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St. Charles warns La Pine could lose clinic in dispute over ambulance fees

(Update: adding video, info, comments from St. Charles, La Pine mayor)

La Pine Rural Fire District board expected to review, vote Thursday on billing care facilities for 911 activations

LA PINE, Ore. (KTVZ) -- The president and CEO of St. Charles Health System and La Pine's mayor are speaking out against plans by the rural fire district to charge for ambulance runs, saying such fees could lead to closure of the La Pine clinic.

"This is, just -- it's insanity," Mayor Daniel Richer told NewsChannel 21 on Wednesday.

The La Pine Rural Fire District says it's had trouble with patients covering the cost of ambulance services, because they're usually covered by Medicare or Medicaid.

Since 2019, the district has instead been charging health care facilities for those transports.

St. Charles officials said in a statement that 95 of those transports involved patients being taken from the two St. Charles clinics in La Pine to its hospital in Bend.

However, St. Charles is refusing to pay the $250,000 they've been charged for those trips by the fire district.

"We believe the responsibility of paying for that transport is not that of the clinics," said Lisa Goodman, the health system's public information officer. "We can't be billed for a service we don't provide."

The hospital system sued last fall over the fire district's bills, calling its current ordinance "illegal" and "arbitrary and unreasonable." Motion hearings in that case are set for May, court records show, and the hospital recently filed a second legal action, seeking a judge's "writ of review" for several district invoices.

On Thursday morning, the La Pine Rural Fire Protection District board will have a public meeting to discuss getting rid of the existing ordinance, replacing it with two new ordinances.

The ordinances would, in their words, "ensure the district has adequate resources to meet the needs of all district citizens."

They added, "It is not unreasonable that medical facilities and health care facilities should have the capability to care for their patients."

Dr. Jeff Absalon, St. Charles' chief physician executive, told NewsChannel 21, "We'd love to see solutions for that. This is not the solution."

St. Charles officials said paying for these transports will most likely force them to shut down both clinics in La Pine.

Mayor Richer sides with St. Charles, adding, "The only answer to the whole situation is to have a higher capability of medical care here in La Pine."

Here's the full joint statement from Joe Sluka, President and CEO of St. Charles Health System, and Mayor Richer, released Tuesday:

When St. Charles opened the doors of its Family Care and Immediate Care clinic in La Pine in May 2018, it did so to bring health care services closer to home for people who live there and in other medically underserved areas like Sunriver, Gilchrist, Chemult and Christmas Valley.

The project was years in the making and made possible in large part by the La Pine community. Individuals, foundations and businesses came together to see health care expanded in the south county area and contributed more than $1 million to fund the clinic, which houses primary care, immediate care, radiology, lab, occupational and specialty services.

Demand for services in La Pine is high. In 2020, more than 20,000 patients visited the clinic, 7,000 of whom were seen in Immediate Care alone. And as more people are seen there, more are referred to St. Charles' Bend hospital for medical emergencies that warrant a higher level of care than what the clinic can provide. In 2020, 715 patients were referred to the Emergency Department, 95 of whom went by ambulance. 

The decision to activate 911 is made with the safety and well-being of patients top of mind. That’s why we became deeply concerned when the La Pine Rural Fire Protection District (LPRFP) enacted an ordinance—Ordinance No. 2019-03—attempting to charge care providers like St. Charles and the La Pine Community Health Center for what the LPRFP claimed were non-emergent ambulance transports. But these “non-emergencies” were patients with potentially life-threatening problems like heart attacks and strokes.

Recently, the fire district decided to review this ordinance and invited public comment. It received overwhelming opposition to the fire district’s fee-based model. This outpouring of resistance to the ordinance included submissions by the Central Oregon Independent Practice Association (COIPA), a group that represents independent providers in the region, the La Pine Community Health Center and one of the co-authors of this piece, La Pine Mayor Daniel Richer.  

You can read the public comments here.

This Thursday, the fire district board is scheduled to review and vote on a replacement ordinance, 2021-01. The proposed new ordinance would direct the fire district to bill care facilities for all 911 activations— not the patient’s insurance, as is standard practice. We strongly oppose this new ordinance, as we believe it could place La Pine health care services at risk.

While the clinic sees thousands of patients each year, it operates at a significant financial loss and has been subsidized by St. Charles as a service to the community. Sadly, if St. Charles is forced to pay for ambulance transports, the increased losses to provide care may prove so challenging that the health system will most likely be unable to keep the clinic open. 

St. Charles cares about the La Pine community and wants to continue to do our part to serve it. The people of La Pine deserve access to the health care services they need, which is why we think the fire district board should reject this ordinance and stop the harmful practice of billing care facilities for transports instead of patients’ insurance. The fire district has many means to fund itself that do not endanger community residents. It’s time they explore those other options.

If you live in one of the areas served by St. Charles' clinic and the La Pine Rural Fire Protection District, we encourage you to attend the fire district board’s next meeting on Thursday at 9 a.m. The meeting is virtual, and you must send your request for the Zoom link to before 3 p.m. on Wednesday. 

We think your health is too important to jeopardize over a fire district funding issue.

Here's what the La Pine Rural Fire Protection District has posted on its website ahead of Thursday's meeting:

Information on Ordinance 2019-03 and Proposed Ordinances

Ordinance 2019-03 was enacted by the fire district November 2019, and effective January 2020.

Its purpose was to ensure anyone calling 911 for an emergency receives help as soon as possible. Whether that is a professional medical and health care facility or a citizen alone at home, on the ranch, on the highway, or in the forest with a medical or fire emergency.

Over 34 years ago, the citizens of the La Pine – Sunriver area realized that medical care was a long way off, limited, and/or difficult to access. They came to a common-sense conclusion that to save lives meant getting highly skilled and equipped paramedics on scene to stabilize critically ill and/or injured patients. This innovatively created Oregon’s first rural fire paramedic program, which has done just as intended – saved many, many lives.

However, at the same time, the community voted that the fire paramedic emergency ALS (Advanced Life Support) transport service is to be a fee-based service and not taxpayer supported. In addition, due to Oregon tax limitation laws the district is under a tax cap – so raising taxes is not an option for the district.

In December 2020, and after a year in practice, the fire district board elected to do an annual review of the new Ordinance 2019-03. Public comment was also invited. Those public comments are linked here: CLICK HERE TO VIEW

After careful review of the past year’s experiences and in consideration of each public comment received, the board is considering two new ordinances to best serve all the citizens of this community and ensure your fire paramedic program can continue to provide all that is requested of it. They will be on the March and April regular board meeting agendas.

Business / La Pine / News / Top Stories
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Max Goldwasser

Max Goldwasser is a reporter and producer for NewsChannel 21. Learn more about Max here.



  1. St charles has been in the press repeatedly for overbilling and withholding salaries recently, while admitting none of it… their failed streak of lies masquerading as negotiation ploys is getting long and wooly

    1. Then tell me why we here in La Pine we are seeing a giant increase of Bend residents moving here because they couldn’t take living in Bend anymore ? We here in La Pine have a lot more class than you in Bend ….your comment proved that.

  2. you do not send possible stroke or heart attack patients by car. It makes no sense to ask the hospital to pay the ambulance bill, it is a service for the patient

  3. So, help me out St Charles Healthcare Systems. You open a Clinic in Lapine to serve the citizens of the Lapine area. You then decide that a transport from your clinic to SCMC Bend is needed. So you call 911, LPRFD responds. And you expect them to transport the person free? What kind of business decision is that? Ambulance revenue is critical for fire and EMS agencies. In addition, every time they send a crew out to you, there is one less crew available to serve the South County. So, you are going to close the clinic, just like you did the New Family Unit at SCMC Redmond, making all of the North County residents fume. Thinks the CEO and upper Management need to take a salary cut. Pay the bills you owe Lapine Fire and work it out. We so, need another hospital in Central Oregon. This monopoly is off the charts.

  4. I read the letters linked in the article. It seems that the Fire Chief in La Pine is making the decision on whether or not an ambulance transport is appropriate. Yet the Fire Chief has no medical training. Why is he able to enable to over-ride the request of a doctor or medical professional???? That’s crazy. Untrained people making inappropriate decisions impact’s a patient’s health. A bad call by the fire department could also result in a huge lawsuit against the City of La Pine.

    When medical transport services are provided, the typical practice is to bill the patient (insurance). That’s what insurance is for. As the ordinance stands, La Pine Fire is choosing to bill a hospital. I’ve never heard of such a thing.

    If you are injured in a wreck, and the cops request an ambulance, do the cops get the bill. No!
    If your car needs a tow truck, and a wrecker gets called, who gets the bill? You do.
    The practice of billing a medical facility for services provided to a patient is nonsense.

      1. Its just stupid to claim a fire chief doesnt have medical training, of course they do… in fact they have ton more experience transporting medical calls than st charles does- its funny this exact thing happened with mt bachelor calls for Bend Fire and they ended up bonding out a new fire station and a bunch of rigs, i can understand why the less land-rover dense south county doesnt want that to be the solution
        Honestly sounds like st charles could be transporting their own patients in their own vehicles but doesnt want the legal exposure- but also doesnt want to pay for it done right, as usual

    1. You are correct PJ. This is an insurance issue. However, knowing Lapine, unless they are on medicare or OHP, they are probably uninsured. Hence Lapine Fire doesn’t want to eat the bill so they bill the provider probably on the justification that they are transporting the patient between two St Charles facilities at St Charles request.

  5. Mississippi – No, have you seen the tents in YOUR beautiful city? The garbage too – Ask the cops what they think of the crime rate in Bend.
    Now, about the transportation service – It does seem funny to me – What does Sisters do? What does S/R do? Does Bend have an ambulance service? If I use the service, I should pay the bill, not spread it out to everyone in the county via taxes. WE, yes I live in La Pine, should be happy just to have the service and a free ride to Bend doesn’t seem right.

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