Kayley Mendenhall / The Bulletin

The tiniest babies, those born more than two months premature, will have to be delivered at medical centers outside of Bend starting in November.

The neonatal intensive care unit at St. Charles Medical Center-Bend has been taking care of premature babies with all levels of complications for years. But the center is about to be downgraded because its medical director is leaving and no new neonatologist is available yet to take his place.

Dr. Allen Merritt, who came to Bend 10 years ago and has built the St. Charles-Bend program to the highest level of neonatal intensive care, announced his resignation as medical director of the program. He has accepted a professorship at Loma Linda University in California, he said, and will also leave his practice at Central Oregon Pediatric Associates in the winter.

Because of contractual obligations, Merritt said, he could not immediately comment on his reasons for leaving. But parents of his former patients said he will be missed.

”He is one of the premier neonatologists in the country,” said Dr. Michael Yarbrough, a retired obstetrician-gynecologist whose triplets were treated by Merritt in winter 2005. ”This is going to be a huge loss for us. It is going to be hard to replace somebody who is as good as he is and as dedicated as he is.”

When Merritt leaves, St. Charles-Bend's Neonatal Intensive Care Unit will have to drop from a Level IIIb facility to a Level IIb facility, said Dr. Kathryn Beattie, vice president of medical affairs for Cascade Healthcare Community, parent company of St. Charles in Bend and Redmond. Levels of care are set through guidelines from the American Academy of Pediatrics.

The difference in levels means the hospital will be able to deliver babies who are two months premature - or at 32 weeks of gestation - but not those who arrive earlier. Instead, mothers in danger of delivering before 32 weeks will be sent to Sacred Heart Medical Center in Eugene or Doernbecher Children's Hospital in Portland, Beattie said.

The hospital already sends some high-risk patients to Eugene or Portland, Beattie explained, if they need specialized care, such as pediatric heart surgery, which is not offered in Bend. In emergencies, moms who come to the hospital already in labor deliver there, and the babies are stabilized before being sent to a different facility.

”There will probably be 15 (percent) to 20 percent (of patients) that we might have to transfer to a higher level of care,” Beattie said. ”That decision is always made in the interest of patient care.”

Yarbrough's daughter, Amanda, and two sons, Lance and Brian, were born at 29 weeks and two days, he said. Brian needed heart surgery and was flown to Portland for the procedure. But without Merritt and his team, Yarbrough and his wife, Julie, believe they wouldn't have three healthy children today.

”Lance was critically ill. We didn't know if he was going to make it through the night. I got up there at 2:30 in the morning and Dr. Merritt and Dr. Natarajan were sitting by his bedside,” Yarbrough said. ”That shows how dedicated he is.”

Dr. Girija Natarajan worked as a neonatologist at St. Charles-Bend and for Bend Memorial Clinic for about eight months. She left in June, Beattie said, for personal reasons.

At that time, the hospital began recruiting for a new neonatologist to fill her position. Beattie said one neonatologist has accepted a position with the hospital, but because of the time it takes to secure licensing and to navigate logistics, she said it may be up to six months until that physician is able to practice here. A neonatal nurse practitioner has also accepted a position in Bend but is currently going through state licensing as well.

Until a new neonatologist begins work in Bend, Dr. Val Bailie, a pediatrician at Central Oregon Pediatric Associates, will act as medical director of the level IIb Neonatal Intensive Care Unit, Beattie said. The hospital will also continue its efforts to recruit a second neonatologist.

”We feel to best serve our community, we need to find someone who is experienced,” Beattie said. ”We don't feel someone coming right out of training is the right solution in Bend. We are a fairly independent unit. We are looking for people who have already ran other units.”

Merritt moved to Bend a decade ago from his positions as professor and medical director of the Neonatal Intensive Care Unit at the University of California, Davis school of medicine. Along with running the St. Charles-Bend Neonatal Intensive Care Unit, during his time in Oregon, Merritt has taught at Oregon Health & Science University in Portland and has served on the Oregon Commission on Children and Families.

In 2003, he was named the state's Doctor-Citizen of the Year by the Oregon Medical Association, The Bulletin reported at the time.

”Our organization is very fortunate to have had Dr. Merritt over the past 10 years,” Beattie said. ”When he came here, the number of deliveries was significantly smaller than it is now. To have had a neonatologist through that growth phase has been phenomenal.”

The Neonatal Intensive Care Unit treated 306 babies in 2005 and monitors an average of nine or 10 premature infants a day, Beattie said. Cascade Healthcare is continuing with construction to expand its Family Birthing Center in Bend, including an expansion of the Neonatal Intensive Care Unit. That $12 million project is expected to be completed by 2008.