Hospital Budget Without Obstetrics?
by Malcolm Macdonald, June 29, 2016
On June 21st the Board of Directors at Mendocino Coast District Hospital (MCDH) approved a 2016-2017 budget with a deficit of slightly more than $900,000. The Board vote was 3-0 for approval, with Kate Rohr absent and Dr. Peter Glusker abstaining. Glusker explained that he could not in good conscience vote to approve a budget with nearly a million dollar deficit built in.
As for Dr. Rohr, she submitted a letter of resignation from the MCDH Board effective last Friday, June 24th. Rohr will retire full time to her home in Maine.
That $900,000 projected budget deficit includes the Obstetrics Department (OB). At the May meeting of MCDH's Planning Committee the Chief of Patient Care Services, Terry Murphy, recited figures that painted OB as a million dollar, or more, loser per year. At that same meeting Chief Executive Officer Bob Edwards was asked if he was in favor of shutting down the OB department. The CEO responded in the affirmative.
No vote was taken at the May Planning Committee meeting regarding a recommendation to the full board of MCDH, primarily because Dr. Glusker asked that more input be given along with more detailed financial data concerning such a closure. At the June 22nd Planning Committee meeting and the special MCDH Board meeting that followed, Dr. Glusker stated that he had made four requests of Chief Financial Officer (CFO) Wade Sturgeon regarding financial information on the closure of the obstetrics department. According to Glusker the information should be open to any member of the public, but to date Sturgeon has not responded to the four requests for this material.
News/rumor of the possible OB closure got out to enough of the community to cause an overflow audience at the late May MCDH Board meeting. At that meeting CEO Edwards did not repeat his Planning Committee meeting desire to close the obstetrics department. He let Board Chair Tom Birdsell appease most of the audience by declaring that MCDH would host a public forum concerning the matter. That meeting date was confirmed in the following public service announcement released on June 22: “The Mendocino Coast District Hospital will host a Community Meeting on Tuesday, July 12 from 6:00 pm until 8:00pm at the Cotton Auditorium regarding the OB Services. The community is encouraged to attend in order to provide their input and receive information regarding the OB Services.”
Critics of the hospital's administration might have asked for an itemized breakdown of the OB Department's revenues and expenses for the past year. In the budget numbers accompanying the June 22nd Board meeting a theoretical “Budget without OB” attributed a $750,000 savings to a professional physician fees line item; however, no specifics regarding this dollar amount were given. One of the arguments for closing OB is that MCDH is birthing ten or fewer babies a month currently. Given that number the cost of an essentially part time OB physician and equally locum tenens (literally meaning a temporary substitute) pediatrician seems quite high. It would seem obvious that such dollar figures need to be specifically delineated.
According to a source close to the MCDH situation, Mendocino Coast Clinics currently helps to subsidize the hospital's OB Department by providing an on call OB doctor for half of every month at no cost to MCDH along with a pediatrician who does the same. To the best of this writer's knowledge that issue has not been brought up at any public meeting.
The problem with the July 12th meeting may lie in the way Board Chair Tom Birdsell has seemingly set up this public forum. It appears that the public will be allowed to give their ten cents worth, but the Board and/or administration will not respond at that meeting. This could allow CEO Edwards, with a majority of a reduced Board membership/majority (remember Dr. Rohr's resignation) to claim that public input was granted, but the actual decision may truly rest with administrators.
One possible solution to the OB Department problem could be the hiring of a pediatrician for MCDH's affiliated clinic, North Coast Family Health Center (NCFHC). This doctor would see family practice patients at NCFHC half time and serve as the on call OB physician for the hospital the other half. The money generated from family practice would help offset OB and pediatrician salaries.
Administration may claim they have tried to recruit OB and pediatric physicians without result. If so, the precise methods and advertising need to be made public, so there is no air of false claims or cover-up.
Other questions that need to be addressed: Administration has claimed that other hospitals have closed OB without major problems for community members. Were those hospitals as far away as Fort Bragg is from Ukiah? Do those hospital districts reflect socioeconomic situations similar to the Mendocino Coast? MCDH births measured by race and ethnicity show Hispanic births up from 33% of total MCDH births in 2013 to 43% in 2014, the most recent measured year.
The current MCDH budget figures seem at least slightly skewed to present OB in a less than favorable economic light. It could appear to some observers as if revenues associated with OB, like ultrasounds, lab tests, and surgeries are missing from the profit line of the department. A questioner might then ask, why are long sought after pieces of equipment shown as part of the loss line for this past year only?
Though MCDH has birthed only 100 or so babies this year, how many of those hundred mothers would be financially and physically able to travel over the hill to give birth? Before closing OB those statistics need to be known down to a very close approximation.
Then there's the blowback that closing OB will cause MCDH. Without an OB department, Emergency Room (ER) doctors and nurses are going to be responsible for many births on the coast. How many physicians and nurses will shy away from the liability load of emergency room deliveries when the childbirths at MCDH's ER mount into the dozens. One of the reasons given for closing the obstetrics department is the cost of OB trained traveling nurses. How much will those costs skyrocket when traveling nurse's agencies figure out that Fort Bragg's ER will be home to a handful or more of emergency childbirth deliveries each month?
Want another tough question to ask at the July 12th forum? It has been asserted that during the recent bankruptcy procedure the ombudsman assigned to MCDH by the bond agency stated that closing the OB department was not an option. Have MCDH's bondholders been informed about the potential closing of OB?
Hopefully, members of the public will have many more questions of their own on July 12th. Perhaps MCDH Board members and its administrators might consider it prudent to field emails and phone calls from their constituency before and after that date.
*Answers of all sorts abound at the author's website: malcolmmacdonaldoutlawford.com