Department of Health Holds Hearings on Memorial Hospital Birthing Unit

On March 17, the RI Department of Health (DOH) held the last of three public hearings in regard to Care New England’s (CNE) proposed closure of Memorial Hospital’s obstetrics unit. Each hearing drew about 100 different community members, birth advocates and medical professionals, and three members of the DOH, including Director Dr. Nicole Alexander-Scott, listened to the public’s concerns. With few exceptions, speakers argued passionately — often tearfully — for the obstetrics unit in Pawtucket to remain open. Video recordings of the hearings can be found on the Coalition to Save Memorial Hospital Birthing Center Facebook page.

Those opposed to the closure are fighting to defend exactly what Dr. Alexander-Scott prioritized for the Department of Health after she was appointed director nearly a year ago by Gina Raimondo. In a June 2015 interview with ConvergenceRI, Dr. Alexander-Scott laid out her priorities for the DOH: to ensure access to quality care, address the social and environmental determinants of health, and increase equity and eliminate disparities in healthcare. She went so far as to say, “I think the name of the Department of Health should be changed to the Department of Health and Health Equity.”

On March 15, when asked by reporters about the decision facing her DOH appointee, Gina Raimondo responded, “As a mother my heart goes out to these young women who are planning to have their babies and then – oh, oops, you might not be able to at this birthing center.” In her comment, Raimondo showed a shocking lack of sensitivity to the amount of planning women put into the way they’ll birth their babies or understanding of the plight of the underprivileged women in Pawtucket and Central Falls who may not have transportation reliable enough to get them to another hospital.

In a way, Memorial was put on this path to restructuring in the ’60s. In 1965, Medicaid and Medicare added more patients to the healthcare system, and to accommodate them, hospitals began expanding — in industry terms, adding beds. Fear of a bed surplus leading to hospitals overcharging or recommending unnecessary hospitalizations to fill those beds led to the Certificate of Need federal law, which was passed in 1972. It states that before a hospital can be built or expanded, it must prove a need in the community. But the definition of a need has evolved, and today, medical professionals generally agree that fewer and shorter hospital stays are better for patients. So now we have too many beds, a problem hospital administrators have been grappling with for decades.

In 2013, the Health  Care  Planning  and  Accountability  Advisory  Council analyzed Rhode Island’s healthcare system in a report it presented to the Rhode Island House and Senate. In its analysis, the council determined that RI has a surplus of about 200 beds.

This brings us back to CNE, which, after a lengthy silence following its February 29 restructuring announcement, is trying to reassure RI residents that it’s more than capable of meeting their maternity care needs. It developed a transportation plan, in which CNE will provide or arrange transportation between Memorial Hospital and Kent or Women & Infants for maternity care Memorial can’t offer at its family outpatient clinic. Women in labor will be transported by ambulance to any hospital with an ER, which is a standard EMS regulation — not necessarily a plan developed by CNE.

The network also states that there are plenty of maternity beds in the state to go around. However, as the Health  Care  Planning  and  Accountability  Advisory  Council said in their 2013 report, “a bed is not a bed.” This means that even though the number of available maternity beds matches up with the birth rate, demographics affect service needs. Service should be “delivered in a culturally competent manner,” something Memorial excels at, and transportation issues should be considered a “barrier to care.”

The underprivileged generally do not seek out healthcare as often as the more affluent, and healthcare professionals are reimbursed by Medicaid patients for 56% of what they receive from private insurers. As a result, healthcare facilities in poor areas often struggle financially. Despite successfully building trusting relationships with members of the community, which encourages patients to seek care, Memorial Hospital has struggled for years and stated recently that since July 2015, it’s been losing $3 million a month. This loss is largely what’s driving the restructuring. However, one speaker at the March 17 hearing argued that disparity in and access to healthcare in underprivileged neighborhoods can only be fought if networks invest in struggling community hospitals. Others argued that if CNE marketed Memorial as well as it does its other hospitals, finances perhaps wouldn’t be as much of a concern.

But currently, they’re a huge concern. In a recent article, we questioned the speed at which CNE is trying to push through this restructuring, and WPRI uncovered information that explains the rush. On March 31, CNE’s lenders will confirm whether the network is in compliance with its bond covenants, which state CNE must have 45 days cash on hand. As of three months ended December 31, 2015, CNE had only 41 days cash on hand. According to WPRI’s article, CNE executives met with members of the Raimondo administration last week, but no request for government intercession was made. Perhaps the speed with which CNE tried to push through the restructuring was a desperate attempt to regain cash and comply with their bond covenants. If that was the plan, protesters changed its timeline by demanding public hearings and ensuring the restructuring wasn’t rubber stamped. No announcement has been made about the pending merger between Care New England and Southcoast, but the parties expect the deal to be finalized by the end of this month.

I am not a disinterested bystander in these proceedings; I gave birth to my younger son at Memorial. My first son was born at Women & Infants, and I went to the hospital with a midwife-approved birth plan that I hoped would result in a low-intervention experience. However, when I arrived at the hospital to deliver my eldest, I gave an anxiety-induced high blood pressure reading — not uncommon for me. I was immediately categorized high-risk and remained in that category even after I relaxed enough to give a normal blood pressure reading. As a result of my high-risk status, I lost nearly all autonomy and choice in my birth, an experience echoed by many other mothers who attended the DOH hearings. My births were textbook, but my son’s birth at Women & Infant’s was treated like a potential emergency, and my second birth at Memorial was treated like a normal life event — a dramatic difference that was a far better fit for me and my family.

A nurse who spoke at one of the public hearings said that plenty of high-risk patients come to Memorial from Central Falls and Pawtucket, but because women experiencing high risk labors should have as much right to choice as women categorized as low risk, the hospital’s standard of care remains the same. Respectful, family-centered care is worth traveling for, as evidenced by one mother’s testimony that “Barrington births in the Bucket.” But for the women of Central Falls and Pawtucket who perhaps can’t travel to seek respectful, family-centered, evidence-based care, how wonderful that they can find it in their neighborhood. And what a shame that CNE plans to take it from them.

CNE is treating the birth experience as a fully transferrable commodity, considering only economics and bed count in its planned restructuring. Protesters say that not all obstetrics units are alike and access to quality care and choice in birth is essential for healthy families. It’s now up to the DOH to decide which approach will prevail.

The Department of Health will accept written comments from the public until March 25. They can be emailed to Paula.Pullano@health.ri.gov or mailed to Rhode Island Department of Health, Center for Health Systems Policy and Regulation, 3 Capitol Hill, Providence, RI 02908. The DOH must approve or deny CNE’s reverse application of need within 90 days of completion.