HUDSON — For Hudson Mayor Kamal Johnson, the closure of the maternity ward at Columbia Memorial Hospital hit close to home.
“Literally, it’s up the block. I can see the hospital from my house,” he told the Times Union in an interview last week.
Johnson and his partner, Adalia Holcomb, welcomed their second daughter in 2021 during the height of the COVID-19 pandemic. A year earlier, the hospital — which is part of the Albany Medical Center network — announced that all births would be transferred to the main Albany facility, a 45-minute drive from Hudson in ideal traffic conditions.
The contractions began on April 18, 2021. The couple drove an hour to Albany Medical Center Hospital, where well-meaning doctors said Holcomb wasn’t ready to give birth and sent them home. As soon as they got to the house, Holcomb’s water broke and they had to turn around, according to Johnson.
“It’s draining when you are doing all that driving, and then, you’re driving with a person in labor, so you’re feeling every element of the road, every bump. Every time you have to brake, that person is feeling it,” Johnson said of the three-hour ordeal. “And chances are, you’re not going be the safest driver when you’re driving in a panic situation.”
Faced with staff shortages and declining birth rates, more than two dozen maternity wards in New York have closed in the last 15 years, forcing expectant mothers like Holcomb to travel farther for care.
Since the start of the pandemic alone, at least seven maternity wards statewide have closed or announced plans to shut their doors, and the sector has been shrinking at a rate of about two facilities per year since 2008, according to a Times Union analysis of hospital birth data and closure requests filed with the state Department of Health.
Other facilities recently on the chopping block were located in Niagara, Wyoming, St. Lawrence and Franklin counties, dealing a blow to rural communities where access to medical specialists has always been limited.
Advocates are sounding the alarm on maternity care deserts in light of new research showing an uptick during the pandemic in maternal deaths and birth-related complications, as well as widened racial disparities. In New York in 2021, the pre-term birth rates for Black women was nearly 14 percent — twice the rate of white women, according to the March of Dimes, a national nonprofit that works to improve health outcomes for women and babies.
“We’re in an infant and maternal health crisis, with pre-term birth rates and maternal mortality rates greater than we’ve ever seen in our history,” said Darcy Dreyer, director of maternal infant health at the New York chapter of March of Dimes. “Access to care is such an important piece of prevention and how we’re going to get out of this crisis.”
New law tested
The latest wave of closures is testing the efficacy of a new state law that requires hospitals to survey underserved populations in the community before reducing or eliminating a service. The information gleaned from the equity impact report is used to supplement an existing certificate of need process, during which hospitals must justify a closure plan to the state Department of Health.
Before the law went into effect at the end of June, hospital units often closed quietly, with little more than a brief in the local newspaper.
The public outcry over the proposed closure of Burdett Birth Center at Troy’s Samaritan Hospital — the only maternity ward in Rensselaer County, which neighbors Columbia County — has been a notable exception. Community efforts to “Save Burdett” have come to the attention of state Attorney General Letitia James, who held a hearing on the issue in Troy last month.
Medical providers, community groups and politicians accuse Samaritan Hospital’s parent, St. Peter’s Health Partners, of planning the closure in secret.
“It was an article in the newspaper,” Chelly Hegan, CEO of Upper Hudson Planned Parenthood, testified at last month’s hearing. “People who care about this community were never included in the conversation, nor was our input valued.”
While the outcome at Columbia Memorial Hospital was less than ideal, hospital officials did make an effort to engage community members in the process, according to Hegan.
“The result is still horrible,” Hegan said. “There are still major problems for us to solve in rural health care and that was not solved by what happened in Columbia County, but the patients were a part of the decision.”
The eight-bed obstetric unit, which closed well before the equity study law was implemented, had been delivering fewer than 300 infants per year, making it impossible to recruit enough full-time obstetricians to safely operate 24 hours a day, hospital officials said.
According to the hospital’s closure plan, patients continue to have access to pre- and post-natal care close to home, but they must arrange transportation to Albany for the birth.
“Each expectant patient’s birth plan includes specific protocols for transportation, which can include a number of options ranging from self-transport, which is how most patients arrive for delivery, to the use of emergency medical services transport,” Columbia Memorial spokesman William Van Slyke said. “This process has proven to be very effective.”
But local leaders say transportation issues continue to arise.
While Johnson and Holcomb were fortunate to have access to reliable transportation, one in four of Hudson’s 6,000 residents lives on an income below the federal government’s poverty line, U.S. Census data shows. Seven percent of Columbia County residents do not own cars, according to census records. In neighboring Greene County, which does not have its own hospital, 9 percent of the population is without a private vehicle.
“Hudson is like the tale of two cities. It’s split between the very wealthy and extremely poor, so, for a lot of people, transportation is a luxury,” Johnson said.
Columbia Memorial also avoided a layer of scrutiny by choosing not to decertify its maternity beds, bypassing the state’s onerous certificate of need process. It highlights a loophole in the system intended to check a rapidly consolidating health care sector.
Since the equity study is tied to the certificate of need process, a hospital could potentially avoid the new requirement by reducing services without formally decertifying beds.
In Troy, St. Peter’s Health Partners has sought to appease critics by voluntarily hiring a firm to conduct the equity impact assessment — becoming the first hospital to do so. Though the study hasn’t been released yet, questions have been raised about the methodology used.
The Save Burdett coalition has published its own study using the same guidelines, concluding that “closure of the Burdett Birth Center would worsen health inequities, causing much harm to medically underserved people in Rensselaer County and adjacent communities.”
Both studies will inform Department of Health officials as they weigh the hospital’s request to close the birth center.
According to Lois Uttley, founder of Community Voices for Health System Accountability, which pushed for the regulations, it’s too soon to know whether the new law will need to be amended.
“I think everybody on all sides — health advocates, the state regulators and the hospitals — probably realized that this was going to be a work in progress at first,” Uttley said. “Asking hospitals to commission these health equities studies is asking them to do something never done before and the health equity assessors needed to learn how to do it.”
A shrinking sector
Mirroring national trends, hospitals in New York have been scaling back obstetric services for years, but real-time data on maternity unit closures is hard to find.
The Times Union analyzed state Department of Health birth data, which is available through 2020, and then reviewed news reports and closure applications filed with the state Department of Health to identify 28 hospitals that have closed or reduced obstetric services since 2008 — in addition to the pending closure of the Burdett Birth Center.
That figure includes Lewis County General Hospital in Lowville, where obstetric services were temporarily paused in 2021 after multiple employees resigned over the COVID-19 vaccination mandate. The hospital has struggled to restore service.
Hospital unit closures picked up slightly after the 2008 recession, state health officials said. Reasons cited for service changes largely came down to staffing and finances.
Geneva General Hospital, the only hospital serving a city of 12,000 in the Finger Lakes, officially decertified its 12 maternity beds in March 2023. But the unit has been out of use since 2014 when all of its obstetricians left for other facilities. Since then, the hospital “has not been able to reestablish the OB service,” hospital officials wrote in a certificate of need filing.
In Troy, which has a population of 50,000, St. Peter’s Health Partners is looking to pare costs and meet profit margins across its six-hospital health care network. Hospital officials have said that the Burdett center is losing about $2.3 million annually — a relatively small burden on the system compared to the $42 million budget gap its flagship, St. Peter’s Hospital, saw in fiscal year 2022.
A majority of the closed or closing maternity wards were located in upstate New York, often in rural parts of the state where mothers already have limited access to reproductive care.
In the Mohawk Valley, for example, nearly 7 percent of pregnant individuals go through their entire pregnancy with little or no prenatal services, a figure well above the upstate New York average of 4.3 percent, state data shows.
Still, New York is faring better than other parts of the country. Just 3.2 percent of counties are classified as maternity care deserts in the state, compared to 35 percent of counties nationwide, according to the March of Dimes.
Dreyer, the March of Dimes director, said stagnant Medicaid reimbursement rates and a tight labor force — which requires hospitals to rely heavily on traveling staff — have created an impossible situation for many hospitals.
“I don’t know what the easy answer is,” she said. “Yes, we want birth centers to stay open, but can we expect them to be operating in the red to the tune of millions of dollars?”
In a statement, a Department of Health spokesperson said the agency is committed to eliminating health disparities and promoting health equity in New York.
“As we continue to see health care systems decrease or eliminate maternal care services, it has never been more important that we carefully examine the impacts these actions may have on communities through such tools as the New York state Certificate of Need process and the newly required Health Equity Impact Assessment,” Health Department spokeswoman Erin Clary said.
Midwifery part of conversation
Boosting Medicaid reimbursement rates is key to making obstetric services more tenable, experts say. Advocates have also proposed allowing midwives more independence in order to expand birthing options and meet reproductive health needs in rural areas.
While New York recognizes some midwife licenses — enabling them to perform home births independently — it is illegal for certified professional midwives, or CPMs, to practice outside a medical facility in the state.
There are currently two standalone midwife-led birthing centers in New York.
Burdett Birth Center, while part of a hospital system, is preferred by some for its unique midwife-centered model of care, which proponents credit for its nurturing birth environment and low cesarean rate.
A more traditional hospital might have continuous fetal heart rate monitoring which limits the mother’s mobility and strict rules around eating prior to birth. Midwives are also more amenable to performing vaginal births after a C-section, experts said.
For Black women, who face disproportionately high maternal mortality rates, the choice of medical practitioner can often make or break a birth experience, according to Zanetta Gary, a Burdett coalition member who had her 5-year-old daughter at the Troy facility. She said she chose the birth center because she knew its staff would honor her birthing decisions.
“The closure of Burdett Birth Center is not just going to create issues in this community, but it’s going to exacerbate existing issues,” Gary testified at the attorney general’s hearing. “Anyone with any exposure to public health … knows that Black women are in danger and this closure is only going to further that.”
2023-10-08 10:04:33
#Maternity #wards #continue #close #York
