EDITOR’S NOTE: Here’s an installment from Tillamook County’s State Representative Cyrus Javadi’s Substack blog, “A Point of Personal Privilege” Oregon legislator and local dentist. Representing District 32, I focus on practical policies and community well-being. This space offers insights on state issues, reflections on leadership, and stories from the Oregon coast, fostering thoughtful dialogue. Posted on Substack, 2/12/25
By Cyrus Javadi, State Representative District 32
Let’s state the unvarnished truth right up front: dialysis is not like skipping that optional Pilates class. When your kidneys quit on you, there’s no “maybe I’ll try again next week.” We’re talking life-or-death, every other day. No one does it for fun, and no one can just “take a break.” Yet, for the past year, the Oregon Health Authority (OHA)—the entity supposedly designed to safeguard public health—has been caught in a tangle of its own red tape while patients in Tillamook endure exhausting, bank-account-draining journeys to Hillsboro simply to stay alive.
This isn’t just a healthcare mishap; it’s a glaring example of how bureaucratic red tape can undermine urgent needs. Government agencies are supposed to help us navigate crises, not add to them. But in this case, the snail’s pace of approvals has forced patients—our friends, family, neighbors—to bear the burden of exhausting, expensive commutes for treatment they cannot afford to skip.
The Tillamook Dialysis Dilemma
It all started when U.S. Renal Care pulled the plug on its Tillamook facility with barely a month’s notice. For 11 local patients—each needing dialysis multiple times a week—options were immediately scarce. Lincoln City’s clinic was at capacity. Astoria was a long haul for people who already feel wiped out after treatments. That left the Portland area, transforming a routine medical appointment into an all-day expedition.
If that were the only problem, it would be bad enough. But here on the Oregon coast, roads can be shut down by landslides, ice storms, or other unpredictable events. When severe weather hits, traveling to the valley can become impossible—never mind safe. One good winter storm, and dialysis can be out of reach for days.
Local healthcare providers, including Adventist Health Tillamook, stepped up to search for solutions. They reached out to major dialysis companies like Fresenius and DaVita, hoping to find someone to replace the closed clinic. Meanwhile, OHA’s approval process moved at a crawl, requiring a stack of applications and plenty of back-and-forth. That meant Tillamook’s only near-term option—a nonprofit provider ready to open a new facility—remained stuck in regulatory limbo.
OHA: The Agency That’s Supposed to Care
For those who might not follow Oregon’s government structure, the Oregon Health Authority is the state’s central hub for public health and healthcare oversight. With a biennial budget of around $27 billion and more than 4,000 employees, the agency is built to tackle everything from Medicaid programs to licensing healthcare facilities. In principle, that means ensuring care is accessible to all Oregonians, urban or rural.
But there’s a difference between having resources on paper and using them effectively in practice. Too often, OHA has been slow to act, particularly when time is of the essence. The bottlenecks and layers of review might have some merit in certain contexts—quality control and safety are important—but in life-and-death cases like dialysis, there has to be a faster track. The Tillamook situation is a painful reminder that bureaucracy can sometimes overshadow common sense, even when urgent healthcare solutions are desperately needed.
No one expects OHA to work magic overnight, but when it takes more than a year to even come close to approving a new clinic, you start to wonder if the regulatory safeguards are overshadowing the mission. After all, if the essential goal is to protect lives, shouldn’t an emergency like the Tillamook dialysis shortage get expedited, not bogged down?
A Year of Waiting
The biggest frustration? We’re well over a year into this saga, and there’s still no firm date for when Tillamook will have its own dialysis clinic again. Each additional delay forces patients to endure draining round-trip journeys to keep themselves alive. Many of these individuals have limited financial and emotional reserves as it is; piling on travel expenses and stress only makes matters worse. And it’s not as if a formal timeline has been laid out—no one seems able to say exactly when the red tape will be cut.
While local advocates write letters, gather petitions, and plead for action, the approval process remains murky. It’s easy to see how people would grow cynical. When the agency tasked with safeguarding public health can’t or won’t move swiftly in an emergency, skepticism is bound to follow.
This doesn’t have to be the norm. OHA, in theory, is well-positioned to respond decisively to crises, especially in rural communities where healthcare options can be scarce. The current slow-motion approach isn’t just inconveniencing patients—it’s actively risking their health. If oversight is meant to protect people, that protection should never devolve into endless waiting.
Walking the Tightrope Between Care and Chaos
Let’s be clear: A certain level of oversight is valid—nobody wants a medical clinic running on corner-cutting approvals. But there’s a balance between diligence and overkill. When the clock is ticking for patients who can’t afford to miss even a single treatment, that balance needs to favor urgent, well-structured solutions.
This impasse also highlights a broader concern about how rural healthcare is handled. Small communities like Tillamook are vulnerable to service closures precisely because they don’t have a lot of backup options. If one company decides to leave, patients can face a life-or-death crisis overnight. And if the state agency in charge can’t respond in a timely way, the crisis just drags on.
We can hope that OHA is taking lessons from this and examining how to streamline emergency approvals. Admittedly, balancing thorough reviews with quick action isn’t a trivial task. But if a year of delayed dialysis services doesn’t move the needle, it’s hard to imagine what will.
Time to Hold OHA’s Feet to the Fire
At the end of the day, this isn’t about bashing one agency for the sake of it—there are undoubtedly dedicated people at OHA trying to do the right thing. It’s about recognizing that bureaucratic inertia can have real and dangerous consequences, especially for medically fragile individuals. Tillamook’s dialysis patients deserve better than endless administrative hurdles.
Whether you lean left, right, or somewhere in between, it’s fair to expect our public health authority to make essential services a top priority. This is, after all, a literal matter of life and death. Dialysis isn’t a luxury. It can’t be postponed. And when geography and severe weather already compound the difficulty, every delay in opening a local clinic makes an already precarious situation worse.
So here’s the simple ask: OHA needs to step up, break through the logjam of regulations, and communicate clear, achievable timelines. A year of waiting and uncertainty is simply too long for patients who need dialysis to stay alive. We should all keep pushing for clarity and action—because if our system can’t handle this urgent need promptly, what faith can any of us have in its ability to address future crises?
And that’s really the crux of it. Government exists to ensure basic services are there when people need them. When that process gets stuck, it’s up to the rest of us—neighbors, lawmakers, journalists—to demand accountability. Let’s hope OHA can turn this around and show that, yes, it’s capable of serving Oregonians as intended. Tillamook’s patients can’t afford another year stuck in limbo, and neither can we.
