman, the appointed patient care ombudsman for Astria Health during its bankruptcy, released a second round of reports regarding patient care at the three hospitals and Astria Health’s other clinics.

Astria Health filed for Chapter 11 bankruptcy protection in May. As part of that process, Goodman was appointed to monitor patient care at Astria Health facilities. Goodman has served or is serving in the same role in nearly 30 health care bankruptcies across the country, including that of the Kennewick Public Hospital District in 2017, according to bankruptcy filings.

In the October reports, Goodman makes clear that staffing shortages have continued to be an issue, especially for Astria Regional Medical Center in Yakima, the largest of the three hospitals. Goodman said while patient care had not been affected by the bankruptcy, she plans to visit Astria Regional more frequently “given all of the various dynamics.”

“While nursing openings were detailed most heavily in the (first) report, other departments have also faced departures with gaps in the replacement of core team members for various reasons,” Goodman wrote in a report about a recent visit to Astria Regional that was filed with the court on Oct. 9.

Astria Health declined to answer questions regarding the layoffs or the staffing issues outlined in Goodman’s reports. Officials did note by email that no nursing positions were affected in last month’s staff reductions tied to consolidation of services:

“Astria Health’s highest priority is, at all times, focused on patient care and safety. No nursing positions were impacted by the systemwide leadership and shared support services model. That model will allow the organization to expand resources at the bedside. We have been successful in recruiting additional nurses to all of the Astria Health facilities, and we continue to actively recruit for nursing and other needed positions.”

The company did not respond to a question about how many people were laid off.

As Astria Health continues its work to emerge out of bankruptcy, here are a few things the ombudsman reports said about the organization’s staffing and operations:

1. Patient care hasn’t been affected. While Goodman had concerns over staffing and other issues, such as a lack of third-party transportation services for patients at Astria Sunnyside Hospital, she stopped short of stating those issues were negatively affecting patient care. However, she said she would heavily monitor the issue in future visits. Regarding Astria Regional, the facility most hit by staff shortages: “While patient care has not been affected to date and patient interviews did not elicit any immediate direct care concerns, (I) would be remiss to not convey the staff and clinician concern regarding the ongoing strain with staffing.”

2. Employees are leaving due to uncertainty over the bankruptcy. While Astria Health maintains it’s making progress with a new revenue collection vendor and that it’s aiming to emerge out of bankruptcy by year’s end, that assurance doesn’t seem to be enough for some. In Goodman’s reports, she notes employees who have departed or were planning to leave due to concerns over the hospital’s bankruptcy, including a nurse at Astria Regional. “In following up with this team member, the departure was reported as directly related to bankruptcy uncertainty,” Goodman wrote.

3. Some employees have worked so many hours they can no longer accrue additional paid time off. In reports on both Astria Regional and Astria Toppenish, Goodman cited frustrations by employees over having to work so much that they’ve accrued the maximum amount of paid time off, or PTO. “(I) constantly observed departmental examples of staffing accomplished through staff pulling extra shifts, forgoing PTO and/or taking extra calls to provide coverage. This cycle has caused many staff to ‘max out’ on their PTO,” Goodman wrote in her report on Astria Regional. She notes this issue in the Astria Toppenish report as well. “Toppenish employees share similar frustrations associated with reaching PTO accrual caps,” Goodman wrote.

4. Astria Health’s relationships with certain staffing groups and vendors were souring before the bankruptcy occurred. In her report on Astria Regional, Goodman addresses staffing in the anesthesiology department. In that section, Goodman mentions a community-based specialty group that opted not to perform services at Astria Regional. The bankruptcy was only a minor factor in the departure, and the group had already had a “series of disagreements” with Astria Regional’s operational decisions in the last few years. In a report on Astria Toppenish, Goodman references a note she made in a previous report that the hospital’s maintenance and facilities department was experiencing a “great deal of vendor strain and fractured relationships” prior to bankruptcy. That strain caused issues when it came time to get parts and service for its equipment, such as its boilers.

5. Employees are not comfortable with voicing concerns, which could impact the ability to monitor patient care. In the Astria Regional report, Goodman notes two examples of employees hesitating to voice concerns. In one case, Goodman said that her role in monitoring patient care was “further complicated by staff and clinicians generally reporting unease in chatting” because they feared reprisal especially if Astria Health opted to do additional layoffs. In the second example, she stated that employees were hesitant to make comments on a compliance hotline, even if they were anonymous. “Because of the number of departments with limited staffing, employees expressed the concern that merely the removal of the employee name does not ensure anonymity,” Goodman wrote.

Reach Mai Hoang at maihoang@yakimaherald.com.