I read Dick Conoboy’s recent article, “Medicare Privatization Continues Apace in Whatcom County” with great interest. I believe he is touching the edge of a much larger public-interest story, not just with PeaceHealth or Whatcom County. Although, what is happening here appears to be part of a much broader problem throughout America’s hospitals and clinics.

A National Problem on a Local Scale

PeaceHealth and Whatcom County are important local examples, but the real story is larger: patients across the country are facing delayed care, blocked access, call-center barriers, bed shortages, Medicare-related cost-control systems, ACO incentives, and corporate healthcare structures that can quietly determine who receives care and who is left waiting. This is not a Republican or Democratic issue. It is a public safety issue, but the public is not aware of the danger.

For starters, we need to understand what “lack of hospital transparency” really means. It is not just missing or incomprehensible paperwork. It means the public does not know how the system works: who gets access to hospital treatment, who is sent home, who is transferred, who is quietly triaged out of the hospital system, or who may be left without the care they need to survive.

The public does not know that American patients are affected when hospitals, clinics, Medicare systems, ACOs, call centers, and cost-control structures increasingly shape access to care - especially in small-town and rural communities.

Let’s look at our local hospital system, PeaceHealth as an example. But remember, PeaceHealth is one example, this concern reaches far beyond our one hospital system.

PeaceHealth: the Tip of the Iceberg

PeaceHealth St. Joseph is described as the sole community hospital for Whatcom County. Their public fact sheet says St. Joseph Medical Center had 72,223 emergency department visits from July 2024 through June 2025. That is about 198 ER visits every day. The same fact sheet lists only 255 licensed hospital beds and an average daily census of 190, as well as 15,944 inpatient discharges. This means nearly 16,000 inpatient hospital stays ended during that year. This number does not represent beds; it shows patient volume. The public concern is whether a hospital serving a large regional population has enough available inpatient beds for patients who need hospital-level care when they need it.

PeaceHealth is one hospital with a few hundred beds and almost 200 ER visits a day. The county population is more than 234,000 people, and the pressure on those beds does not stop at the Bellingham city limits or even the county line. Let’s look at some numbers.

Whatcom County has about 235,000 people, Skagit County has about 133,000, Island County about 87,000, and San Juan County nearly 19,000 people. That is roughly 473,000 people in just those four nearby counties. PeaceHealth also operates facilities in Alaska, including Ketchikan and Prince of Wales Island. These numbers represent real people who may need emergency care, inpatient care, specialty care, transfer care, or a hospital bed.

I am not suggesting that every patient in Alaska comes to Bellingham for a bed. I am saying the public deserves to know how PeaceHealth’s regional clinic and hospital expansion affects transfer pressure, specialty-care pressure, and hospital-bed demand across the system.

The public has been told PeaceHealth serves the community, but we have not been told their definition of “community,” nor enough about how many people may be competing for a very limited number of hospital beds. Or, more importantly, who decides what happens when there are no beds left.

“A Clear and Imminent Danger”

Let’s look at a typical scenario: A sick, elderly person comes into the emergency room. The ER doctor evaluates the patient and believes the patient should be admitted. But there is no inpatient bed available.

Now what? Does the ER doctor have the power to admit the patient? Or does the decision move to a gatekeeper: bed management, utilization review, case management, discharge planning, insurance review, ACO cost-control review, or a “community services” person?

So, what about the patient?

Are they admitted?

Held in the ER?

Transferred to Seattle?

Sent to another county?

Sent home with instructions?

Told to call their primary doctor?

Told that community services will follow up?

This is what the public does not know. And not knowing is the danger. Because a hospital bed is not just a piece of furniture. A hospital bed means access to medical treatment, nursing care, monitoring, medication, oxygen, testing, specialists, and the chance to survive. When there are more seriously ill patients than available beds, someone is deciding who receives that kind of care and who does not. If one bed is available and several people need it, that is no longer just a capacity problem. It becomes a life-and-death decision. The public has not been clearly told that “no bed available” can mean “no hospital treatment available,” no matter how sick a person may be.

When almost 200 people a day come through the PeaceHealth emergency department, the public deserves to know what happens to sick people when there is no available bed.

We deserve answers to simple questions:

How many people come into the ER each day?

How many are admitted?

How many need admission but wait because no bed is available?

How many are sent home from the ER?

How many are transferred to Seattle or another hospital?

How many are diverted before admission?

How many are referred to “community services” instead of receiving a hospital bed?

How many elderly, disabled, rural, medically complex, or nursing-home patients are affected?

How many beds are licensed on paper, and how many are actually staffed and available?

How often is St. Joseph at or near capacity?

Who has the authority to override or block an ER doctor’s medical judgment when no bed is available?

PeaceHealth’s planned hospital expansion proves the problem is real. But expansion takes years. People are living with the capacity problem now.

Public Oversight is NOT Optional

When a hospital is the sole community hospital for a large region, it should not be allowed to operate as a closed system. The public depends on that hospital in life-and-death situations. If there are not enough beds, the public has a right to know. If ER doctors cannot admit patients because capacity gatekeepers control bed access, the public has a right to know. If patients are being transferred, delayed, discharged, or sent to “community services” because there is no bed, the public has a right to know.

A hospital that serves as part of the public safety net must be accountable to the public, not only to its executives, insurers, ACO contracts, or internal corporate boards.

Which Raises Another Question

Why is the Whatcom County Council not visibly involved in hospital-capacity oversight and public healthcare safety?

If PeaceHealth St. Joseph is the sole community hospital for Whatcom County, then hospital capacity is not just a private corporate matter. It affects emergency response, ambulance transport, disaster preparedness, elder safety, rural residents, disabled people, medically complex patients, nursing-home patients, and every family that may need a hospital bed.

The County Council may not own the hospital, but it does have a responsibility to public health, emergency preparedness, and community safety. The public deserves to know whether county leaders are asking for regular public reports on hospital capacity, ER boarding, transfer delays, staffing shortages, bed availability, discharge pressure, and transfer outcomes.

If they are asking those questions, where are the public reports? If they are not asking those questions, why not? Are our local leaders awake to this issue, or has the public been left sleeping while the hospital-bed crisis grows behind closed doors?

When you or someone you love goes to the ER, the question may not be only, “How sick are you?” It may also be, “Is there a bed, and who controls access to it?” Which is why hospital transparency is a public safety issue.

Corporate Healthcare

This issue is about public safety, human dignity, and whether communities still have a voice in decisions that affect life, death, and care. There are consequences for blindly trusting a healthcare corporation that has become too large and too powerful to question.

When most doctors in a community are employed by hospitals, insurance companies, or corporate-owned medical groups, patients have a right to question who is truly free to advocate for them. When doctors are limited by corporate policies, cost-control systems, bed shortages, call centers, and financial pressure, then patients may be left without the independent medical advocate they believe they still have.

People across this country are being harmed by a system they cannot see, question, or understand. Before any more of our humanity is lost behind closed corporate doors, people must demand answers about this broken system.

My greatest hope is that this local example will reach a journalist or investigator who is willing to examine this same tragic situation repeating, again and again, on a national scale across this country.