The Board of Directors of the Mendocino Healthcare District held a “Study Session regarding the Future of OB Services on the Mendocino Coast” on Thursday, January 23. Whether new Board President Jessica Grinberg sprinkled happy dust or it was simply the way the meeting had been organized, for the first time in recollection this particular hospital board presented the appearance of collegiality rather than discord.
The organization of the meeting served as a contrast to the Town Hall get together on obstetrics (OB)/Labor & Delivery held in Fort Bragg on January 3. Much of that devolved into something like gotcha comments from one side or the other of an issue that deserves more careful consideration.
President Grinberg allowed slightly more than 20 minutes of public comment on the topic, at one point encouraging audience members to get their say in because the rest of the meeting would not permit community input. Some of those comments fell into the “same old, same old,” predictable category. However, a statement read in tag team fashion by Myra Beals and Linda Jupiter did touch on salient points if/when the Labor&Delivery [L&D] Department at Mendocino Coast District Hospital (MCDH) is closed. The bullet points of Beals and Jupiter's remarks: “Have the ability to do an emergency C-section at MCDH when transport is too dangerous and the C-section is medically necessary… Acquire and outfit an additional ambulance that can accommodate laboring women and post partum complications… Make financial arrangements for a midwife or OB trained nurse or Family Health Practitioner… to ride along…”
Their statement went on to call for, “[A]ny equipment that will help prenatal care that is currently done in L&D that could be done in a clinic setting to both MCC [Mendocino Coast Clinics] and NCFHC [North Coast Family Health Center]… Provide extra staffing in the ER based on suspected birth numbers for the upcoming month.”
That request seems to presuppose a sudden closure of L&D at MCDH and the future dependence of coastal mothers on the L&D department at Adventist Health's Ukiah hospital. As did another part of the statement: “Pay for and provide transport to and from Ukiah for prenatal care after 28 weeks for anyone who has financial need or [is at] greater risk. Be prepared to accommodate the families as well. Provide childcare for single mothers... either in Ukiah (while mom is delivering) or at home if that is the mother's choice…”
Beals and Jupiter also called for a system that would provide for immediate transfer of records for a woman presenting in the [coastal] ER in labor. Their final comment concerned the funds the coast hospital district gets from the Measure C parcel tax. They asked that the remainder of this year's parcel tax money be spent on the items they listed. Other speakers from the community cited the support of the parcel tax from voters who believed that at least part of those funds would be used to sustain the local Labor & Delivery Department.
The items above represent only a partial list from the statement presented by Ms. Beals and Ms. Jupiter.
MCDH Chief of Staff, Dr. William Miller, presented some detail as well as a summary of 23 conditions a task force of local doctors deem necessary to ready the local hospital for a L&D system that will become one of “stabilization and transport” if L&D is closed.
Some of these points answered the requests of Beals and Jupiter. Readers should keep in mind that said task force came up with the 23 conditions, or challenges, within one week's time. In that period they have created solutions to many of the challenges. Their report was not released to the public as they are still at least days away from finalizing it for submittal to the Hospital’s board of directors.
Chief Nursing Officer Lynn Finley gave a report to the board about training of nurses along the same lines as the doctors' task force. Her counterpart at Howard Memorial Hospital (HMH) in Willits was among seven speakers from the inland Adventist Health facilities in Willits and Ukiah. They answered several detailed questions from MCDH Board member Amy McColley, who herself is an OB-trained nurse. The Adventist answers came back with at least as much specificity as the queries.
Then there was Lucresha Renteria, executive director of Mendocino Coast Clinics (MCC). She wants the coast hospital to wait a year before closing L&D. MCC employs the only long term coastal OB/GYN, so that creates an obvious financial backdrop for the delay.
MCC makes a tidy profit from prenatal care. On the other hand, MCDH bares the economic burden of keeping L&D open despite only 50 or so births at the facility in the last year. That burden in dollars represents a $2.1 million loss annually, according to figures recently released by MCDH Interim Chief Executive Officer (CEO) Wayne Allen.
Ms. Renteria claims it would take a year to transition to the stabilize-and-transport methods Dr. Miller and MCDH's chief nurse implied could be accomplished in a few months. I brought this question up with an Adventist Health official a couple months back. That official estimated a successful transition period at four months.
To support her argument for a year-long delay, Ms. Renteria cited the MCDH ad hoc OB committee formed more than three years ago. That committee issued a report about two and a half years back. Ms. Renteria properly noted that this report did not mention planning for such a transition to a stabilization and transport method. She pointed out that she and others in the minority on that OB committee wrote dissenting reports, which presumably cited just such a need. Therefore, it is a bit duplicitous to say on the one hand that you were aware two and a half years ago about the need to prepare for life after L&D on the coast and, while executive director of a clinic that employs an OB/GYN, not being ready for such a transition when the potential for L&D closure has drawn ever more imminent then to cry out for a year long further delay from the facility that is losing over $2 million per year in keeping L&D open. Come now, Ms. Renteria, such a specious argument may fool some people, but certainly not everyone.
What is more confusing, perhaps confounding, about Renteria's delay tactic is that she has been working with MCDH Board President Grinberg to establish the beginnings of a Women's Healthcare Center on the coast. Such a facility, presumably in the vicinity of MCDH and MCC, could provide pre- and post-natal care along with any number of other services. Under present regulations, having mainly to do with emergency C-section situations that require “decision to incision” within 30 minutes, it might be a stretch for the women's healthcare facility to become a full fledged birthing center as well.
Nevertheless, such a venue could become something of a shining example of what the remaining healthcare district can yet accomplish, post affiliation. Retired physician Buz Graham is helping to formulate a grant proposal to the Susan Thompson Buffett Foundation.
In Ms. Renteria's defense, she did bring up an important matter. That is the need for Adventist case managers to familiarize themselves with all current expectant mothers on the coast who may need to utilize L&D in Ukiah. When this point was made it appeared that the remaining Adventist healthcare givers were taking copious notes from the front rows of the audience seats.
The January 23 study session was an information only affair. Any final board of directors vote on the closure of L&D at MCDH remains a pending matter.
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