Win Gruening: A strong, independent community hospital is important to Juneau



Juneau’s city-owned Bartlett Regional Hospital is in the news, presenting the community with yet another challenging situation.

According to hospital officials, over the last five years, competitive pressures and inflationary increases have contributed to a deterioration in financial performance. Additionally, the pandemic accelerated the movement of medical treatments to out-patient facilities, which insurers reimburse at much lower rates.

BRH is losing about $1 million per month and without trimming costs or finding other revenue sources, the hospital will run out of cash and could be forced to close within three years.

While it’s possible that the hospital could be sold, it’s doubtful it would survive in the same configuration or offer the same services as it does now.

And therein lies the conundrum facing city leaders.

Selling the hospital or curtailing non-core programs and services will resolve the immediate financial challenges now but present less quantifiable social service challenges in the future.

Community outreach events on June 4 and June 10 generated significant public testimony about Bartlett programs and services being considered for elimination or reduced service. Those programs include hospice and home health services; Rainforest Recovery Center (a 16-bed residential and outpatient treatment program); Bartlett Outpatient Psychiatric Services; Crisis Observation Services Crisis Residential and Stabilization Services for Adults and Adolescents; and the Aurora Behavioral Health Center (serving autism patients).

While these services are deemed non-core programs, all received passionate support as high-need services without suitable local alternatives. Annual losses attributed to each program ranged from $813,000 for hospice and home care to almost $4 million for Rainforest Recovery Center. 

The increasing competition from Southeast Alaska Health Consortium is also a factor. Originally funded by the Indian Health Service and intended to provide medical care to the Native community, SEARHC has aggressively expanded its facilities throughout the region. With over 1,200 employees, they now serve 27 communities throughout Southeast Alaska including Juneau. In Sitka and Wrangell, SEARHC operates both local hospitals after financial pressures compelled city governments to cede control. 

SEARHC now offers pharmacy services, dental care, primary care, specialty care, imaging, and laboratory services to all Southeast residents, not just Native patients. Their urgent care clinic in Juneau competes directly with BRH’s emergency room. SEARHC’s newly expanded facilities in Juneau may soon compete with the hospital’s short-stay surgery center – one of Bartlett’s largest revenue producers.

Some testifiers noted that SEARHC does not compete with other medical providers on a level playing field. Indian Health Service funding amounted to about $85 million last year, which SEARHC received through the Alaska Tribal Health Compact to treat Native clients. However, SEARHC also billed over $100 million to Medicaid and Medicare for many of those patients, effectively “double-dipping” to add to their profit margin. 

BRH statistics reflect that 50% of Rainforest Recovery Center patients are SEARHC beneficiaries but the hospital receives no reimbursements from SEARHC for their care. SEARHC can choose to “cherry-pick” more lucrative medical services to offer while deciding to avoid the financial drag of services that may be money-losers.

SEARHC’s 15-person board includes representatives from all over the region. Neither SEARHC’s board meetings nor its records are open to the public except for limited financial disclosures.

In contrast, Bartlett Regional Hospital is a public entity with full transparency in all its operations. Bartlett board members, appointed by the City and Borough of Juneau Assembly, are from Juneau and must be responsive directly to citizens. BRH is therefore more likely to address Juneau’s health concerns and challenges and tailor its services to meet the specific needs of the local population it serves.

There’s no guarantee that any Bartlett Regional Hospital medical service now being provided will be offered if the hospital is sold to SEARHC or any other outside entity. Only the citizens of Juneau and their elected leaders can ensure that these services are provided and funded.

This is just one of several challenges facing the community. The fate of Juneau’s hospital should be a top priority for the current Assembly, and any new members elected on October 1.

After retiring as the senior vice president in charge of business banking for Key Bank in Alaska, Win Gruening became a regular opinion page columnist for the Juneau Empire. He was born and raised in Juneau and graduated from the U.S. Air Force Academy in 1970. He is involved in various local and statewide organizations.


  1. SEARHC is playing a fast game. One they appear to be winning.

    There is a sad truth here. Bartlett offers some niche services which are money losers. Always will be. If Bartlett is to survive long term, it must make some very hard choices. We simply do not have the economic resources to support Bartlett as it exists now.

    We live in a contracting community which is overburdened by a socialist government which can’t say out of our pockets. Maybe if our faux junta wasn’t funding a new JACC, wanting a Taj Mahal for new offices, and so many other things we might be able to do this.

    But the faux junta wants it all. Regardless of our inability to fund it.

  2. At the same time, our population isn’t exempt from blame. We “want”
    our public funded drag shows, fewer ships, a school on every corner, no cuts in city services, and to do nothing which makes us a better place to raise a family.

    And we didn’t want mean tweets so we voted for a senile, corrupt man who took us to the highest interest rates in 40 years.

    Simple fact is, CBJ has maxed out its credit card.

  3. Good job of reporting relevant facts Win; many of which are quite troubling. For example, SEARHC’s “double-dipping” makes either the dispersing federal bureaucracies look very incompetent or the laws governing them to be in need of revision. As to the fact native benefit organizations do not reimburse Bartlett services seems a disgraceful betrayal of their purpose; loopholes and technicalities aside.

    In the big picture, Juneau taxpayers must prioritize… as our local economy continues withering. We must choose between keeping public libraries or an emergency room open. Or between keeping public swimming pools or a substance rehab open. Or between keeping a Parks & Rec Department or a Mental Health unit open. On and on. The problems Win has described will only get worse if unaddressed.

  4. Wasn’t Bartlett Regional Hospital the place where mental health patients were sent when Anchorage facilities couldn’t take the patients? Oh, that is right, we don’t hospitalize mental health patients anymore. I forgot.

    • In Juneau we’d probably put them through a drag show, demand they list their top 35 pronouns, and ask them if they want to vote for Grandpa Bloodstains now or later.

    • Anchorage sends them to the Loussac Public Library where they get to participate in fun activities like edged-weapon assault tactics…

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