Obstetric Complications At Coast Hospital
by Malcolm Macdonald, July 20, 2016
The Mendocino Coast District Hospital's Board of Director's hosted a public forum about the Obstetrics (OB) Department Tuesday evening, July 12th, at Fort Bragg's Cotton Auditorium. A crowd of a hundred or so coastal residents and hospital staffers first listened to and watched a PowerPoint presentation by hospital CEO Bob Edwards. The high or low light of this was Edwards' claim that the OB department is projected to lose over $900,000 in the coming fiscal year. Edwards also cited the high cost of registry nurses as a part of the price of doing business in the OB Dept., though he at no time repeated the simple declarative statement he made at a committee meeting this spring when the CEO said he was in favor of closing OB.
Several of the public speakers commented that they felt Edwards seemed to present figures and information that leaned heavily on the side of OB closure. More or less ninety percent of the members of the public who spoke in the following two hours strongly favored keeping the OB Department at Mendocino Coast District Hospital (MCDH) open. Many spoke passionately about their own birthing experiences. Several cited the hour and a half drive to Ukiah Valley Medical Center (UVMC) as an unacceptable alternative.
Dr. Brent Wright, the only local practicing OB physician, spoke early on, remarking that MCDH is not a business, but a health care district. He and others have acknowledged that annual births at MCDH have dwindled down to somewhere around a hundred for this past fiscal year, but he further stated that it is difficult to place a value on even one life. More than one mother talked about how either she or her baby wouldn't have survived if they had to make the trip to Ukiah for a premature or otherwise troubled birth.
Edwards cited both a parcel tax measure and/or switching MCDH to a “Hospital Fee” structure as possible methods that could raise millions more annually. It is important to note here, that as of this date the only parcel tax concept presented by Edwards has been a straight tax per parcel. That method ignores the geographic and financial realities of a hospital district that encompasses tens of thousands of acres of timberland. Under the method in which each parcel is taxed an equal amount, a simple town lot in Fort Bragg would pay the same amount as corporate timber companies which own many parcels that are hundreds of acres in size. Not to mention that a 1950s style house in Fort Bragg would be taxed the same amount as a home/mansion overlooking the Pacific Ocean. If MCDH's Board adopts a straight up “all parcels are the same” mentality, they will be heading directly into the 1% vs. the 99% maw that doesn't fly on the Mendocino Coast.
Then there is the MCDH Board itself. Past Chair Sean Hogan noted the upcoming November election when three Board of Directors seats will be picked at the ballot box. Retired orthopedic surgeon Kate Rohr resigned in late June; Hogan is not seeking another term; only current Board chair Tom Birdsell is seeking re-election. That means that by 2017 there will be at least two new Board members.
The current board is hardly in accord. Board member Dr. Peter Glusker read a prepared statement that expressed some of the reasons why Dr. Rohr resigned. Quoting from Glusker's statement: “Dr. Rohr’s frustration at being prevented from analyzing the hospital’s finances and producing real change for the hospital was a major factor in her resignation. She has publicly stated, 'I cannot accept fiduciary responsibility for an organization in which I do not receive or trust the basic financial information'.”
Glusker's prepared statement began by citing a study by the Nicholas Petris Center on Health Care Markets and Consumer Welfare at U.C. Berkeley on the issue of OB closures in California hospitals. Again quoting Glusker's prepared statement, “They looked at 389 hospitals over an eight year period and compared those which closed OB departments to those which added new services. Closing OB departments resulted in deterioration in financial position related to a loss of patient relationship to the hospital and other factors. Hospitals did better financially when they added new services, instead of discontinuing them, particularly OB.
Therefore the assumption of administration that closing OB will help finances is not supported by available data. Contrariwise, adding a new service, for example palliative care which, we could do very well here, and which could utilize both swing beds and home health would be likely to improve the financial status.”
As Glusker read, it was at this approximate point that Chairman Birdsell attempted to gavel Glusker silent, apparently due to a three minute time limit or his distaste for criticism of MCDH's administration (meaning CEO Edwards and Chief Financial Officer Wade Sturgeon). The crowd wouldn't have it. Several voices demanded Glusker be allowed to finish.
He did so by relaying Dr. Rohr's response to the aforementioned study. “The absolute MOST significant finding of the study is that closing OB did NOT improve financial performance. In fact it statistically shows that closing OB had a disproportionately NEGATIVE effect on finances. That is, overall hospital business at those hospitals decreased more than could be accounted for by the loss of OB business itself. This is not a surprise to someone from the business world. If a business has a service that is part of the basic definition of its core mission, closing that service cannot possibly improve its finances. In this case labor and delivery is about as basic a core service of what it means to be a hospital. It is well known that if a core service cannot be made profitable the correct task is to streamline and make it as efficient as possible. This is the basic concept of the so called ‘loss leader’.”
Dr. Glusker then wrapped up with this, “My own attempts to obtain the financial details underlying the administration’s OB budget listing a one million dollar deficit were thwarted and resulted in more barriers being put in my way. I managed to get OB departmental statements for January and May, 2016. These reveal very disturbing inconsistencies, raising serious questions about the accuracy of the data. I suggest that this requires an independent analysis of the accounting for OB for the last year to determine accurate information, and then to plan HOW to manage OB.
“A recent study by Lorch et al, examining what happens to babies when regional OB units close, found an approximate 40% increase in infant mortality in the first three years. After that services were effectively redistributed to OB units geographically close enough to provide care. Our location does not allow OB services close enough to provide care for the kinds of problems that lead to infant mortality.
If OB were to be closed here, besides further losing the community’s trust in the hospital, we also put patients at significantly greater risk with ER doctors trying to deal with failed home births, malpositioned or crowning babies, placenta previa or a need for an emergency C-section. These problems pose critical medical risks for mother and baby, leading to infant mortality or potentially lifelong neurologic disabilities. The distance to the nearest obstetrician and hospital does not allow transfers in most of these situations. The medico-legal risks for the hospital are also increased. ER care for OB is not good quality care. When Sean Hogan was president of the board his emphasis was on quality of care. Finally, the administration needs to cooperate with the board and not try to direct the board as they are with attempts to close OB, and the Board needs to focus on planning and strategy.”
Clearly there has been an ever widening rift between the two doctors on the MCDH Board (now one) and the CEO and CFO. The questions over the OB Dept. are perhaps the tip of the iceberg at an institution with more than $16,000,000 in capital expenses still outstanding in the near future as well as the legal requirement to construct a more or less entirely new facility in thirteen and a half years at who knows what cost. Those folks who turned out, those who watched on Mendocino TV, and more, are going to need to stay involved and informed.