Sean Janssen, The Union Democrat

Mark Twain St. Joseph's Hospital, the third-largest employer in Calaveras County, has begun to notify employees of layoffs scheduled to begin as early as Jan. 7.

Hospital spokeswoman Nicki Stevens said the economic climate has brought an increase in uninsured patients to the hospital, and reductions in payments from government healthcare programs have also taken a toll.

"Like all other health care providers nationwide, we have been impacted," Stevens said. "We are working to be more effective here and efficient … in doing so, we must also maintain financial stability."

Stevens said she cannot yet provide an estimate of how many jobs will be cut, but said the hospital employs about 290 people. She said "some nursing and other positions" will be impacted.

The hospital is attempting to relocate as many affected employees as possible to other hospitals within the Dignity Health system. Dignity operates about 40 not-for-profit hospitals in the western United States, including about a half-dozen in Northern California.

Employees who cannot be transferred in that way will receive severance packages, she said.

The hospital is also implementing a hiring freeze on open positions, she said.

"We will continue to meet all staffing requirements," Stevens said. "Patient care will not be impacted."

Stevens said the hospital has a positive outlook on full implementation of the Patient Protection and Affordable Care Act in coming years. It will be beneficial to the county's health care system due to various streamlining measures, reform of health care financing and its expansion of the insured population, she said.

This year was difficult for the hospital, as a scathing grand jury report in the spring offered numerous criticisms of the effectiveness of the relationship between the public Mark Twain Health Care District and Dignity Health, which manages the hospital and five satellite clinics in the county through a 22-year-old agreement.

The district entered that contract after costs of operating an independent rural hospital grew unsustainable. The Dignity Health lease is expected to go to a public vote prior to renewal in 2019.