The next time you’re driving through Eastern Oregon, try not to be pregnant or get in a car crash in Baker County. We can’t help you anymore.

On Aug. 26, 2023, the only birthing center in Baker County closed.

It was proceeded in death by Baker County’s only ICU and pediatric care center earlier in 2023.

The closures were opposed, mourned, and are now suffered by the community of 16,000 people they served.

The decisions to close the ICU/pediatric center and birth center were made by MBAs, not MDs, in the St. Alphonsus and Trinity Medical network. The decisions were made by people who will never know someone who was in a car wreck in North Powder or a baby in Sumpter — but I do.

This is a story of one family I have known most of my life, and how they are living through the loss of critical medical care in Eastern Oregon.

This is only one story. It doesn’t capture the experiences of the other rural folks, people of color, poor folks — those most affected by health care deserts.

There’s just no way I can explain how it feels when someone far away looked at some numbers and decided to close your ICU, your pediatric care center, and your birthing center knowing their decisions would certainly kill some of us.

**

I called my friend Dallas Defrees as she recovered at her home and family ranch in Sumpter from a high-risk pregnancy and hard birth. In the background new baby Clementine cooed.

Clementine is Dallas and her husband Riley Hall’s second child. Their son, Roby, was born a few years ago at the St. Alphonsus Medical Center in Baker City. While her first pregnancy was tough, Dallas said it was made easier by the fact she had a long relationship with her doctor.

“My doctor saw me go through years of infertility, then get pregnant, then she saw me through a traumatic birth, and now she cares for me and my son.”

Dallas anticipated the same “circle of care” in Baker City with her second birth. But his time her doctor would not see her through delivery.

In August, Dallas and Riley had to start planning how to have a baby in the winter in a rural county. The next closest maternity care options were in La Grande, 70 miles away, and Ontario, 100 miles away, from their home in Sumpter Valley.

“First, we thought of delivering in La Grande but with the closure of the Baker ICU and birthing center, they are taking on a huge patient load,” said Dallas.

The couple considered Pendleton, two snowy mountain passes away, as well as Boise, Idaho. They knew with Dallas’ high-risk pregnancy they would have to find a new doctor and move temporarily to be near a birthing center.

“The week before we moved to Boise, I sat in my living room and watched the storm outside,” said Dallas. The freeway was closed in both directions meaning she couldn’t go to La Grande or Boise. “I thought, ‘I don’t know what would happen if I went into labor now.’ I didn’t know if I could even make it to the Baker ER or if Life Flight would be available.” Dallas worried about all the scenarios.

But she is fortunate to have a nurse (her husband Riley) and a doctor (her brother Dr. Nathan Defrees) to lean on.

“I want to make clear how lucky we are,” said Dallas. “As hard as this was for us, this would be devastating for people in our community who don’t have the funds, means, transportation or familial and friend support to have a birth somewhere else.”

At 36 weeks she started having early labor. Dallas and Riley made the move to Boise, leaving Roby with his grandparents. “It was so hard to leave him,” she said. “I felt like I didn’t know if I would see my son again.”

Four days after they arrived in Boise, Dallas went into labor. The birth had complications. Baby Clementine aspirated blood and needed medical care. Dallas had placenta accreta, a serious condition where the placenta grows into the uterus.

“I was having blood loss and had to have an emergency hysterectomy and a blood transfusion.”

She imagined what might have happened if she had been driving from Baker to Boise in labor.

“I have quick labors so even if the roads had been open, I could have had a baby on the side of the highway. In that scenario, I probably would have died.”

**

Nathan’s wife Jess Defrees, a teacher in Baker City, had two of their three children at St. Alphonsus in Baker.

“I knew what we had in Baker was really special. It wasn’t just convenient; it was really quality care,” she said. “I didn’t take for granted the quality of care in Baker, but I took for granted the access.”

Idaho’s ban on abortions adds greater uncertainty. The ban has put a lot of Idaho physicians in a tough spot, not knowing what care is legal or allowed. That affects Oregonians too, as fetal medicine doctors and OB/GYNs leave Idaho.

As Jess’ husband, my friend Dr. Nathan Defrees explained, “In rural communities we rely on urban centers for advanced health care access. To not have that access [in nearby Idaho] makes it more dangerous to be pregnant in Eastern Oregon.”

Eastern Oregon women with high-risk pregnancies or labor complications must make a new calculation.

If they need a “big city hospital,” do they go to Boise or Portland? Boise is closer, but doctors may be restricted from providing life-saving care in the wake of the confusion and fear of the abortion ban. Portland doctors can provide care, but in an emergency, they may be too far away to provide it in time.

***

The Defrees’ see the lack of local decision-making power as a primary reason St. Alphonsus closed the ICU, pediatric care, and birthing center in Baker City.

“What has happened in Baker is a cautionary tale — don’t give up local control of your hospital,” Dr. Defrees told me.

He points out that while birth centers have been closed in big hospital chains in Springfield, Redmond, and Toppenish, Wash., independent hospitals in John Day, Enterprise, La Grande, and Burns still have maternity care.

Nathan and I went to OSU with another rural family physician, Dr. Eva McCarthy, who spent three years at Burns’ community-centered rural hospital. Dr. McCarthy served some of the most remote Oregonians at the Harney District Hospital where people may have to travel two hours one way to see a doctor. During pregnancy this is a huge burden.

“A ‘normal’ pregnancy requires at least 14 check-ups but people over age 35 or who have high blood pressure or other medical conditions need more frequent visits,” she said.

She worried about her patients spending so much time on remote roads where cell service is spotty.

“It could be 45 minutes before another car comes upon you,” she said, “and if you need medical care on the highway, it could take an ambulance an hour to reach you.”

Dr. McCarthy also enumerated other challenges in rural hospitals besides distance including weather and lack of access to specialists. But she also emphasized the resiliency of rural health care and strong relationships in rural communities.

“People in Burns had a wide range of skills they built up intentionally to weather challenges. I don’t see that in suburban and urban communities where people just fill their singular role. It is just a different mindset — to equip yourself to be useful in lots of different ways for your community.”

Dr. Defrees sees Harney District Hospital as an example of the local control and decision making that is needed now.

“In Baker we need to move toward a county health district and a community-run hospital. We have an opportunity to provide better local care.”

The challenges for Baker City and rural and underserved communities are growing. Dr. McCarthy worries we will see more loss of medical access in Oregon.

“When other large healthcare systems see how easy it is to shut down maternity care in Redmond and Baker, it could become a domino effect.”

But she says these closures shouldn’t continue — they should trigger a bigger conversation.

“Shutting down maternity wards is absurd. It is the canary in the coal mine for our health care system.”

**

For large hospital systems, the cost of 24/7 birthing center staff in small hospitals is the problem. Most rural hospitals lose money on maternity care, and many rural communities are aging.

I want adequate, robust care in rural communities, so I started spitballing ideas to Dr. McCarthy about using telemedicine or volunteer rural fire departments to fill the maternal care gap.

She stopped me.

“I admire how rural communities are good at making do, but people in power should know better and do better for rural people,” she said. “Decision makers take advantage of the resilience and self-efficacy of these rural communities.”

“We should not accept solutions for rural people and underserved communities that do not provide the proper standard of care,” she said.

Dr. McCarthy illuminated the downside to a tightknit community that scrambles, fundraises, problem solves with limited resources. My whole rural life I haven’t expected better or more. I realized that at some level, I believed part of living out here was accepting less and getting by.

Or as Dallas put it, “rural women pride ourselves on being hardy.” But her recent birth experience is not something we should accept or expect for anybody.

“The big health care systems are deleterious to our welfare and well-being. We don’t matter to them. Literally, Dallas and Clementine don’t matter,” she said. “They are more worried about losing money than losing people.”

The money versus life tension of health care is hard to take. Health care has a dollars and cents cost, but we don’t value life that way. Health care should be about people, but it is so often about money.

“Hospital administrators and MBA’s make decisions about health care using business models, but health care isn’t Amazon or Microsoft — it’s people’s lives,” Dr. McCarthy told me. “The value proposition should be focused on basic human rights.”

I am mad as hell about the situation in Baker County, but the same disparities and worse are unfortunately shared. We know by the numbers people of color, poor people, and rural people have some of the worst outcomes under this harmful healthcare model.

As Jess Defrees put it, “I watched Nathan go through his medical training with the oath to ‘do no harm.’”

“But health care decisions are in the hands of people far away, and their choices are actively doing harm to my community.”