The steps are being taken in response to economic changes in health care, according to a Mercy statement released to The Tribune Thursday. Health care is expensive. There is absolutely no denying that, Mercy Hospital Fort Scott President Reta Baker said Friday. She said obtaining the equipment to provide health care costs the hospital a significant amount of money. We see increasing costs in drugs, we see increasing costs in equipment replacement, increasing costs in supplies, Baker said. Weve worked very hard in the last 10 years not to pass costs on to the public, because costs are already high, so weve been very careful in not spring water making that happen. So it makes it difficult to keep our reimbursement up to our expenses. She said making cuts such as Mercy Fort Scott has had to make is hard on the staff. (Its) very hard on the staff to see things changing and understand the economy of it, Baker said. Mercys struggle is not new. In January 2014, Mercy Hospital Fort Scott laid off 12 employees and prior to that reduction, 20 to 25 positions were not filled. In June 2014, one full time employee and another who served in Fort Scott and Independence, were laid off. In spring 2014, the services fell under scrutiny when a discernment committee was formed to determine the hospitals future.