BREWSTER, Wash. – Three Rivers Hospital is proposing a modernization project designed to address aging infrastructure, improve patient care, and ensure the community has access to a sustainable local hospital for decades to come.
The proposed project would invest nearly $48 million in improvements to the existing Three Rivers Hospital campus. The total breaks down to about 73 cents per $1,000 of assessed property value, or $219 per year for a home valued at $300,000.
Rather than replacing the hospital with an entirely new facility, the project would preserve and maximize the hospital’s existing building while making critical upgrades to infrastructure, patient spaces and clinical areas.
The hospital expects the proposal to go before voters in the November 2026 election.
Keeping Care Local
Three Rivers Hospital has served residents of Okanogan and Douglas counties for 77 years. Today, the public-owned hospital provides emergency care, inpatient and transitional care, surgery, imaging, laboratory services, rehabilitation therapy, women’s health, orthopedics, family medicine, and other services close to home.
But much of the hospital’s infrastructure and some of its clinical spaces are aging. Electrical, plumbing, HVAC and other building systems require more investment to meet the demands of modern healthcare. Some patient and clinical areas also no longer provide the space, privacy, or workflow needed for today’s standards of care.
“Three Rivers is an essential part of our community, and we have a responsibility to make thoughtful investments that allow it to remain here for the people who depend on it,” said Chief Executive Officer Scott Graham. “This project is about protecting access to local healthcare and enhancing the patient experience so they don’t need to travel long distances.”
What Would the Project Include?
The proposed modernization would focus on improvements throughout the existing hospital and a two-story addition connecting the hospital to Three Rivers Family Medicine.
Major components would include:
- A centralized entrance for hospital and clinic services to improve access and convenience for

A rendering of what an updated patient room could look like by the end of 2029, if the modernization project bond passes in November.
patients and visitors
- A dedicated ambulance bay connected to the Emergency Room to improve patient transport
- Relocating the
- Updating inpatient rooms with private showers to improve comfort, dignity and privacy
- Expanded operating rooms to meet current technology standards and state requirements
- Expanded radiology space to accommodate modern imaging equipment and patient privacy
- Implementing the EPIC electronic medical record (EMR) system, improving communication and medical record sharing between Three Rivers and larger organizations like Confluence Health, while patients can take advantage of the MyChart patient portal
- Replacement and modernization of aging electrical, plumbing, medical gas and HVAC systems, which would be housed in a new outbuilding behind the hospital
- Accessibility and other improvements throughout the facility, such as moving the laboratory to a larger location closer to the other services
The project is intended to make better use of the hospital’s existing footprint while addressing the infrastructure and space limitations that have developed over decades of technology advancements and healthcare regulation changes.
Building on Community Input
The current proposal builds on years of community conversations and planning about the future of local healthcare. The updated proposal reflects that ongoing work and is intended to provide a responsible path for modernizing the existing hospital, rather than starting over with a completely new facility.
“We appreciate everyone who takes the time to reach out to us and make their voice heard,” said Board Chair Mike Pruett. “We want to know what our district residents and patients think. Behind the scenes, Three Rivers has been working with the other two hospitals in Okanogan County regarding what the future of health care should be and how we can work together. Those conversations are continually happening to preserve access to care in a county as large as ours.”
A Long-Term Investment
If approved, construction is currently anticipated to take approximately two years, with detailed design, permitting, bidding and other preparation taking about a year before construction begins.
Three Rivers will also continue to pursue grants, loans and other funding opportunities that could help offset the cost of the project. For example, funding from the Rural Health Transformation Program can be used to address other building needs such as the roof.
Because Three Rivers Hospital is a public hospital district, the proposed project would be financed through a voter-approved general obligation bond. The bond would be repaid over 30 years through property taxes, with the final tax rate dependent on assessed property values and other factors.
The hospital will provide additional information about the proposed project, including project details, frequently asked questions, financial information, renderings and updates, at:
threerivershospital.net/bond.
Community Information Sessions
As part of its commitment to transparency and community engagement, Three Rivers Hospital plans to meet with community organizations, civic groups, local governments, schools, emergency service organizations and other community partners throughout September and October.
Hospital leadership will offer presentations and tours to help community members understand the proposed improvements, see the current facility, and ask questions about the project.
“We want people to have the opportunity to ask questions and see for themselves why these improvements are needed,” Graham said. “Our goal is to provide clear, straightforward information so our community can make an informed decision.”
Some of the scheduled meetings and tours are posted on the hospital’s website, along with a contact form to request a meeting with the team.
About Three Rivers Hospital
Three Rivers Hospital is a public, nonprofit Critical Access Hospital serving nine communities throughout Okanogan and Douglas counties and the Methow Valley. The hospital provides 24-hour emergency care and a broad range of inpatient, outpatient, surgical, diagnostic and specialty services designed to keep quality healthcare close to home.
Three Rivers Hospital’s Statement on Immigration Enforcement
Three Rivers Proposes Modernization Project to Strengthen Local Healthcare
BREWSTER, Wash. – Three Rivers Hospital is proposing a modernization project designed to address aging infrastructure, improve patient care, and ensure the community has access to a sustainable local hospital for decades to come.
The proposed project would invest nearly $48 million in improvements to the existing Three Rivers Hospital campus. The total breaks down to about 73 cents per $1,000 of assessed property value, or $219 per year for a home valued at $300,000.
Rather than replacing the hospital with an entirely new facility, the project would preserve and maximize the hospital’s existing building while making critical upgrades to infrastructure, patient spaces and clinical areas.
The hospital expects the proposal to go before voters in the November 2026 election.
Keeping Care Local
Three Rivers Hospital has served residents of Okanogan and Douglas counties for 77 years. Today, the public-owned hospital provides emergency care, inpatient and transitional care, surgery, imaging, laboratory services, rehabilitation therapy, women’s health, orthopedics, family medicine, and other services close to home.
But much of the hospital’s infrastructure and some of its clinical spaces are aging. Electrical, plumbing, HVAC and other building systems require more investment to meet the demands of modern healthcare. Some patient and clinical areas also no longer provide the space, privacy, or workflow needed for today’s standards of care.
“Three Rivers is an essential part of our community, and we have a responsibility to make thoughtful investments that allow it to remain here for the people who depend on it,” said Chief Executive Officer Scott Graham. “This project is about protecting access to local healthcare and enhancing the patient experience so they don’t need to travel long distances.”
What Would the Project Include?
The proposed modernization would focus on improvements throughout the existing hospital and a two-story addition connecting the hospital to Three Rivers Family Medicine.
Major components would include:
A rendering of what an updated patient room could look like by the end of 2029, if the modernization project bond passes in November.
patients and visitors
The project is intended to make better use of the hospital’s existing footprint while addressing the infrastructure and space limitations that have developed over decades of technology advancements and healthcare regulation changes.
Building on Community Input
The current proposal builds on years of community conversations and planning about the future of local healthcare. The updated proposal reflects that ongoing work and is intended to provide a responsible path for modernizing the existing hospital, rather than starting over with a completely new facility.
“We appreciate everyone who takes the time to reach out to us and make their voice heard,” said Board Chair Mike Pruett. “We want to know what our district residents and patients think. Behind the scenes, Three Rivers has been working with the other two hospitals in Okanogan County regarding what the future of health care should be and how we can work together. Those conversations are continually happening to preserve access to care in a county as large as ours.”
A Long-Term Investment
If approved, construction is currently anticipated to take approximately two years, with detailed design, permitting, bidding and other preparation taking about a year before construction begins.
Three Rivers will also continue to pursue grants, loans and other funding opportunities that could help offset the cost of the project. For example, funding from the Rural Health Transformation Program can be used to address other building needs such as the roof.
Because Three Rivers Hospital is a public hospital district, the proposed project would be financed through a voter-approved general obligation bond. The bond would be repaid over 30 years through property taxes, with the final tax rate dependent on assessed property values and other factors.
The hospital will provide additional information about the proposed project, including project details, frequently asked questions, financial information, renderings and updates, at:
threerivershospital.net/bond.
Community Information Sessions
As part of its commitment to transparency and community engagement, Three Rivers Hospital plans to meet with community organizations, civic groups, local governments, schools, emergency service organizations and other community partners throughout September and October.
Hospital leadership will offer presentations and tours to help community members understand the proposed improvements, see the current facility, and ask questions about the project.
“We want people to have the opportunity to ask questions and see for themselves why these improvements are needed,” Graham said. “Our goal is to provide clear, straightforward information so our community can make an informed decision.”
Some of the scheduled meetings and tours are posted on the hospital’s website, along with a contact form to request a meeting with the team.
About Three Rivers Hospital
Three Rivers Hospital is a public, nonprofit Critical Access Hospital serving nine communities throughout Okanogan and Douglas counties and the Methow Valley. The hospital provides 24-hour emergency care and a broad range of inpatient, outpatient, surgical, diagnostic and specialty services designed to keep quality healthcare close to home.
Levy renewal request on Aug. 4 ballot
BREWSTER, Wash. — Three Rivers Hospital is asking residents of Okanogan Douglas County Public Hospital District No. 1 to renew its one-year Emergency Room levy in the Aug. 4 primary election.
The measure would authorize collection of about $1.46 million in 2027 at a rate of 33 cents per $1,000 of assessed property value – the same rate voters have approved annually since 2020.
The levy is classified as an “excess levy,” meaning it must be renewed by voters each year and requires 60% approval to pass.
What the levy funds
Unlike the hospital’s permanent regular levy, which supports general operations, the excess levy is dedicated to keeping the Emergency Room open and staffed around the clock. District residents have expressed a strong preference for physician coverage in the ER, and this levy is the primary mechanism for funding that commitment.
“The community has shown up for this levy every year since 2020, and we’re grateful for that consistent support,” said Chief Executive Officer J. Scott Graham. “That trust is something we take seriously. This renewal allows us to continue the level of emergency care our patients and families have come to rely on.”
“I am proud to help Three Rivers Hospital make a difference in my neighbors’ lives every day,” said ER Director Joshua Corsa, M.D. “This levy helps our team provide high-quality, modern, life-saving care close to home, where it can be most effective.”
For a home assessed at $300,000, the estimated annual cost is approximately $99. Property owners can use a tax estimate calculator at threerivershospital.net/levy.
About the ballot measure
The Board of Commissioners approved Resolution 2026-04 on April 26, 2026, placing the measure on the August 4, 2026 General Election ballot. The levy would be collected in 2027 only.
“I see firsthand the critical role our emergency department plays in caring for our community,” said Christine Smith, RN, Chief Nursing Officer. “This levy helps sustain staffing, equipment and resources needed to provide timely, high-quality care. Consistent community support has had a direct impact on maintaining reliable access to emergency services.”
About Three Rivers Hospital
Three Rivers Hospital is a Critical Access Hospital located at 507 Hospital Way in Brewster, WA, serving residents of south Okanogan County, north Douglas County, and the Methow Valley. The hospital district is among the largest geographically in Washington state, covering approximately 2,500 square miles.
For more information about the levy, visit threerivershospital.net/levy.
Learning together: Three Rivers at this year’s rural health conference
Last week, CEO Scott Graham represented Three Rivers Hospital on a panel titled “Hospital Financial Stress: What Should Boards Pay Attention To?” at the WSHA & AWPHD Rural
Three Rivers CEO Scott Graham, second from left, participates in a panel at the annual Rural Hospital Leadership Conference in Chelan in June. Photo by Leslie McNamara.
Hospital Leadership Conference in Chelan. The panel focused on the financial realities facing rural hospitals today, including how CEOs and boards are preparing for upcoming changes tied to federal policy, and what boards need to hear from leadership to stay financially informed.
Scott spoke about TRH’s experience during COVID-19, when a state order pausing elective surgeries caused hospital revenue to dry up almost overnight. He described how the Washington State Hospital Association (WSHA) went “all hands on deck” to help TRH secure emergency state funding and avoid closure during that cash crisis. His key message to fellow rural hospital leaders: reach out for help early, and don’t let shame around financial distress get in the way of asking for support. He also spoke to the importance of transparency with hospital boards, emphasizing that TRH’s board is briefed weekly on the hospital’s financial standing so there are no surprises.
Joining Scott on the panel was a CEO from East Adams Rural Healthcare, which was recently the first hospital in Washington to convert to a Rural Emergency Hospital designation. They shared a similar story of financial distress and how WSHA’s support helped them avoid closing their doors.
The Three Rivers team also took in a keynote from Washington’s new Secretary of Health, Dennis Worsham, at the conference. Worsham shared what he’s learned traveling the state and listening to communities during his first 100 days in office, with rural health access very much part of the conversation.
The Rural Hospital Leadership Conference has become a can’t-miss event for our team each year. Beyond the sessions themselves, it’s a chance to connect with fellow rural hospital leaders from across the state, compare notes on shared challenges, and bring home new ideas and resources. WSHA and AWPHD continue to be invaluable partners in supporting rural hospitals like Three Rivers, and this year’s conference was no exception.
Pictured from left: Three Rivers Board Chair Mike Pruett, Vice Chair Cherri Thomas, COO Jamie Boyer, CFO Antone Eek, and Board Secretary Leslie McNamara attend the keynote speech from state Secretary of Health Dennis Worsham. Photo by Scott Graham.
Three Rivers Health Link | Summer 2026
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Free Event at Our Clinic | June 11, 2026
Please join us from 4 – 6 p.m. Thursday, June 11 for a Care & Coverage open house at Three Rivers Family Medicine, 415 Hospital Way in Brewster. The event is free and open to everyone. Come meet our providers, chat with our insurance navigators, get valuable information from our invited guests, and sign up for a free raffle! Questions? Please email media@trhospital.net.
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Board Leaders Discuss Rural Healthcare on Local Podcast
Three Rivers CEO Receives Statewide Honor for Rural Health Leadership
TRH Earns Gold Award for Stroke Care
Changes to Medicare Telehealth Coverage Effective October 1
Due to the expiration of temporary Medicare rules, Medicare no longer covers telehealth visits when the patient is located at home. This affects Rural Health Clinics across the country, including Three Rivers Family Medicine.
Behavioral health and substance use disorder services are currently exempt and may continue via telehealth, but most other Medicare-covered services must now be provided either in person or from an approved medical facility (such as a clinic, hospital, or skilled nursing facility).
Other types of coverage, such as commercial insurance, may be subject to different rules.
Patients with upcoming affected telehealth appointments will be contacted to discuss options.
We appreciate your patience during this transition. If Medicare coverage resumes for telehealth services, we will share that news as well.
Questions about an upcoming visit? Please call our clinic at (509) 689-3749.