This story is part of a collaborative reporting series with Radio Catskill and the River Reporter examining the state of healthcare in the Upper Delaware River Valley region and beyond.

This July, Crystal Run Healthcare in Rock Hill closed one of only two OB-GYN practices in Sullivan County open at the time.

Two of its OB-GYN providers relocated to Crystal Run’s Middletown location, and the other two stayed in Sullivan County: one at Sun River Health and one at Garnet Health Medical Center. 

The service cuts also redirected more patients to Crystal Run’s Middletown location. Lisa Mazzella, a patient services representative for Crystal Run, said it wasn’t the first time she had seen services reduced as patient volume increased.

Mazzella, who’s been a patient services representative for Crystal Run Healthcare for eight years, said these restructurings have increasingly led to unsafe staffing levels and unrealistic workloads for an already strained workforce.

In 2023, Optum, a subsidiary of UnitedHealth Group, acquired Crystal Run Health. Since then, the healthcare system has laid off hundreds of laboratory workers and is considering selling off some specialty practices to other large New York health systems. 

READ: As Optum Eyes Sale of Specialty Practices, Workers Worry About Future of Patient and Worker Care

Mazzella says the region’s healthcare workforce is shrinking, largely in part due to corporate layoffs. For instance, Crystal Run laid off six phone team workers and has since shifted those responsibilities into existing roles.

“They were reabsorbed [into] other positions, and this is where the workload is going,” said Mazzella. “They’re trying to get as much out without paying for the additional position that they’re asking us to play.”

Mazzella says since Optum acquired Crystal Run, patient service staffing has decreased from 40 to 26 patient service representatives. Meanwhile, patient volume has increased with recent service cuts, says Mazzella.

Crystal Run did not respond to our detailed questions about staffing numbers and patient volume but they did say they were focused on making health care “simpler, more affordable, and easier to access” across the state.

“Nine out of 10 primary care and OB-GYN patients receive answers to clinical questions within 24 hours and prescription refills within 48 hours, and most patients can secure timely appointments,” a Crystal Run healthcare spokesperson told Radio Catskill. “We remain committed to being a trusted partner in the communities we serve and ensuring patients receive the best possible care.”

‘Why can’t they invest in us?’

New York State Comptroller Thomas DiNapoli released a report in August 2025 that found rural counties face far more healthcare professional gaps than for New York State.

The number of nurse practitioners (NPs) in rural counties is an average of 10.5 NPs per 100,000 people in rural counties compared to 16.4 NPs per 100,000 people across the state. Sullivan County had the largest number of people underserved – more than 25,600 residents – due to physician shortages, according to the report. 

Margaret Franks, a statewide staffing coordinator at the New York State Nursing Association, said the lack of safe staffing conditions in hospitals and medical centers has directly shaped these nursing workforce gaps.

Franks says the issue isn’t a shortage of nurses but a failure to retain them. The workforce gaps come after a challenging few years in rural healthcare, she says.

“ We had so many nurses who left after the pandemic and many facilities were in a hiring freeze saying that they needed to recoup the money that had been lost during the pandemic, which left us incredibly short-staffed. Our patients are coming in sicker than ever,” she said.

Franks travels across New York to advocate for safer staffing protocols to nurses, health care leaders, and unions. She said she rarely sees large health systems negotiate safe staffing provisions in union contracts, ensure nurses have enough coverage to take breaks, or hire qualified nursing graduates to fill open positions.

New York has taken some legislative steps to address some of these underlying issues. In 2021, the state passed a law requiring staffing committees at all hospitals and 1:2 nurse-to-patient ratios in critical care units. 

But Franks says she often sees healthcare systems not comply with the law.

“Why can’t they invest in us? Why can’t they invest in enough nurses at the bedside when they have all this research showing that it improves patient outcomes, it reduces the length of stay, and it’s more positive for [a] nurse and patient?’”