HOW HEALTH CARE HAS CHANGED OVER 100 YEARS

LONGVIEW CENTENNIAL

A delivery room in Longview's first hospital appears stark to the modern eye, holding little more than a narrow metal bed, sink, crib and shelving.

Although the hospital was state-of-the-art at the time, advancements over the last 100 years cast it in an antiquated light.

Modernized hospital rooms are just one small piece of the major changes Longview's health care system has undergone in the last century.Coming out of the COVID-19 pandemic, the industry faces new and ongoing challenges.

Early hospital history

In the early 1920s, Longview founders did not plan to build a hospital at first, but decided the need was enough to justify fundraising for a facility.

The Long-Bell Lumber Company donated the site on the corner of 15th Avenue and Douglas Street — where the current hospital stands — but did not initially contribute money. A fundraising association brought in donations but it wasn't enough to cover the cost, and the company ended up donating and getting a large loan.

After eight months of construction, the three-story Longview Memorial Hospital was completed in late 1924.

A decade later, nurse Helen Lawrence opened the Longview General Hospital in converted hotel space on the top floor of the Willard Building on the corner of 12th Avenue and Broadway.

In 1935, a physician group took ownership of the operation, renamed it Cowlitz General Hospital and moved into the unused rail passenger depot at the foot of Broadway.

Until about 1941, competition between the two hospitals helped keep costs relatively low and held care to a high standard. Then World War II increased costs and drew some younger doctors into military service.

After financial issues tied to the war, Longview Memorial closed in 1943. The Sisters of St. Joseph of Peace (later PeaceHealth) bought it and reopened it as St. John's Hospital. A new wing opened in 1952, adding 50 beds.

Cowlitz General, sold to a nonprofit group in 1954. In the early 1960s, the health department declared the old train depot was no longer fit for use and a new multi-million facility was completed in 1968.

A major St. John's expansion was underway at the same time, and the eight-story building opened a few days after Cowlitz General's new facility.

The increased use of health maintenance organizations — insurance groups that provide health services for a fixed annual fee — made sustaining two hospitals in a town Longview's size untenable.

In 1984, Cowlitz General, renamed Monticello Medical Center in 1977, was sold to Sutter Health Systems. The California company then sold the facility to PeaceHealth in 1987, ending Longview's two-hospital era.

Clinic consolidation

After the hospital buyout, a new competition emerged when Kaiser Permanente moved to town in 1984.

The clinic on Hudson and Seventh Avenue opened in 1989, with membership quickly expanding to more than 27,000 patients. After its $2.5 million remodel in 1992, the number of doctors at Kaiser's Longview clinic increased from seven to 18, according to The Daily News archives.

PeaceHealth opened its own clinic — PeaceHealth Medical Group — in the early 1990s.

The expansions of PeaceHealth and Kaiser clinics contributed to the consolidation and closure of most private doctors' offices over the last 30 years.

Kirkpatrick Family Care is one of the only private practices left in Longview. Owner Rich Kirkpatrick said when he was growing up in 1950s Longview, most doctors were family practitioners and there were few specialists. His father, Neal Kirkpatrick, started the town's first internal medicine clinic in 1949, later joined by Rich's uncle Wendell Kirkpatrick in 1953.

In those days, doctors would take turns being on call and there was plenty of work for everybody, Kirkpatrick said. Most patients with insurance were covered by Cowlitz Medical Service (which merged with King County Medical Blueshield in the late 1980s), with fewer limitations than current plans, he said.

"There was never a real scramble to get patients, and patients really had a free choice," Kirkpatrick said.

After attending medical school, Kirkpatrick returned to Longview in 1976 and opened an internal medicine group with several other doctors.

"We kind of went from a family practice doing everything kind of situation to a lot of specialists," he said.

Over the next two decades, Kaiser Permanente and PeaceHealth Medical Group expanded, with the hospital buying out private practices and specialty groups, Kirkpatrick said.

In 1996, a majority of the 10 doctors with Kirkpatrick's internal medicine group voted to sell to PeaceHealth. Kirkpatrick joined with father and uncle to form Kirkpatrick Family Care.

"I didn't want to work for a corporation. I'm very independent minded and I'm impatient," he said.

The office remains busy, with a majority of patients on Medicare, Kirkpatrick said. The problem with Medicare is the reimbursement rates have not kept up with inflation or rising costs, making them significantly lower than commercial rates, he said.

Insurance changes

Changes in health insurance coverage, including the creation of Medicaid and Medicare in 1965, have altered how and where patients seek care.

As of June 2023, about 42,445 Cowlitz County residents, or 37.5%, were eligible for Medicaid, up from about 34% in 2020, according to the Washington Health Care Authority. That's compared to 29% of residents statewide in 2023.

As the number of patients with Medicaid and Medicare increased, some clinics evolved to serve them and other low-income residents.

In the early 1970s, a group of volunteers started the Cowlitz Family Health Center to provide family planning and Women, Infants and Children (WIC) nutritional services.

The nonprofit went through a major change in the mid-1990s when it began offering primary care and received federal funding to hire doctors and additional staff. In 2000, the organization added dental care after seeing a huge need in the community for uninsured and low-income patients, former CEO Dian Cooper said previously.

In 2015, Family Health Center merged with Drug Abuse Prevention Center (DAPC) in an effort to get more people into substance abuse and mental health treatment, according to TDN archives. Most recently, the organization opened its new behavioral health building in November 2022, making room to expand services.

In the early 2000s, local health care professionals joined together to form Community Health Partners, which began holding free clinics in 2005 to help ease the overload of low-income patients treated at the hospital's emergency room, according to TDN archives. After nearly a decade of operating out of Kaiser Permanente, the free clinic moved to a permanent location on Washington Way in 2021.

While the community previously struggled with a high rate of uninsured residents, the number fell significantly after the Affordable Care Act went into effect. The rate of Cowlitz County residents under 65 without insurance dropped from about 17% in 2013 to 7% in 2020, according to County Health Rankings compiled by the University of Wisconsin's Population Health Institute.

Doctor shortage

An evolving challenge is the shortage of health care professionals, particularly primary care doctors.

Starting in the 1990s, the number of family physicians in Longview and nationwide declined as some retired. Others switched to more lucrative specialist positions and fewer new doctors chose to practice primary care in rural communities.

By the 2010s, Cowlitz County had one of the state's lowest rates of primary care physicians per 10,000 people, according to a University of Washington survey taken at the time. The Longview Women's Clinic and the Pediatric Clinic closed in 2013 because they failed to hire new doctors to replace those who retired or moved, according to TDN archives.

The ratio of population to primary care physicians has continued to widen from one doctor for every 1,430 patients in 2012 to one for 1,710 patients in 2020, according to the most recent County Health Rankings report.

To help combat the shortage, Kirkpatrick Family Care has turned to nurse practitioners or physician's assistants, Kirkpatrick said. Many staff come to Longview for their first job, he said.

"We're happy to have them bring their enthusiasm and eagerness to help people," Kirkpatrick said.

COVID-19 pandemic and future challenges

Like most of the nation, Longview's health care system's latest challenge was the COVID-19 pandemic.

Following the World Health Organization declaring the novel coronavirus a pandemic on March 11, 2020, Washington's restrictions halted many routine appointments and procedures.

Health care professionals tackled the difficulties of diagnosing and treating a novel virus, while some patients faced lingering symptoms.

After a relatively lower rate of cases and hospitalizations in 2020, highly-contagious variants drove up Cowlitz County numbers in late summer 2021. PeaceHealth St. John's COVID-19 unit filled an entire floor and the morgue purchased a refrigerated trailer after running out of capacity in early September. High rates of illness continued into early 2022 before dropping off.

The rollout of COVID-19 vaccines in early 2021 presented new logistical tests and subsequent vaccination mandates created strife between some patients and health care professionals.

The pandemic exacerbated existing problems of staff shortages and low insurance reimbursements, putting Washington hospitals in an unsustainable financial position in 2022.

Washington hospitals lost more than $2 billion last year, according to the Washington State Hospital Association. This spring, the Legislature passed a program to help bring in some additional federal money but shortfalls remain.

While it's unclear what health care in Longview will look like in another 100 years, the pandemic put a spotlight on the importance of public health and the myriad of challenges facing the community.