"At a time of significant community need, hospitals are having to make very difficult decisions about how to keep their doors open, maintain services and retain staff," wrote Becky Hultberg, president and CEO of the Oregon Association of Hospitals & Health Systems, in an April 6 letter to Gov. Kate Brown. "Hospitals are implementing a variety of strategies, including reductions in hours and salary, paid furloughs, transitioning to per diems and layoffs."