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Vidant Health announced Monday that nearly 200 positions will be eliminated, the result of a $18-million budget shortfall for the health system.

Of the 191 employees to be laid off across the Vidant Health system, many were informed Monday, according to a Vidant Beaufort Hospital email. Vidant Health employs more than 14,000 people, and its services span 29 counties in eastern North Carolina, including hospitals in Ahoskie, Edenton, Greenville, Kenansville, Nags Head, Roanoke Rapids, Tarboro, Washington and Windsor.

The following is a list of where the 191 positions will be eliminated, according to a Vidant Health statement released Monday:

• Vidant Health Corporate — 82
• Vidant Medical Center — 75
• Vidant Medical Group — 11
• Vidant Beaufort — 7
• Vidant Edgecombe — 4
• Vidant Roanoke-Chowan — 4
• Vidant North — 3
• Vidant Chowan — 2
• Vidant Duplin — 2
• The Outer Banks Hospital — 1
• Vidant Bertie — 0

In an email to Vidant Health employees, Vidant Health CEO Dr. Mike Waldrum explained the efforts taken to recover from the first-quarter budget shortfall started with a “financial performance improvement process.”

“The first steps in this process were to reduce costs, implement operational efficiencies and discontinue recruitment and hiring for certain non-patient care positions. After these assessments, it was determined a workforce reduction was also necessary,” Waldrum wrote.

The news comes seven months after Vidant Behavioral Health — the 19-bed inpatient facility at Vidant Beaufort serving those with mental health/substance use issues — was closed in Washington, and its patients and some staff were transferred to other facilities. In 2013, the decision to close Vidant Pungo Hospital in Belhaven came after the 49-bed hospital’s loss of $1.8 million the prior year and resulted in approximately 100 of 127 Vidant Pungo employees either being transferred to other facilities or laid off. In 2016, Vidant built a new, state-of-the-art multi-specialty clinic in Belhaven that operates 24 hours a day, seven days a week.

Waldrum is a firm supporter of Medicaid expansion, believing the health of North Carolina’s rural hospitals depends on it. Rural hospitals, such as those in the Vidant system, are faced with a traditionally underserved population with a high burden of disease, a growing number of patients relying Medicaid and a lack of focus on rural health policy, according to the press release.

“I have continued to share the urgent need for support of rural health care due to the challenging environment we face, including decreasing reimbursements and the lack of Medicaid expansion. Despite our high volumes, these challenges have resulted in Vidant Health experiencing a budget shortfall during the first quarter of (Fiscal Year 2020),” Waldrum stated in the email.