Rebuilding homes this spring in a Paradise neighborhood leveled by the 2018 Camp Fire. Felicity Barringer
Sharon LeRossignol’s husband, Thomas, had already been in deteriorating health when he contracted coronavirus in the pandemic’s first year. When he had his first heart attack a decade ago, his trip to the nearby hospital in Paradise, California, took ten minutes, although he then had to make a second trip to a larger facility for heart surgery.
But the 2021 hospital trip to try to save his lungs and his life didn’t take 10 minutes, it took 45. Why? The hospital they had been closest to, physically and emotionally, was gone.
In the months after the devastating 2018 Camp Fire, the LeRossignols, who had decamped to Chico, were among a smattering of residents who had returned to Paradise. The community where they had spent a lifetime, damaged and largely deserted as it was, was still home. “He didn’t want to die in Chico,” Sharon LeRossignol said.
In the end, he did. Paradise’s only hospital, Adventist Health Feather River, closed down after it was damaged in the fire, so the ambulance took Thomas LeRossignol to the Enloe Medical Center in Chico for coronavirus treatment. He died there nine days later, at the age of 76.
A different sort of tragedy lingers
California’s most devastating fire meant a massive loss of lives and homes and, for Paradise residents, the end of any sense of security from natural disaster. Closure of the Feather River hospital meant a different kind of loss: of the kind of security provided by proximity to emergency care and medical specialists. The continued presence of a well-appointed clinic and a variety of medical providers does not fill the gap. The Paradise area has become one of 68 hospital deserts in the state; there are hundreds more around the West.
With all the focus on everything else Paradise has lost — 86 victims of the fire, more than 11,000 houses burned to the ground, including the LeRossignol home — the loss of the hospital seems more an afterthought. But becoming a hospital desert is its own, different sort of tragedy that lingers, even as the town’s rebuilding proceeds.
What happened after the Camp Fire
Paradise is a small town situated on top of a ridge where the ground of eastern Butte County in northern California rises to become part of the Sierra Nevada and its forests. Freshly painted homes line the streets, and neon orange construction signs sit on every corner. On the hills, you can still see the charred trees from the wildfire that leveled the town.
The Camp Fire of 2018 was California’s deadliest and most destructive wildfire, killing 86 people and causing more than $16 billion in damages. Ninety-five percent of Paradise was destroyed; smoke and water damage rendered the unburnt homes uninhabitable.
Without running water or electricity, no one could live in Paradise for nearly eight months, and residents like the LeRossignols had to find somewhere else to go: some lived with family in nearby Chico, while others never returned. The town’s population has dwindled from 25,000 to less than 8,000.
A portion of Paradise’s hospital Adventist Health Feather River was damaged in the fire. A few years ago, residents held out hope that the hospital may return once the fire-damaged sections were replaced. But lacking a staff to operate the facility and a sizable population to care for, the Sacramento-area-based Adventist Health has no intention to reopen.
“As part of the Camp Fire in 2018, Adventist Health Feather River experienced considerable structural and physical plant damage, rendering it inoperable and ultimately leading to its closure in Nov. 2018,” Adventist Health spokesperson Japhet De Oliveira wrote in a statement.
He went on, “as the community and world has changed dramatically since 2018, our approach to care delivery prior to the fire has been realigned and further realigned after COVID-19, which ultimately has led to our decision not to rebuild the hospital.”
A loss of security and a loss of jobs
The loss of the town’s only hospital had another impact: the loss of a major employer.
Feather River hospital employed close to 1,300 people, a sizable number for the town’s small population. Brandon Mortimer, 40, used to work at the hospital part-time as a respiratory therapist and now has pivoted to civil engineering. “Paradise has never been a wealthy community, but [working for the hospital] was one of the best jobs you could have,” he said.
Trish Fulton, a nurse who used to work at Feather River before it closed, says that Adventist Health was “gracious” after the fire. The hospital looked at their employees’ wages for the month prior to the fire and continued to pay them at that level for the three months following the hospital closure.
Adventist Health offered to move some people’s employment to one of their other facilities, both in Butte County and across the country. Some accepted; other employees decided to seek employment elsewhere.
The hospital’s bonds to the community
Feather River first opened for services in 1950 to serve the communities of Paradise, Magalia and smaller neighbors; it joined Adventist Health, a faith-based nonprofit, in 1973. The 101-bed hospital boasted an emergency room, cancer center, maternity unit, outpatient surgery center, cardiology services and radiology services.
LeRossignol spoke to how tight-knit the community was and how well she knew everyone at the hospital. “They took good care of people,” she said. “I had my daughter there, she had three kids there and my granddaughter had four.”
“As nurses and physicians, we interacted with our patients outside in the community,” said Fulton. “We were very close.”
The older parts burned, but the newer ones, including the emergency room and the surgical unit, remained intact. But even the parts that didn’t burn were inoperable without water and electricity.
Fulton recalls working at the cancer center early in the morning of the fire. She and her supervisor remarked about the high winds outside and the fire in the distance. Fulton was worried, but her supervisor said that they would be told when they needed to take action. At around 8 a.m., she looked out her office window to see a fire blazing across the parking lot.
She and her colleagues evacuated all the 69 patients in their unit, who were then transported — by helicopter, ambulances and employee vehicles — to other hospitals in the area.
Nearly half of the hospital was damaged by the fire, Fulton said. The older parts burned, but the newer ones, including the emergency room and the surgical unit, remained intact. But even the parts that didn’t burn were inoperable without water and electricity.
Hopes for a reopening
In mid-May, the hospital stood shuttered, cleared out from the inside and lettering fading away from the building. Geralynne Rader, 58, a Paradise resident, now knows that it is gone for good. But some in her circle still hold out hope. “Even talking to folks today,” she said, “a lot of people don’t understand that the hospital has pulled out.”
Surrounding hospitals absorbed the influx of patients at the height of the wildfire evacuation. One of these is Enloe Medical Center, where Thomas LeRossignol died, and Oroville Hospital, a general hospital located south of Paradise. Most Americans live less than 10 miles from the nearest hospital, but these hospitals are 18 miles and 21 miles from Paradise.
Paradise currently has a medical facility run by Adventist Health that offers primary care services. There’s a clinic offering vision and dental services, another offering physical therapy. There are resources for general practitioners, not for specialists.
For a short time, the emergency room in the hospital building in Paradise was reopened by some staff who wanted to return and operate it as a standalone emergency room. It didn’t stay open for long.
What distance from medical care means
In the immediate aftermath of the fire, evacuated residents were likely closer to one of the other facilities. But as residents tried to move back eight months later, the lack of healthcare access posed serious concerns.
Fulton, the nurse, noted that when she had a gastrointestinal issue with active bleeding, her doctors at Enloe told her to stay in Chico because, in the event of an emergency, an ambulance would be too slow.“The doctor said, ‘If you start to bleed, you will not make it to the hospital in time,’” Fulton recalled.
For a short time, the emergency room in the hospital building in Paradise was reopened by some staff who wanted to return and operate it as a standalone emergency room. It didn’t stay open for long; without the capacity to admit patients into a nearby hospital, a standalone emergency room wasn’t feasible.
Patients also find it hard to keep up with the high turnover of health-care providers, according to Director of Butte County Behavioral Health Scott Kennelly. If a doctor or nurse has moved to a different location, Kennelly said, it said it disrupts the trust already established. “They don’t want to rebuild a relationship with a trusted provider who no longer works for them and has left the area.”
LeRossignol has switched her provider multiple times over the last few years because many of them keep leaving Paradise. But in addition to becoming acquainted with a new provider, she said, she also has to pay a new patient fee.
The strain on neighboring healthcare providers
Without Feather River, the responsibility of caring for thousands of people has fallen on the shoulders of neighboring healthcare facilities.
“Enloe Medical Center spent over $5.3 million, without any external funding or help, to keep up with the overwhelming need and continue caring for patients,” Enloe spokesperson Suzie Lawry Hill wrote in a statement. The ramifications of such strain is seen in the reduced availability of health care providers, increased wait times at specialty clinics, longer hospital stays due to a lack of post-acute care facilities.
Ambulance costs have also skyrocketed, as the transport time from Paradise to the nearest emergency room has jumped from 5 or 10 minutes to 30 minutes. When Mortimer’s mother-in-law had to be transported to Enloe by ambulance, they were looking at a bill upwards of seven thousand dollars, Mortimer said.
Without a hospital to rely on, LeRossignol said most of her family living in Paradise never moved back. Of the 45 family members she had in town, only six returned once the town was inhabitable again. Without a hospital, “the community pretty much falls apart,” she said. Every time she needs medical help, she has to make the drive to Chico.
Geralynne Rader, who lives in an assisted care facility in Paradise, worries that an ambulance wouldn’t get her to the hospital in time in case of a stroke, heart attack or fall.
Though Brandon Mortimer, the respiratory therapist, isn’t too concerned about the lack of a hospital — he is 40 — he said his parents never returned after the fire for this reason. “A hospital for a community, it’s a sense of security,” he said. “[The lack of a hospital] undermines your confidence in your ability to live somewhere.”
In a changed town, changes in healthcare needs
The town has changed: it’s newer and emptier. The only visible signs of the fire are the charred trees on the hills and empty lots along the streets where buildings used to stand. Congregations are younger and smaller, and fewer grandparents accompany the schoolchildren.
People now go to Enloe in Chico to have babies if they have insurance; otherwise they go to Adventist Health and Rideout Hospital in Marysville, which is an hour’s drive south but offers cost-effective care.
Substance abuse and addiction have risen significantly following the fire, according to Kennelly. A couple weeks following the Camp Fire, Kennelly noticed customers leaving Costco with two items: toilet paper and alcohol. As residents have struggled with their mental health since the fire, Kennelly said that the lack of a hospital and access to primary care has certainly added stress as patients had to shift to telemedicine and were unable to see their providers in person.
Who is moving back
The lack of a hospital isn’t the only thing deterring people from returning. The town is a site of immense grief for many; any smell of smoke produces a panic and triggers past trauma, said Joelle Chimmock, director of the Hope Center, which distributes free furniture to residents struggling to rebuild their homes.
“Everyone’s in one stage of trauma or another,” agreed Butte County Environmental Health Director Elaine McSpadden.
And many residents can’t afford to move back, Chimmock said. They struggle with housing, permitting and if homeowner’s insurance is available — not a given — they can’t afford the premiums. Since few homes survived the fire, most homes up for sale are newly built ones. The price per square foot has jumped since the fire, from $170 per square foot to $270, according to Movoto market trends data. Payouts from the PG&E settlement continue to be delayed.
Meanwhile, wages have remained stagnant. The cost of living has skyrocketed, affecting even those who have been able to retain their jobs since the fire. A 2022 census report showed that 15.9 percent of Paradise residents live below the poverty line. Of those seeking help from the Hope Center, 93 percent self-reported an annual salary of under $20,000.
“Disaster doesn’t discriminate, but recovery does,” Chimmock said.
Staff and Contributors
Syler Peralta-Ramos is a member of the Stanford class of 2020. He has lived in Wilson, Wyoming his whole life and developed a keen interest in nature photography and conservation from a young age, inspired by the multitude of photographers that congregate in the Teton region as well as his parents who also share a love for photography.
‘& the West’ is published by the Bill Lane Center for the American West at Stanford University, which is dedicated to research, teaching, and journalism about the past, present, and future of the North American West.
Bruce E. Cain