There may come a day, in the not too distant future, when the stork no longer visits Sonoma Valley Hospital.
With birth rates down and expenses soaring, delivering babies there has become untenable, costing the hospital an average of $60,000 a month, administrators say.
That’s why CEO Kelly Mather plans to put a proposal before board members next month to close the hospital’s maternity wing once and for all. The proposal – details of which will be released in early January – would be considered by the five-member board during its regular Thursday, Jan. 9 meeting.
Mather said she hates the idea of closing such a cherished part of hospital operations, but believes the hospital has no choice.
“Our financial health and viability is key right now,” she said last week.
Administrators say there are many factors, not just obstetrics, hurting this district hospital’s bottom line. Overnight stays are way down, for example, and payouts from Medicare have been slashed. Recently, the hospital was forced to stretch funding in order to meet tough new standards for seismic safety. (A grand opening for the new earthquake-safe wing, which includes an emergency room and operating suites, was held last month.)
But many of those other problems have been addressed by now, Mather said, and closing obstetrics would be the last of several recent restructurings designed to fix a bad budget situation.
Why the maternity ward is losing money is partly a case of simple demographics: In Sonoma Valley and throughout the county, the number of overall births is in steady decline. In 2012, the Sonoma County Department of Health Services reported that the county’s birth rate – already well below the state average – had “continued its decrease for the sixth consecutive time period, down approximately 7 percent from 2002-04.”
For these and other reasons, “The idea of the traditional community hospital is becoming obsolete,” Mather said.
The last straw came in October, Mather said, when Medicare cut compensation to medical facilities treating a large percentage of lower-income patients, as Sonoma Valley Hospital does. As a result, $750,000 a year “just went away on Oct. 1,” she said.
Cheryl Johnson, CEO of Sonoma Valley Community Health Center, said she can appreciate Mather’s dilemma.
“Kelly’s done a good job in going to the community and educating them about the hospital’s position,” she said, adding that “It’s hard to argue with the numbers.”
“From a rational point of view it’s an understandable position. From an emotional point of view it’s hard to swallow.”
Johnson said 80 percent of all births at Sonoma Valley Hospital are patients from her center. “So for us, we are in the process of assuming the worst, and making plans to alter our model to adjust to the plans that the hospital is making.”
In particular, she said, Sonoma Valley Community Health Center is considering the options of sending patients to Petaluma Valley Hospital in Petaluma or Santa Rosa Memorial Hospital in Santa Rosa. Both facilities are operated by St. Joseph Health System.
“Either place is going to require transportation,” which can be problematic, Johnson said. (Mather said Sonoma Valley Hospital’s emergency room will continue to handle sudden and unexpected births, a fairly common occurrence for ERs.)
Closing the local maternity ward will disproportionately affect “women with the least resources,” said Dr. D. Paul Amara, a Sonoma OB/GYN who put the percentage of hospital births by Community Health Center patients at closer to 65 or 70 percent – a smaller but still significant number.
Amara has run the local maternity ward since 1997, and “I’ve had the privilege to be involved with the birth of over 3,300 Sonomans during that time,” he said.
Like others close to the issue, he sees the proposal to close obstetrics as a matter of “balancing financial constraints against the need for services.” And he is careful to note that “it’s not a decision that’s been made; it’s under discussion.”
But he couldn’t help but discuss the hospital’s maternity wing in affectionate terms.
“It’s a gem of a unit,” he said, which “inspires me to continue practicing OB.” He also described the unit’s many nurses as “wonderful and extremely dedicated,” and worried about their future should obstetrics be closed.
Finally, he said, there is the impact on patients to consider. And while closing obstetrics might save money in the short run, Amara said there are positive long-term effects – “downstream revenue,” as he put it – of continuing to deliver babies at SVH. For example, people born there can become dedicated patients later in life, insisting on using their hometown hospital.
“Unfortunately, demographics are against us,” Amara acknowledged. Should the hospital board choose to close obstetrics, he said he would continue practicing while working on a “smooth transition to another hospital.”
As for the board members who must make the final call, “I don’t envy their decision,” Amara said. He called them “respected, dedicated volunteers from the community,” and added that he would respect their final decision on the matter.
Mather said she is still holding out hope that a better solution can be found. Lately, for example, the hospital has benefitted greatly from wealthy local patrons.
“If a philanthropist gives us $60,000 a month, I won’t (recommend the board) close the service, and I’ll be happy,” she said.