An Open Letter to the PeaceHealth Board: J’accuse
A public-record-based demand for transparency, accountability and fidelity to mission | July 2026
I write as a PeaceHealth physician who believes deeply in the work of our caregivers and in the communities that have entrusted this institution with their health. I also write anonymously because I do not have confidence that criticism of senior governance can be voiced safely from within.
This letter relies on public records. It does not allege criminal conduct. It alleges a failure of stewardship, transparency, accountability and fidelity to mission.
I accuse PeaceHealth of demanding sacrifice from caregivers while insulating executives
<p>PeaceHealth’s Form 990 for the fiscal year ending June 30, 2025 reported more than $4 billion in revenue, approximately $3.9 billion in expenses and more than $24 million in revenue over expenses after three consecutive loss years.[1][2] The system employed 20,135 people.[2]
The same public record showed former chief executive Liz Dunne receiving total compensation exceeding $4.4 million. Cascadia Daily News reported that this was more than $1 million above the prior year and more than $2.6 million above the compensation attached to the position a decade earlier.[1][2]
PeaceHealth also paid more than $1 million in severance to several former executives, spent nearly $13 million on travel, and disclosed first-class or charter travel, companion travel and housing allowances or residences for an undisclosed number of highly compensated employees.[1][2]
Compensation may be lawful and benchmarked. That does not make it morally inevitable. A compensation committee’s invocation of a market does not answer whether a Catholic charitable institution should follow that market upward while asking caregivers and communities to absorb layoffs and lost services.
I accuse PeaceHealth of treating workforce reductions as necessity without proving necessity
PeaceHealth announced a workforce reduction of approximately 1% in May 2025.[6] In October 2025, it announced another systemwide reduction of approximately 2.5%, reported as roughly 241 positions.[5]
In February 2026, it disclosed 94 additional positions, including 26 in Bellingham; Washington’s WARN notice described 94 permanent layoffs effective April 12, 2026.[3][4]
Reportedly affected work included hospice, mental health, cancer services, nursing support and patient access.[3][5][6] These are not abstractions. They are the people who answer phones, arrange care, support nurses and physicians, guide frightened families and preserve continuity for vulnerable patients.
This letter does not claim that every eliminated position was necessarily indispensable or that no operational redesign could ever be justified. It claims that PeaceHealth has not publicly supplied the hospital-level finances, savings calculations, service-impact analyses or patient-safety evidence needed to justify successive reductions.
Do not tell caregivers that layoffs are dictated by necessity while executive compensation is dictated by the market. Both are governance choices.
I accuse PeaceHealth of substituting systemwide opacity for local accountability
PeaceHealth’s principal public tax filing presents consolidated systemwide information. It does not provide the public with complete hospital- or market-level operating statements for St. Joseph Medical Center, Southwest Medical Center, Sacred Heart, Peace Harbor, Ketchikan Medical Center or the other communities whose tax support, philanthropy, labor and trust sustain the system.[1][2]
The public cannot adequately assess local performance, central administrative allocations, intercompany transfers, service-line profitability, consultant costs, outsourcing, vacancy savings, temporary staffing, overtime or the downstream costs of delayed access.
PeaceHealth has explained publicly that margins, reserves, debt and capital investment are interdependent.[10]
That is true. Fitch reported nearly $2 billion in debt, almost $2.5 billion in unrestricted cash and investments, an A+ rating and a negative outlook; S&P; rated approximately $789.5 million of 2025 bonds A-.[8][9] These facts describe genuine financial complexity. They do not establish that each layoff was necessary, nor do they excuse the absence of local detail.
The more complex and consequential the institution, the stronger the duty of legibility.
I accuse PeaceHealth of allowing consultants to influence public consequences without public accountability
Cascadia Daily News reported that outside consultants were working inside PeaceHealth amid employee fears of additional cuts, while PeaceHealth stated that final decisions remained with the organization.[7] If consultants recommended restructuring, workforce reductions, outsourcing or service changes, the public deserves to know who they were, what they were paid, the scope of their work, the assumptions they used and whether their recommendations were adopted. Final authority may remain with executives and the board, but that makes disclosure more important. Leadership cannot invoke external expertise to legitimize decisions while shielding the advice, incentives and fees from scrutiny.
I accuse PeaceHealth of failing to disclose the real economics of its layoffs
For each workforce action, PeaceHealth should disclose projected gross savings and realized net savings. Net savings must account for severance, unemployment costs, recruitment, turnover, contract labor, overtime, vacancies, outsourcing, delayed care, lost referrals, reduced service capacity and the administrative cost of the restructuring itself.
The organization should also publish a cumulative clinical-impact assessment. Evaluating each eliminated position in isolation can conceal the combined effect of thinner staffing across scheduling, nursing support, hospice, behavioral health, cancer care and access.
Without these records, neither caregivers nor the public can tell whether the reductions improved stewardship or merely shifted costs and risk to patients, remaining staff and local communities.
I accuse PeaceHealth of maintaining executive privilege during institutional retrenchment
PeaceHealth’s public filings show rising legal fees, substantial travel expenses, executive benefits and severance at the same time that workforce reductions were imposed.[1][2]
These categories may include legitimate expenses. The question is not whether every dollar was improper. The question is what leadership reduced before eliminating community-facing work. No executive should receive incentive compensation during a year involving broad involuntary layoffs unless the board publicly demonstrates that reasonable reductions in executive compensation, consulting, contracting, travel and nonclinical administration were exhausted first. Extraordinary severance after major layoffs or material governance failure should require a detailed public explanation.
I accuse PeaceHealth of providing too little disclosure about captive insurance
PeaceHealth’s Form 990 reports foreign self-insurance activity associated with the Cayman Islands.[1] A captive insurer can be a legitimate risk-management structure: an organization owns an insurer that covers its own risks.[13]
The existence of a captive is not itself evidence of wrongdoing. The problem is that the public cannot readily understand the captive’s legal identity, capitalization, governance, premiums, reserves, claims, investments, reinsurance, fees, tax treatment or financial benefits to PeaceHealth.
A charitable institution has no moral entitlement to opacity merely because it has complied with the minimum disclosures required by law.
I accuse PeaceHealth of reporting community benefit without enough information to judge it
PeaceHealth reported approximately $288 million in community benefit during the most recently reported year.[1][2]
Some of that benefit is unquestionably real and valuable. It includes financial assistance, subsidized services, unreimbursed care, education, community-health programs and grants to local organizations.
But “community benefit” is not synonymous with cash charity. The category may include Medicaid reimbursement shortfalls, professional education, subsidized services and internal accounting allocations. PeaceHealth reported approximately $6.9 million in grants and assistance on the principal Form 990 – far less than the headline community-benefit total.[1]
The public deserves to know precisely how the $288 million was calculated. This is particularly important because the Washington Attorney General previously found deficiencies in PeaceHealth’s financial-assistance practices, resulting in millions of dollars in refunds to low-income patients.[12]
PeaceHealth should not ask the community to accept a large aggregate number as proof of charity while withholding the hospital-level detail needed to evaluate it.
I accuse PeaceHealth of using Catholic identity as branding while governing like an ordinary corporation
A Catholic healthcare institution should be judged by more than whether it satisfies the technical requirements of a Form 990. It should be judged by whom it protects when money becomes tight; whether human beings are treated as costs or members of a healing community; whether leadership accepts sacrifice before imposing it on people with less power; and whether the poor, vulnerable, mentally ill and dying remain at the center of its decisions.
PeaceHealth’s public mission promises to promote personal and community health, relieve pain and suffering and treat each person lovingly.[11]
When hospice, mental-health, nursing, cancer and patient-access positions are eliminated while multimillion-dollar executive compensation persists, the question is not merely whether PeaceHealth remains legally nonprofit. The question is whether it remains morally recognizable as Catholic.
I call for leadership and board accountability
The executive leaders collectively responsible for proposing, implementing or defending these compensation, restructuring and workforce policies should resign or be removed following an independent review.
This demand does not assume that every executive participated equally in every decision or allege that every executive is personally corrupt. It recognizes that collective accountability must exist somewhere.
The governing board itself must undergo an independent review. Directors who approved excessive compensation, severance and benefits – or failed to demand compelling evidence before authorizing clinical and community-facing layoffs – should resign. The board cannot credibly investigate a governance failure in which it may have participated.
I call for a new model of executive recruitment and compensation
PeaceHealth should recruit leaders who understand that guiding a Catholic charitable healthcare system is a vocation of public trust, not simply another rung in the national hospital-management market.
Executive base compensation should be set at 10% below the independently determined market rate for comparable nonprofit systems. That would remain exceptionally generous while establishing that service at PeaceHealth entails a measurable commitment to mission.
Incentives should be tied primarily to clinical quality, patient safety, access, caregiver retention, psychological safety, reduced administrative burden, community-health outcomes, charity care, workforce stability, patient experience, transparent stewardship and reduced disparities.
I call for immediate corrective action
PeaceHealth should:
1. Offer reinstatement to employees whose positions were eliminated during the 2025-26 reductions, beginning with direct clinical, hospice, mental-health, cancer, nursing-support and patient-access roles. Where reinstatement is impossible, provide priority placement, restored seniority and appropriate compensation for resulting losses.
2. Declare an immediate moratorium on further involuntary layoffs and service reductions until an independent clinical, financial and community-impact review is complete.
3. Commission an independent forensic governance and financial review by an organization with no recent consulting, auditing, legal or commercial relationship with PeaceHealth.
4. Publish hospital- and market-level financial statements, including separate results for St. Joseph Medical Center and the Northwest network, with intercompany transfers and central administrative allocations identified.
5. Disclose every restructuring consultant retained since 2024, including contracts, fees, scopes of work, recommendations and financial relationships.
6. Publish projected and realized savings from every layoff, together with severance, recruitment, temporary staffing, outsourcing, vacancy, overtime, delayed-care and lost-service costs.
7. Release a complete accounting of executive compensation and benefits, including incentive metrics, deferred compensation, retirement contributions, housing, first-class or charter travel, companion travel and severance obligations.
8. Explain the Cayman captive-insurance arrangement, including its legal name, ownership, governance, capitalization, premiums, reserves, claims, investments, reinsurance, administrative expenses and tax treatment.
9. Publish a meaningful breakdown of the reported $288 million in community benefit, distinguishing direct financial assistance, Medicaid shortfalls, education, subsidized services, research, cash grants and internal accounting allocations.
10. Place elected frontline physicians, nurses and other caregivers on the governing board with full voting rights and meaningful protection from retaliation.
11. Create an independent caregiver ombudsman and protected reporting channel outside the executive chain of command.
12 . Adopt and enforce a robust nonretaliation policy covering employees and medical staff who raise concerns about finances, staffing, patient safety, ethics or fidelity to mission.
13 . Commission an independent patient-safety assessment of the cumulative effects of staffing reductions rather than examining each eliminated position in isolation.
14. Require the Sisters of St. Joseph of Peace, or the appropriate Catholic sponsor, to conduct a formal mission-fidelity review and publish its complete findings.
15. Submit future executive-compensation packages and broad workforce reductions to a public mission-impact review before final board approval.
To the board
You may dismiss this letter as the anger of an anonymous physician. Or you may recognize anonymity for what it is here: the measure of one physician’s lack of confidence that candid criticism can be voiced safely from within.
Do not ask us to believe that multimillion-dollar compensation is dictated by the market while layoffs are dictated by necessity. Both are choices.
Do not ask caregivers to live the values of sacrifice, stewardship and service while executives are exempted from them. Do not invoke the Sisters’ legacy to legitimize decisions that appear irreconcilable with the spirit of that legacy.
PeaceHealth does not belong morally to its executives, consultants, bondholders or compensation committees. It belongs to the patients who entrust us with their lives, the communities that support its tax exemption, the caregivers who sustain it and the religious mission whose name it continues to use. The time for managed messaging is over.
Open the books. Reverse the publicly unsubstantiated layoffs. Replace the leadership responsible. Reform the board. Rebuild trust.
Until then, every invocation of “mission” will ring hollow.
– A PeaceHealth Physician
Sources and documentation
Bracketed numbers in the letter correspond to the sources below. Links are embedded for editorial verification.
1. PeaceHealth, Form 990, tax year July 1, 2024-June 30, 2025. Primary public filing for revenue, expenses, assets, liabilities, compensation, severance, executive benefits, travel, legal and insurance expenses, grants, community-benefit reporting and foreign activities. Filed May 6, 2026. https://www.cascadiadaily.com/wp-content/uploads/2026/07/Source-ProPublica-Nonprofit-Explorer-PeaceHealthFiscal-Year-Ending-June-2025-Form-990.pdf
2. Owen Racer, “Follow the money: PeaceHealth’s executive pay and rising legal fees, revenue,” Cascadia Daily News, July 9, 2026; updated July 10, 2026. Analysis of the FY2025 Form 990, including executive compensation, severance, legal fees, travel, contractors and reported community benefit. https://www.cascadiadaily.com/2026/jul/09/follow-the-money-peacehealths-executive-pay-and-rising-legal-fees-rev enue/
3. Owen Racer, “PeaceHealth to eliminate 94 positions, including 26 jobs in Bellingham,” Cascadia Daily News, February 11, 2026. Identifies the number and reported types of positions eliminated in the February 2026 action. https://www.cascadiadaily.com/2026/feb/11/peacehealth-to-eliminate-94-positions-system-wide-including-26-jobs-i n-bellingham/
4. Washington State Employment Security Department, PeaceHealth WARN notice, filed February 11, 2026. Public notice concerning 94 permanent layoffs at Washington locations, effective April 12, 2026. https://esd.wa.gov/employer-requirements/layoffs-and-employee-notifications/worker-adjustment-and-retraining-n otification-warn-layoff-and-closure-database
5. Owen Racer, “Update: PeaceHealth cutting 2.5% of total workforce, more than 50 jobs impacted in Bellingham,” Cascadia Daily News, October 28, 2025. Documents the systemwide reduction of approximately 241 positions. https://www.cascadiadaily.com/2025/oct/28/peacehealth-cutting-2-5-of-workforce-amid-unpredictable-healthcarelandscape/
6. Owen Racer, “PeaceHealth cutting 1% of workforce, local impact unknown,” Cascadia Daily News, May 29, 2025. Documents the earlier systemwide reduction and hiring restrictions. https://www.cascadiadaily.com/2025/may/29/peacehealth-cutting-1-of-workforce-local-impact-unknown/
7. Owen Racer, “Consultants inside PeaceHealth invoke fear of more cuts,” Cascadia Daily News, February 5, 2026. Reports outside consultants, employee concerns and PeaceHealth’s statement that final decisions remained with the organization. https://www.cascadiadaily.com/2026/feb/05/consultants-inside-peacehealth-invoke-fear-of-more-cuts/
8. Fitch Ratings, PeaceHealth Series 2025 rating report, September 24, 2025. Reports debt, unrestricted cash and investments, the A+ rating and negative outlook. https://www.fitchratings.com/research/us-public-finance/fitch-rates-peacehealth-wa-ser-2025-revs-a-affirms-idr-at -a-outlook-revised-to-negative-24-09-2025
9. S&P; Global Ratings, PeaceHealth Series 2025 fixed-rate revenue bonds, September 30, 2025. Reports an A- rating on approximately $789.5 million in taxable fixed-rate revenue bonds. https://www.spglobal.com/ratings/en/regulatory/article/-/view/type/HTML/id/3450131
10. PeaceHealth, “Financial Stewardship Series.” PeaceHealth’s explanation of operating margins, reserves, debt, capital investment and strategic priorities. https://www.peacehealth.org/sites/default/files/2023-03/Financial-Stewardship-Series_final.pdf
11. PeaceHealth, “Our Mission, Vision and Values.” PeaceHealth’s public statement of its Catholic healing mission and organizational values. https://www.peacehealth.org/about-peacehealth/mission-values
12. Owen Racer, “PeaceHealth to refund millions to low-income patients after AG investigation,” Cascadia Daily News, November 20, 2023. Reports the Washington Attorney General’s findings and resulting patient refunds. https://www.cascadiadaily.com/2023/nov/20/peacehealth-refunds-millions-after-ag-investigation/
13. National Association of Insurance Commissioners, “Captive Insurance Companies.” Explains captive insurance as self-insurance through an insurer owned by the organization whose risks it covers. https://content.naic.org/insurance-topics/captive-insurance-companies
Statement concerning evidence and opinion
The financial figures, reported benefits, workforce reductions, credit ratings and organizational policies cited in this letter are drawn from publicly available sources. Statements concerning moral failure, mission inconsistency, inadequacy of public justification, loss of confidence and the remedies demanded represent the author’s analysis and opinion.
The letter does not allege criminal conduct.
Several records necessary for a complete evaluation do not appear to be publicly available, including hospital-level financial statements, projected and realized layoff savings, consultant contracts and recommendations, detailed clinical-impact analyses, complete allocations of travel and legal expenditures, intercompany transfers, and full financial and governance records for PeaceHealth’s captive-insurance arrangement.
This letter demands disclosure of those records; it does not claim to know what the undisclosed records contain.