This article has been updated to incorporate a statement sent by Legacy Wednesday night.
State health officials on Wednesday warned they will take “appropriate regulatory actions” against Legacy Health if administrators follow through on plans to close its Gresham hospital’s maternity unit.
Legacy announced earlier in the day that it was pressing ahead with plans to close the maternity unit at its Mount Hood Medical Center by March 17 despite not having the necessary state waiver and amid heightened scrutiny from lawmakers. The health system’s announcement drew a rebuke from the health authority — which had already warned the system that officials needed more information before the closure could go through.
Health authority spokesman Jonathan Modie told The Lund Report in an email that “we have NOT approved the waiver and we made that clear.”
“Health officials have made clear to Legacy Mount Hood on at least two occasions, in written communications sent to hospital leadership, that Legacy Mount Hood Medical Center may not discontinue required maternity services unless and until OHA has granted a waiver to that hospital,” according to a follow-up statement sent by Modie.
The waiver request submitted on March 6 reiterates Legacy’s previous statements that keeping the maternity unit open is not financially or operationally feasible. Signed by Legacy Mount Hood Medical Center President Bahaa Wanly, the document states that because of staffing shortages and resignations the hospital will have to go on divert status by March 17, which means patients in labor will be directed elsewhere.
In its Wednesday press statement, the system indicated it would carry through on the planned closure and send pregnant patients to Randall Children’s Hospital in Portland for delivery.
“We find that problematic and unsafe for the community,” state Rep. Zach Hudson, D-Troutdale, told The Lund Report. Like other critics of the closure, Hudson said he worries about what will happen to women as they make longer trips to give birth. He also isn’t convinced Mount Hood Medical Center is prepared for patients who will show up to give birth.
Legacy spokesperson Elizabeth Baker issued a statement to The Lund Report late Wednesday night stating that the hospital system did not intend to close the maternity unit. Instead, Legacy intended to transition the unit to “a new care model that continues to deliver safe, quality care in a new, financially viable model,” according to the statement. But before Legacy could transition, it saw a large number of staff leave and it made the decision to close the unit, according to the statement.
“As we reviewed our operations across our six hospitals, the Mount Hood Family Birth Center stood out because of its low volume of births coupled with an unusually high-cost care model that required 24/7 staffing by an obstetrics doctor,” reads the statement. “24/7 staffing with obstetrics doctors is generally employed at high-volume birth centers with at least 1,500 annual births.”
An earlier statement by Baker sent to the The Lund Report on March 13 at about 4:30 p.m. said the maternity unit closure is necessary due to a lack of staff to operate it safely. Ten minutes before 7 p.m. on that same day, Anna Davis, a health authority manager, sent Wanly an email pointing out that state regulations required him to show how closing the maternity unit would benefit patients.
Davis’ email asked nine detailed questions in roughly two-and-half pages asking about capacity at Randall Children’s Hospital. She also asked about expanded services Legacy says will be offered at the Gresham hospital, what alternatives it considered, details of how pregnant women would be transported between hospitals and how the closure will affect marginalized communities. She also indicated that Legacy’s plans appeared to conflict with Multnomah County emergency medical services rules.
The email again cautioned that the hospital’s license and federal certification could be affected if it closed the maternity unit without approval and stated the waiver request would not be processed until Legacy provided answers to her questions.
“I think Legacy should be wondering whether they’re putting their license in jeopardy by not offering the services that they are legally required to offer,” said Hudson. “So I guess the ball is in their court.”
Legacy’s teams are preparing answers to the health authority’s questions and will submit them Friday, according to the statement issued late Wednesday.
The statement did not answer questions from The Lund Report about the availability of maternity services at the hospital after the closure, why it waited to submit the waiver request and if it’s concerned about losing its license.
Lawmakers look into closure
Legacy Mount Hood Medical Center serves about 275,000 people in the eastern Portland metro area as well as communities located farther east in the vicinity of Mt. Hood. Hudson, as well as other community members and elected officials, are worried the maternity center’s closure will mean longer travel times and potentially dangerous circumstances for pregnant women in these communities when it comes time to give birth.
Hudson, along with two other east Multnomah County Democrats, on Tuesday introduced House Bill 3592, which revamps the process for hospitals that want to close maternity units. The bill directs the Oregon Health Authority to evaluate how a hospital’s closure of a maternity unit would affect low-income, disabled, LGBTQ, minority and protected classes before signing off.
Critics of the closure say Mount Hood Medical Center serves a considerable population of people of color and low-income patients. The proportion of women covered by the Medicaid-funded Oregon Health Plan served at the Mount Hood Medical Center’s maternity unit has been roughly at 60% in recent years, according to state numbers.
State Rep. Ricki Ruiz, a Gresham Democrat co-sponsoring the bill, told The Lund Report in a text that the legislation requires hospitals seeking to end maternity services to provide data showing patients won’t be harmed.
“This legislation is essential in understanding the realities of a hospital closure when the Health Authority receives these waiver requests,” state Sen. Chris Gorsek, D-Gresham, told The Lund Report in an email. “We live in a diverse state, and not one Oregonian should miss out on services because of where they live, how much they make a year, or what language they speak.”
The bill has been referred to the House Rules Committee instead of the House Behavioral Health and Health Care Committee. Hudson said the Rules Committee will hear the bill because it includes legislative leaders from both parties and can move legislation quicker than the House’s policy-oriented committees.
The Rules Committee has scheduled a March 21 hearing on the closure, and the three east Multnomah County lawmakers have joined others in asking the health authority to reject Legacy’s waiver request.
Hudson said the bill likely won’t become law in time to affect Legacy’s planned closure.
‘Close no matter what’
Previously, Legacy spokespeople issued statements saying the health system had no choice but to close the Mount Hood Medical Center maternity unit. The waiver request submitted by Wanly to the health authority states that the hospital’s obstetric care model was designed with the expectation births would increase. Instead, babies born at the hospital dropped from a peak of 980 in fiscal year 2017 to 786 in 2022, according to the document.
Hospital administrators tried to move the maternity unit to a different model of care that involved obstetric doctors taking calls from home and midwives providing constant coverage. But several obstetric physicians resigned and Legacy announced in January it had no choice but to close the unit.
“It feels like their intention has always been to close no matter what instead of following the proper procedures,” Hudson said. “Which says to me that they did not examine all the possibilities available to them.”
Hudson said Mount Hood Medical Center has enough revenue to keep the maternity unit open even if it’s money-loser. Health authority figures show that the hospital had an operating margin of $43.2 million between 2017 and 2022— amounting to a profit margin of 5 percent.
Hudson said he and other lawmakers have spoken with the hospital’s staff and are concerned that emergency room workers won’t have the training or expertise for women showing up in labor.
“It’s important for our community to know that while scheduled deliveries will no longer happen at Legacy Mount Hood Medical Center, we will continue to provide women’s health services at Mount Hood,” reads a statement issued Monday by Baker.
Legacy’s obstetrics and gynecology doctors, as well as midwives will continue to serve women in east Multnomah County, according to the statement. The health system will also establish a high-risk pregnancy outpatient care center at the Gresham hospital while expanding other women-focused services.
Legacy did not respond to questions from The Lund Report about using hospital margins to keep the maternity unit open, as well the training of emergency department staff and procedures they can perform.