In a new request to the state, the head of Legacy Health’s Gresham hospital said the facility may have to start sending pregnant patients elsewhere as soon as March 17 and state officials should allow the health system to follow through on plans to halt maternity services.
The development, however, comes just days after a warning from state officials that reviewing Legacy's closure application could take several weeks — and closing without the state's OK may lead to state or federal sanctions.
Bahaa Wanly, president of Legacy Mount Hood Medical Center, on Monday submitted the formal request to the Oregon Health Authority to allow the health system to close the birthing unit at the Legacy Mount Hood Medical Center. The request, obtained by The Lund Report, follows weeks of outcry over how the birth center’s planned March 17 closure would affect the less affluent and diverse communities it serves. But Wanly indicated in the request Legacy is determined to close the center.
State regulations require general hospitals to provide maternity services unless the health authority waives the requirement. To get a waiver, hospitals must explain what options they considered to keep their birth center open and how discontinuing the service will not only ensure patient health but improve it.
“Legacy Health finds itself in a severe financial crisis after three years of pandemic-related healthcare costs and challenges,” reads Legacy’s request, which asked for a three-year waiver of the requirement to provide labor and delivery services at Mount Hood Medical Center.
The obstetric care model Legacy put in place at Mount Hood before the pandemic in 2019 was designed with the expectation that births would rise, according to the document. Instead, babies born at the hospital dropped from a peak of 980 in fiscal year 2017 to 786 in 2022, mirroring the decline of births in east Multnomah County from 5,000 to 3,000 in the same time period, the document states.
Legacy expects the trend to continue and the waiver states that just 16 percent of births from east County ZIP codes are taking place at the birth center.
The waiver request restates Legacy’s previous explanation that keeping the center open became untenable following the resignations of several obstetric physicians it planned to staff the birth center with along with other worker shortages. The document states that the situation will cause the hospital to go to divert status, requesting that ambulances take less critical patients elsewhere because of capacity issues.
“Based on these resignations, other staffing shortages precipitated by these resignations, and our need to plan for the safe care of patients, we have developed contingency plans in the event we have to go on divert status as soon as March 17,” reads the document.
Legacy announced on January 27 that it would close the birth center by March 17. As state officials waited for the waiver request, André Ourso, a health authority administrator, sent a March 2 letter to Wanly cautioning him that the hospital could face state or federal sanctions such as suspension or revocation of its license if it closed the birth center without approval.
Ourso said in the letter he was reiterating a message delivered during a Feb. 9 meeting between health authority staff and Ingrid Brydolf, an attorney for Legacy. Ourso wrote that staff told Brydolf during the meeting that the hospital could not discontinue required services without a waiver.
“In addition, OHA staff clarified for Ms. Brydolf that the OHA’s waiver review process can take several weeks,” Ourso continued. “To date, OHA has not received a waiver request from LMHMC; therefore, OHA has not begun any waiver review process.”
Legacy details plans
The waiver request explained that Legacy’s management intended to change the birth center’s model of keeping it staffed with obstetric physicians to a “more traditional model” of doctors taking calls from home with midwives providing 24-7 coverage.
“Legacy's intention was never to close the Family Birth Center, but to move to a financially sustainable obstetrical coverage model,” reads the request. “However, due to substantial resignations from physicians who did not want to change the model, it became impossible to staff the Family Birth Center and ongoing OB-GYN call.”
The waiver request states that the hospital will continue “outpatient women's services, including prenatal care, GYN (gynecologic) and lactation services” and will “expand inpatient GYN services with the development of our minimally invasive robotic GYN service line.” Additionally, Legacy is planning to expand obstetrics and gynecology care by adding a Maternal Fetal Medicine clinic to the Mount Hood campus, according to the document.
The birth center serves about 275,000 people in east Multnomah County as well as communities on Mt. Hood. Since Legacy announced the closure, hospital staff, elected leaders and community members have sharply criticized the decision, saying it’ll put expectant mothers in danger.
The health system said previously it planned to direct patients that would normally be served by the birth center to Randall Children’s Hospital in Portland, about 30 minutes away and longer with traffic. Patients will be diverted there if Mount Hood Medical Center goes to diver status, according to the waiver request.
The document submitted by Legacy explains it is preparing for the closure by providing enhanced training to emergency room staff. Pregnant patients who seek care at the Mount Hood Medical Center’s emergency department and need to be admitted to the hospital will be transferred to another hospital that provides obstetric services by Life Flight Air Services, AMR ambulance service or others, the waiver request states.
“Transport will be appropriate, via ground or air, based on urgency of presentation. In addition, we will install a ‘Life Flight button’ that summons helicopter transport when needed emergently,” reads the document. “Transit time by helicopter to Randall Children's Hospital is seven minutes.”
Health authority spokesman Jonathan Modie provided The Lund Report with an emailed statement explaining that Health Facility Licensing & Certification Program staff will “thoroughly review the request.”
“Because waiver requests often result in requests from OHA for additional information and clarification before a determination can be made, no timeline has been set for completion of the review,” the statement said.
A group of east Multnomah County legislators and local elected leaders issued a letter late last month stating that they had continued talks with hospital leaders to find a way to keep the center open.
“Although we wish there were a simple fix or an easy funding solution to keep the birthing center open, the reality is that the situation surrounding a private hospital and their individual business decisions is complex,” reads the letter. “Nevertheless, we are continuing to look for a viable solution. We are working with the Oregon Health Authority and Governor Kotek to make sure we have explored all the options available.”