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Dr. John Zambito, Medical Director of the Emergency Department at Yakima Regional Medical Center, speaks to Maria Perez, registered nurse, left, Friday, Jan. 10, 2020, at Yakima Regional Medical Center’s Emergency Department in Yakima, Wash.

About 10 days before Christmas, several Astria Regional Medical Center doctors and Astria Health executives were on a conference call with a prospective buyer.

Dr. John Zambito, emergency department medical director for Astria Regional, was among those on the call. Most of the conversation was about whether the potential buyer could come in and help the hospital, he said.

He and his physician colleagues left the call encouraged.

“There was hope,” he said. “There was a glimmer of hope.”

That hope was dashed Tuesday when Zambito received another call: The sale offer had fallen through.

And a day later, on Wednesday, as he worked another day in the emergency room, he received word that Astria Regional was going to close.

Astria Health made the closure announcement Wednesday after receiving approval from the U.S. Bankruptcy Court. The hospital filed a sealed motion about the closure on Jan. 3, meaning the contents were unavailable to the public until Wednesday.

The Yakima-based organization announced Saturday that Astria Regional’s emergency department would close at 12:01 a.m. Monday. The organization’s news release said all operations would cease within two weeks, or by Jan. 22.

Zambito, emergency room physician Dr. Rachel Monick, and Dr. Mark Silverstein, chief of staff at Astria Regional, met with the Yakima Herald-Republic on Friday to recall what happened during the past two months, and to discuss how closing Regional could affect health care in the Yakima Valley.

While there were red flags, few, if any, of Astria Regional’s physicians and staff expected Astria Health, which had filed bankruptcy protection in May, to close the hospital.

“I’ve been the ER director since 2010. I’ve sold all my guys, my physicians, my physician assistants, my nurse practitioners, even the nurses I’ve worked with (on the idea) that we were going to be open. That we were going to stay,” Zambito said. “They’ve been through thick and thin through multiple sales (of the hospital). And now they’re going to be out of work.”

Since announcing the closure, Astria Health has yet to respond to specific questions from the Yakima Herald-Republic and declined a request for an in-person interview.

“We will field written questions at this time,” the company said in a written emailed statement Friday. “Astria Health is entirely focused on patient care and current operational issues to ensure the safe delivery of care during this transition. There are legal constraints we must also meet.”

Sunny outlook

Until Wednesday, Astria Health wasn’t publicly discussing a possibility of closure.

When Astria Health first filed for Chapter 11 bankruptcy protection in May, administrators provided a sunny outlook. Executives blamed an issue with the organization’s revenue cycle vendor, noting that it had failed to collect tens of millions of dollars over the prior eight months.

The inability to collect revenue caused a cash flow issue with its hospitals, especially Astria Regional.

Astria Health executives, including CEO John Gallagher, expressed confidence that a new revenue cycle management system would boost revenues and enable the organization to emerge from bankruptcy by the end of 2019.

“We put (a deadline) on ourselves because we have confidence in the revenue cycle flipping, and we’ll see positive progress and be able to negotiate a plan with creditors,” CEO John Gallagher said in May.

Astria Health expressed that same optimism to hospital physicians and staff during the first months following the bankruptcy filing.

Silverstein said, as a member of the board of trustees at Astria Regional, he got more frequent updates at monthly meetings, but the tone and content were similar.

“About once a month, we get some filer that came out electronically,” he said. “It would say, ‘Everything is great.’ Nothing significant about the bankruptcy except for a couple of lines that said, ‘We’re moving ahead, things look good, we’re doing a refinance. Blah blah blah.’ But nothing that got to the meat of what was going on behind the scenes.”

Attorneys for Astria Health never mentioned closing Astria Regional Medical Center in bankruptcy filings or hearings, though it was clear the hospital was struggling.

Reports from Susan Goodman, an attorney appointed by the court to serve as patient care ombudsman, indicated operational challenges, including a lack of nurses and other staff available to help patients in the emergency room and dropping patient census numbers.

During a status hearing on Nov. 15, Astria Health attorney Sam Maizel said that while the new revenue cycle vendor boosted collections, cash flow was still an issue. He also stated that despite the debtor-in-possession financing, Astria Regional Medical Center was struggling financially.

Still, the organization maintained that it was still making progress to emerge from bankruptcy either through securing exit financing or by selling assets.

Growing concerns

In November, Astria Regional’s medical staff — its physicians — gathered for an annual meeting.

Gallagher, who usually attended the meeting, did not appear. Only Astria Regional Chief Operating Officer Darrin Cook showed up.

“(Cook) was very kind, but he knew nothing,” said Monick, the emergency room doctor.

The no-show was a red flag for Astria Regional’s doctors. During that meeting, the physicians started talking to each other about what they were seeing within the organization, such as equipment being moved from Astria Regional to Astria Health’s other hospitals. Concerns grew about Astria Regional’s future.

“We realized, these are not the kind of decisions you make if you’re staying open,” Monick said.

That prompted the physicians to get an attorney and see how they could get involved with the bankruptcy reorganization process.

That effort ended quickly when the lawyer told them that unless they were a creditor, they wouldn’t have much say in the bankruptcy process.

In December, there was a meeting of Astria Regional’s board where Gallagher sought approval to close the hospital.

But it was painted as a move done if it was “absolutely necessary,” said Silverstein, who was a member of the board. Silverstein also participated in the conference call with the potential buyer during that same month.

“It was sold as a bargaining chip in trying to get a purchaser,” he said. “Everybody (signed the document). But things were still in the dark. The administration doesn’t communicate.”

Confusion

The days following the closure announcement could be described as pure confusion as there was little communication, even to physicians and directors, on the closure process.

When asked whether staff were given an outlined closure plan from the company, Monick said, “We got the same news release you got.”

“I still don’t know when my last day is,” Zambito added.

Silverstein recalled a conversation he had with Gallagher’s assistant by email shortly after the closure announcement.

“I said, ‘Can you ask John when this halt on admission happens?’ She said, ‘No, you have to talk to Darrin (Cook, Astria Regional’s chief operating officer). He’ll be in touch with you,” Silverstein said. “I then ran into Darrin in the hallway downstairs, and he said, ‘Right now.’

“That was it. The letter’s out; we’re done. With no explanation or delineation of timelines.”

There will be even more uncertainty as some 500 physicians and staff members, some who have spent years, even decades, at Astria Regional, contemplate their next career move.

It’s likely there won’t be enough positions locally, Zambito said.

“I don’t care how much money you’re losing, you’re displaced a lot of professionals out of this town,” Zambito said. “You’re going to have talented people leave.”

And many also will face the challenge of providing for themselves and their families while they seek new employment.

For Christmas, the physicians bought hams and turkeys to give to nurses and other staff members. Silverstein had leftover coupons that could be redeemed for already paid-for hams and turkeys.

“I’ve been walking around the last two, three days just giving the rest of those out,” he said. “Next week, they’re going to be out of the job. They’re going to need food.”

Reach Mai Hoang at maihoang@yakimaherald.com or Twitter @maiphoang

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