After Saint Alphonsus announced in June its plans to close its birthing center — then in August pulled out of a plan to keep it open — Gov. Tina Kotek, along with Oregon Sens. Ron Wyden and Jeff Merkley, began looking for ways to maintain maternity services in Baker County. To inform their effort, they asked the federal Health and Human Services department for a thorough assessment of the community’s obstetric needs.
That report, issued Sept. 1, concluded Baker County residents face significant communication, transportation, childcare, income insecurity and housing and lodging barriers. As a result, they will be “particularly vulnerable for potential adverse maternal and infant outcomes” due to Saint Alphonsus closing the birthing center.
Hospital leaders cited declining deliveries and a lack of staffing as reasons for closing the center. The hospital’s owner, Michigan-based Trinity Health, is the nation’s fifth-largest hospital system and holds a $5 billion investment portfolio.
In a statement, Wyden said the report “confirms” his beliefs that Saint Alphonsus’ decision puts expectant parents at “serious risk.”
Mark Snider, a media representative for the hospital, said Saint Alphonsus received the report on Friday and is reviewing it.
“We have no additional comments at this time,” Snider said.
‘Potentially life-threatening impact’
According to HHS, Baker County residents join almost half of all rural counties in the United States that no longer offer hospital-grade obstetric services. Rural communities have higher rates of maternal deaths, and with higher than state average poverty rates in Baker County, HHS says the outlook isn’t good.
“The closure of the birthing center may have a significant and potentially life-threatening impact on pregnant patients and families in this underserved region,” the report said.
ONA Labor Representative Rhonda Kenny said Saint Alphonsus executives are “perpetuating long standing disparities in healthcare by denying services where they should be expanding them.”
Grande Ronde Hospital is the closest hospital to Saint Alphonsus that provides obstetrics services, an approximately 45-mile drive. The next nearest hospital with obstetric services is the Saint Alphonsus Medical Center in Ontario, a 76-mile drive. For “high-level” maternity care, pregnant patients will have to travel to Boise, Idaho.
In addition, the report found that weather-related closures of roads connecting Baker County to other regional hospitals are frequent, exacerbating travel concerns. MetroWest — the ambulance service in Baker County — has three ambulances. However, the report states MetroWest may not have enough staff to run them simultaneously.
“Saint Alphonsus’ abrupt decision to terminate OB services – rejecting the offer of US public health nurses – put(s) expectant parents at serious risk by eliminating local care and forcing moms in labor to travel sometimes dangerous mountain roads for care,” Wyden said in response to the report.
Community concerns raised to HHS included the potential for out-of-hospital births, adverse maternal and infant outcomes resulting from the inability to access hospital-based obstetric services within the county, lack of transportation and child care if traveling outside of the county for medical care is necessary and the potential loss of employment if they needed to relocate to be closer to a hospital.
With Baker City’s YMCA child care services set to close on Sept. 29, those concerns are well founded, the report says.
While the report concludes that the center’s closure will negatively impact Baker County, the county isn’t the only community to feel the effects.
Halfway, located 54 miles from Baker City, relied on Saint Alphonsus for maternity services until Aug. 26, when the birthing center closed. While the drive to Baker City was nearly prohibitively long, it was preferable to the 87-mile to the next closest hospital with obstetric care in Weiser, Idaho.
Halfway’s Pine Eagle Clinic expects more patients to require transportation by Life Flight to access obstetric care in Boise.
While Saint Alphonsus has already taken steps to address the gap by training emergency department staff to care for pregnant patients and coordinating with other regional hospitals and emergency transportation services, HHS suggested a few additional short and long-term actions to mitigate adverse outcomes from the birthing center’s closure.
Potential next steps
The brunt of the county and Saint Alphonsus’ work is cut out for them, with transportation, childcare, income insecurity and lodging presenting the most significant barriers to medical access.
The report suggests the county and hospital start with increasing community education by adding a website banner announcing the closure, offering an obstetric hotline and establishing case managers to help pregnant patients access resources. The hospital also should improve its transparency and communication with the local community to rebuild trust.
Other recommendations include establishing non-emergency transportation services for pregnant patients, educating patients about federal and state leave programs, speaking with employers about pregnant employees potentially needing to temporarily relocate, increasing housing and lodging allotments for pregnant patients, collaborating with other hospitals to identify low-cost housing and lodging options and exploring grant funding opportunities for childcare.
HHS also suggested the county establish other local obstetrician services. Other healthcare systems could utilize Saint Alphonsus’ labor and delivery beds for obstetric services or the county could create a stand-alone birth center.
Saint Alphonsus told HHS it was open to leasing its labor and delivery beds but hadn’t received any proposals.
The hospital could also consider reestablishing its birth center.
In August, Wyden, Merkley and Gov. Kotek and the nurses union pushed the hospital to reconsider its plans to close, but hospital leaders said it was unrealistic to maintain the department, in part because the center was losing money year over year — $5.3 million in 10 years.
Though it had originally asked for federal funding for six nurses to keep the center open, the hospital later said it actually needed funding for nine.
Additionally, the hospital said it had to pay higher wages to temporary nurses to keep the center running, blamed unsuccessful recruitment efforts, and said current nurses were “unsatisfied with their work.”
According to the report, nurses said they were satisfied, even with decreasing obstetric volumes.
Kenny pointed at the discrepancy as evidence of Saint Alphonsus executives “distort(ing) facts” to justify closing the center.
“Saint Alphonsus recruitment efforts suffered because disconnected executives refused to pay competitive wages,” Kenny said.
Baker County Commission Chair Shane Alderson told The Lund Report in an email that “While Saint Alphonsus has not necessarily been transparent or timely. We will continue to work collaboratively to support the needs of families in Baker County. The HHS report gives us a third-party assessment that we can use in both short term and long term planning. Baker county still believes that having labor and delivery services in Baker City is the best option for our citizens.”
