Jack Chastain says he could have been in and out of surgery to have a tumor removed from his face that was first discovered in May 2018. Instead, he waited about seven months and continues to experience complications.
Chastain, who lives in Chiloquin and recently turned 80, has gone through bouts of constant pain and been back and forth between doctors as they work to remove additional amounts of cancer, squamous carcinoma, that has built up in his nose.
He has been unable to eat solid foods or use dentures often since they push upward on his upper lip and bridge.
When he asked one healthcare worker why they had to wait so long, eventually he was told it was due to “staff shortages.” He claims that his own doctor also chalked it up to a “mistake.”
“They could have done this in a week,” Chastain told the H&N.
A statewide problem
Primary care shortages are nothing new across Oregon. The Oregon Health Authority often releases its list of health professional shortage areas, or HPSAs, across the state.
Only four areas — this includes affluent regions such as Benton, Deschutes and some Portland area counties — are not marked as an HPSA.
The majority of areas with the designation also share one trait with Klamath and Lake counties: they are labeled as “low-income” areas, which often struggle with healthcare availability.
In Klamath County, there is one doctor for every 1,160 people, according to information collected from the Robert Wood Johnson Foundation’s annual County Health Rankings and Roadmaps. Some of this data dates back to 2015.
Lake County is in a much worse situation with only one physician for every 1,960 people, or four local physicians for all residents. Deschutes County is doing better than most rural Oregon areas, with one doctor for every 960 patients.
The statewide average is one doctor for every 1,070 patients.
It is often unknown how many patients go through similar experiences to Chastain’s — in-house liability contracts and agreements often keep patients from being able to take legal action once they consent to treatment, and medical records are often kept private through state and federal privacy laws.
Surgery experiences at Sky Lakes Medical Center could vary depending on who you ask.
Phyllis Tedford, for instance, said she was “in and out” quickly when doctors discovered she had breast cancer.
But Tedford, who knows Chastain and lived next to him for years, said she has seen firsthand what her friend has to go through.
She said she does not understand any of it, staffing shortages or not.
“But they could have sent him to Medford or Bend,” Tedford said. “That’s not an excuse, that they don’t have enough staff.”
In addition, at least two lawsuits related to shortfalls in care or alleged neglect have been filed through Klamath County Circuit Court since 2018, court records show.
One claim for an alleged “personal injury” at the hospital was since dismissed, though another case seeking damages in the amount of $777,000 for alleged “malpractice” and “severe hardware failure” of a previous operation are pending.
Patients must ‘self-advocate’
Even as more doctors become available, others continue to be bogged down by new practices and services they may not have previously needed to use.
This includes several databases such as Epic, which compiles lists of medications, recommendations, prior visits and other data points.
But each hospital may not necessarily share the same systems, which makes record transfers that much more complex.
This is why it is important that patients continue to be their own personal advocates, according to Dr. Grant Niskanen, vice president and chief hospitalist at Sky Lakes.
Niskanen first arrived in Klamath Falls 11 years ago. He previously worked in rural New Hampshire, which he said had very similar strains in primary care coverage.
In Klamath Falls, Niskanen said he also sees 15 to 20 patients in a half-day period.
“But things are missed,” he said. “If you haven’t heard about that mammogram in a week or two, you should call the office — just not assume that we’re perfect, because no one is.”
He also points out several technological challenges that doctors now face: several in-house medical systems are meant to reduce the workload of doctors and give them more one-on-one time with patients.
Instead, many of them are tied down by a nearly unending flow of lab results, charts, emails and other messages.
“They’re just getting deluged every day with things that are (in their) inbox,” Niskanen said.
Less specialists, increased ER visits
In addition to primary care doctors, Sky Lakes also has challenges in having less specialists than most areas. Niskanen said that they do not currently have a neurosurgeon or kidney specialist in the area.
Through most of 2018 and 2019, the hospital had four general surgeons and six orthopedic surgeons.
This is why Niskanen said it has become more important than ever for patients to “be their own advocate.”
Shortages in primary care doctors being able to take new patients has also led to an increase in emergency room visits, which sees about 32,000 patients a year.
A new urgent care center at the Collaborative Health Center could also ensure that more people could get into the doctors they need and quicker, Niskanen said.
“Hopefully, with the new building and urgent care, that’ll start to stabilize,” he said. “But that’s one of the things we’re looking at — ER visits are expensive for everybody.”
Struggles for retention
Niskanen stays active in the push for additional staff recruitment efforts, sometimes even connecting his profession back to recent economic developments in the area.
The Sky Lakes vice president spoke on the difficulties of retention at a Klamath Falls City Council meeting in January. He said that out of dozens of candidates interviewed in the past year, one signed on.
Niskanen said it was often difficult to compete with areas such as Bend and Medford, which have had less struggles with economic gains since the 2008 recession and often have more resources and activities to offer.
“Bend is where they want to go,” Niskanen said.
There are, however, other plans in the works to bring more doctors in and give rural areas such as Klamath County an edge.
Signs of progress
Niskanen and others often talk of new hopes in sight through a new Collaborative Health Center and other offerings through Oregon Health and Sciences University.
The Portland-based medical center already trains dozens of incoming doctors at Sky Lakes, some of whom return to or remain in Klamath Falls.
Dr. Joyce Hollander-Rodriguez is one of them. She graduated from OHSU in the early 2000s and completed her residency in Klamath Falls where she first trained.
She is now the regional associate dean of the Campus for Rural Health and oversees several collaborative programs between Sky Lakes and OHSU.
The new $50 million, 100,000 square-foot medical center could be finished in late 2019. The goal is for Cascades East Family Practice, a new urgent care facility, OHSU and other primary care doctors to share four floors at the location.
Hollander-Rodriguez believes that the new center, in addition to other education efforts through OHSU, could help tackle issues that patients and doctors alike face in rural areas.
“The goal in the long run is that they (medical students) really understand that context of rural care,” Hollander-Rodriguez said.
Help on the way
But those such as Chastain still struggle to find help, often seeking out new doctors or gambling with their health as they remain on waiting lists.
Niskanen said that the hospital does have patient advisory panels, which work with patients to find solutions for such problems. He also said that the hospital has an on-staff patient advocate that may work with someone going through such delays.
These boards and the hospital advocate then works with doctors to resolve the issue, according to Niskanen.
“We’ve made changes because of these concerns,” he said.
As of March 4, Chastain said that doctors at Sky Lakes have removed additional tumors from his face. Meanwhile, he’s awaiting additional procedures needed at a hospital in Bend.
Outside of needing medical care, Chastain stays generally active and optimistic about his own life. Another friend, Ritch Rissell, says Chastain often works to help people with accessibility needs throughout the area.
This includes building wheelchair ramps and others, work Chastain says he continues even as doctors work with him through the healthcare system.
Chastain’s goal is to get everything taken care of as soon as possible, he says — all while he’s “still young.”
“I do what I can,” he said.