INSUFFICIENT CONSIDERATION GIVEN TO LESS EXPENSIVE ALTERNATIVES

I believe that the door has not been left open widely enough to consider a variety of alternatives. Among some of the alternatives I see, (none of which would require fixed capital costs of a building or the operating expense of a facility and staff) would include spending any available public federal, state or county grant money on increasing the number and improving the training of emergency first responders, specifically Paramedics already assigned to fire, City police and County sheriff's departments. More completely equipping their vehicles and stations, especially with communications equipment to receive medical direction at trauma sites, would permit them to more effectively and more quickly handle accidents and provide highly critical care services to persons traumatized by automobile, boat or airplane accidents, burns, chemical spills, heart and stroke victims and a variety of other immediate care conditions. Emphasis should be placed first on getting emergency care to the patient, not getting the patient to the care. Minutes are often crucial in many trauma events. Beginning procedures during transport may mean the difference between life and death, or permanent brain function loss. Available grants could thus be spread around to all the communities in Columbia County where Paramedic sponsoring entities already exist and not solely for the benefit of the Hwy.30 corridor.

EMERGENCY OBSTETRIC CARE

One of the greatest financial burdens on rural healthcare providers as a whole is the enormous burden of malpractice insurance premiums charged for obstetric (OB) care. Many healthcare providers have simply "gone out of OB business". There are many reasons for the high premiums, but almost all come from the basic root of parents' expectations of a perfect outcome, every time. And if the baby or care is less than perfect, the healthcare provider is always blamed and expensive litigation usually ensues. The tremendous financial burden that SHH would incur by providing OB services just cannot be emphasized enough.

Emergency births are far less frequent than we imagine and a normal pregnancy is not considered an acute or emergency care condition since most women will have had 9 months or so to plan their deliveries.  Admittedly, some babies choose a different arrival date than do their parents and some do create medical emergencies but most properly trained Paramedics would be able to handle a large percentage of the non-problematic deliveries. If problems or complications arose, first responders can be in radio contact with birth-trauma providers for assistance while transporting the mothers to that center.

EXTENT AND IMPACT OF "MEDICALLY INDIGENT" IN COLUMBIA COUNTY

A representative of Boise referred to that Company's recent acquisition by another company, and the eventual "spin-off" to other companies of components of Boise. The Boise correspondent estimates that a significant reduction will occur in the number of employees remaining at its St. Helens plants.

Given the already high unemployment rate in Columbia County, quoted by the Oregon Department of Employment for August 2004 as 9.5% (some 40% higher than the State as a whole) I assume that the proposed SHH would see a high proportion of "medically indigent" patients. By comparison, in 1990 the County's unemployment rate was only 6.7%, (although still almost 30% higher than Oregon as a whole.) Undoubtedly, that historic unemployment rate had a substantial contributory effect on the former District Hospital's inability to operate in a financially sound manner.

I am of the opinion that most of those people in Columbia County who do not commute to work in Portland; who do not have work-provided healthcare insurance and all those who are unemployed, will not have sufficient income to allow them to pay the high cost of inpatient healthcare services without assistance and will need "charity care" of some kind provided by SHH.

The high proportion of "medically indigent" in the County as a whole would place a considerable burden on the taxpayers of the Hospital District to make up that unrealized income.

SERVICES TO NON-DISTRICT PATIENTS