Eight years ago, Erik Thorsen — CEO of Columbia Memorial Hospital in Astoria, Ore. — received a warning that no hospital administrator wants to hear: A big earthquake could cause his hospital's building to collapse. His staff and his patients could die in a matter of moments.
"They basically said, 'None of you are prepared for a major natural disaster from the Cascadia subduction zone,'" recalls Thorsen.
The Cascadia subduction zone is an earthquake-prone region that stretches about 700 miles from California to British Columbia. Thorsen's hospital sits right along it — which is why a team of experts and engineers from the state had come to talk to him and other leaders from coastal hospitals about earthquake risk.
Alarmed, Thorsen — who grew up in this area, left for college, and then returned to raise his family here — got to work fundraising and planning in order to fortify his hospital to withstand an earthquake and provide shelter during a tsunami.
A critical part of the project's $300 million budget was to come from FEMA, the Federal Emergency Management Agency. Their $14 million grant would help to build a tsunami evacuation zone in the hospital.
But in April, the Trump administration canceled the grant program that awarded the funding, called Building Resilient Infrastructure and Communities (BRIC) program. A report from the Urban Institute estimates this cancellation jeopardizes over $3 billion nationally in hazard mitigation funds to protect communities from threats like floods, wildfires, tornadoes and hurricanes.
When the news reached Astoria, construction plans were already well under way.
"We did go back to the design team and say, 'What would it take to actually take these elements out?'" says Mark Kujala, a Clatsop County commissioner who worked on fundraising for the project. "And because it's so integrated into the project, that just wasn't feasible."
The hospital broke ground in September. The current plan for filling the $14 million hole left by FEMA: There is no plan.
"Unfortunately, FEMA — even prior to the shutdown, had kind of gone silent on us," says Thorsen. "And now with the shutdown … very silent on us."
No worse place to locate a hospital
Columbia Memorial Hospital was constructed in its current location in 1977, when earthquake risk was not as well understood. In addition to being constructed in a zone vulnerable to a major earthquake, the hospital sits in a low-lying plain just blocks from the waterfront, on unstable ground.
"The theory is if the earthquake happened, that ground underneath us would liquefy and the building would potentially collapse," says Thorsen. "If we happen to remain upright and a tsunami comes our way, maybe we get 20 to 30 minutes of notice to evacuate people up the hill."
That would mean moving vulnerable patients — in some cases, critically ill patients — out of their environment and into another, in the middle of a disaster zone, in a matter of minutes. Other earthquake-prone places like Japan have already built such structures to avoid this scenario by moving to higher ground within their buildings. But Oregon is late to the game, some experts say.
" We're sitting here on — you know the overused phrase — [a] ticking time bomb," says Chris Goldfinger, who studies paleoseismology at Oregon State University.
A magnitude 9 earthquake, says Goldfinger, is a realistic possibility in the Cascadia subduction zone.
"Those happen on average just under [once every] 500 years," says Goldfinger. "We're 325 years since the last one."
At least 25,000 people could die in this scenario, according to some estimates.
There are only three hospitals in Oregon in this region.
"Honestly, with this project, we could be the only hospital that could survive and serve the residents — for about 60,000 people," says Thorsen. "It's a big responsibility."
Currently the hospital is a sprawling, one-story building, and modeling has predicted that several feet of water could flood the hospital's ground floor during a tsunami. When it is complete, the new hospital will be dramatically taller, growing from one story to four (plus a fifth level for a helipad). The idea behind the vertical evacuation zone is that once the earthquake has stopped and the new building is still standing, people can congregate in the top several floors, built especially to be able to withstand a tsunami.
In order to help mitigate that potential disaster, engineers designed a plan to anchor the hospital to bedrock 65 feet deep. "The building is 97 feet and the helipad sits on the roof," says Thorsen, gesturing to the hospital and describing its new design. A 100-foot drill — basically an enormous version of the kind of drill bit one might find in a household toolbox — is already making deep holes to secure the piles.
Although the Pacific Northwest is beginning to build these kinds of structures, Goldfinger says, they're hard to finance without federal support. "The federal government is really the only entity that's large enough to deal with this as a national-level problem," he says. "It's just well beyond anything that the states could do alone."
"It is just incredibly frustrating"
Though Thorsen and his staff say they were given some indication that existing BRIC grants would still be distributed, they've yet to see any money.
The BRIC program was established under the first Trump administration in order to fortify communities against natural disasters. After it was canceled, a lawsuit challenged the program's termination and a federal judge issued an injunction.
"It is just incredibly frustrating," says Democratic Congresswoman Suzanne Bonamici, who represents the area. Bonamici says she and her staff have been pleading with anyone who will listen to help access the money.
" I lost count of how many calls I have made, trying to get somebody from FEMA on the phone," says Bonamici.
FEMA did not respond to a request for comment on this story.
Plans for a new hospital, says Bonamici, provided her peace of mind about a potential catastrophe in her district. Some predictions forecast a magnitude 9 earthquake here could be the worst natural disaster the U.S. has ever seen.
"It is going to be a safe place not just for patients or employees in the hospital, but for the community, " says Bonamici. "They can't outrun a tsunami. "
In addition to saving lives, she says, the project will save property and money. "It is really critical that — now that they're underway with construction — this funding comes through."
Waste, fraud, and abuse hits different at a local level
When Trump officials started talking about cutting "waste, fraud and abuse," Willis Van Dusen was enthusiastic. A registered Republican, Van Dusen was mayor of Astoria for more than two decades. Eliminating waste, he says, is what he and fellow Republicans wanted.
"This is what Trump ran on," he says.
But when Trump's "waste, fraud and abuse" campaign came to his town, Van Dusen says he felt differently. "What is more important than a hospital in a rural community like Astoria?" he asks.
Astoria has a history as a fishing and logging town, but more recently it's given way to big-city retirees and craft breweries. It's a rare, politically moderate area — a place, says Van Dusen, where neighborhoods are socioeconomically mixed and people are typically more concerned with questions of practical issues like trash collection than identity politics.
Few issues are more practical than having a trusted hospital nearby, says Van Dusen. When he had a heart attack some years ago, it was doctors at Columbia Memorial who brought him back. "I had actually died," he says, pointing to a framed EKG reading he keeps in his office.
Making sure that this hospital can keep providing care during an earthquake and tsunami, he says, is the opposite of waste, fraud and abuse.
"Just to jerk that money away from us," he says, "it makes me livid."
Van Dusen says he's not the only one in this town who's mad, regardless of political party. "Every single Republican that I have talked to is livid over what's happening," he adds.
Hospital CEO Erik Thorsen says they are not giving up — even without the federal money. Construction continues. They've been thinking through other ways to finance it.
Thorsen feels a responsibility for protecting this community where he has spent most of his life. "We have this obligation to make sure that our patients and our residents and citizens are safe," he says.
Without the federal government, though, the path ahead is unclear.
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