Obstetric Cuts at Coast Hospital

At its Thursday, January 30th meeting the Mendocino Coast Healthcare District's Board of Directors voted to transition the Labor & Delivery (OB) Department at Mendocino Coast District Hospital (MCDH) to a “stabilize and transfer” model. Board Vice-President Steve Lund made the motion “to transition from [the] existing Labor and Delivery model no later than June 30, 2020. The transition plan shall include all necessary policies and strategies needed to ensure patient safety, essential staffing to handle emergency C-section requirements, and a robust support system to meet the needs of all OB patients in our care to the best of our ability.

“Staff is hereby directed by the Board to work internally to develop such strategies and systems necessary to support this change as soon as practical. We ask that regular monthly updates be provided to the Board to ensure that all requirements and resources needed to complete this transition by the designated deadline or sooner are in place.”

The Lund motion passed on a 3-1-1 vote, with Lund, Board President Jessica Grinberg, and past Board President Karen Arnold in favor. Director Amy McColley voted, “No,” and Board Finance Chair John Redding abstained. Redding had earlier offered a motion that would have delayed a vote until a complete written plan from a medical staff task force (referenced in last week's AVA) was presented to the board. That motion died for lack of a second. McColley opposed the Lund motion because she wanted more detailed protections for coastal women who are currently pregnant before those expectant mothers are transitioned into the “stabilization and transfer” model.

What this all means is no more births at MCDH except in the rare case of one in the emergency department. Whenever possible expectant mothers on the Mendocino Coast will be transferred to the Adventist Health (AH) Labor and Delivery Department in Ukiah. Howard Memorial Hospital, the AH owned facility in Willits has been without Labor and Delivery for decades.

According to figures released by the hospital, Labor & Delivery lost $2.1 million dollars over the last year. Given the hospital's precarious financial situation, something had to give. The only comparable money loser at MCDH is its North Coast Family Health Center (NCFHC), which sees tens of thousands of patient visits per year. Last year there were fifty-six births in the L&D department. Approximately one hundred eighty coastal women chose to give birth somewhere else (most in Ukiah) last year. Thus, three out of four mothers-to-be have already been choosing to go over the hill to give birth.

Yes, those rare cases of births in the ER will inherently be more risky, especially C-sections. Traveling an hour and a half to Ukiah Valley Medical Center creates a certain amount of added risk. Presumably, most traveling mothers-to-be will not arrive at the last minute, the final hour, possibly not even the day of giving birth. Some will, though, and that will add an element of uncertainty.

This is the new normal in rural areas across the state and the country. More than a hundred small American hospitals in low population centers have closed in the 2010s. Administrators and board members all over have had to make tough decisions like the one made by the Mendocino Coast Healthcare District. Those hundred other rural hospitals made their hard financial decisions too late.

MCDH's financial problems go back well over a decade. Required repairs were ignored because the money wasn't there for them. The same has been generally true for equipment upgrades. The hospital's OR was shut down for nearly five full days recently due to not following guidelines that should have been upgraded two to three years ago.

MCDH could be shut down by Medicare or the state department of public health if more violations of that sort occur again in the near future. In addition, statewide and nationally, the cost of providing health care steadily rises while reimbursements to the hospitals arrive in fewer and fewer dollars. Among other reasons to affiliate with a larger hospital system is the advantage of better negotiating power with insurance companies.

To be sure, the last few MCDH Board meetings have seen a fairly organized group of die hard speakers in favor of retaining Labor and Delivery (OB). Their appeals come from almost all angles. Some seem to only cite the truths or partial truths that they want heard. Some say one thing last week then pretend it wasn't said this week. Some of them are speaking from heartfelt personal experience. As with any major issue of any given time, the potential for divisiveness can rear its head. One example occurred near the end of the community input on the OB matter when a man rose to speak. Before he'd even reached the microphone a woman in the row behind me said to her neighbor, “Oh, these men just want to close OB.”

Not that it truly matters, but two of the three Board of Directors votes to switch to the “stabilization and transfer” method, effectively shutting down L&D, were cast by women.

As stated earlier, Director John Redding abstained on the OB vote. There have been other abstentions on fairly crucial MCDH Board votes in recent months. Maybe it's time to clarify when a vote to abstain is appropriate. In general, the following concepts hold forth concerning the right to abstain from voting on a board agenda action item. If the board member feels ambivalence about the matter at hand or a sense of disapproval that doesn't rise to active opposition, she/he may abstain.

An abstention may be invoked if the board member holds a position about an issue, but popular sentiment appears to overwhelmingly support the other side, the board member can refrain from voting his or her conscience. A board member can, and probably should, abstain when she/he feels he/she isn't adequately informed about the issue. In other words, a board member can more or less cite any number of reasons for abstaining, or simply abstain without stating a reason publicly.

One elephant in the room during the coast hospital board meeting concerns Adventist Health's unspoken, yet relatively clear desire to get the L&D decision over and done with. AH doesn't want that public relations stain on their operations, but more importantly they don't want the financial losses to continue any longer than possible. Though it will not sit well with those who have hoped Labor & Delivery services would continue at MCDH, Thursday night's board decision may help assuage some of the uncertainties in the affiliation process.