No more babies to be born at Sonoma Valley Hospital after October

The Sonoma Valley Health Care District board voted Wednesday to close the hospital’s obstetrics department as a cost-cutting move, despite the entreaties of a standing-room-only crowd.

The board voted 4-1 to close the department, which is expected to sustain a half-million-dollar loss in the fiscal year 2018 and has seen a 35 percent drop in births since 2015.

The closure was the only issue addressed by the board at the meeting.

But the vocal crowd of about 50 people – including pregnant women, newborns, toddlers, expectant dads, nurses and doctors – won a small victory. Instead of closing in September 30 as originally proposed, the board voted to close the department Oct. 31.

“I wish the financial realities of reimbursement and politics and running a hospital in the Bay Area, where costs are outrageously high, were different,” said board chair Joshua Rymer. “These are hard realities. I say this with huge sorrow in my heart, but I don’t see a way for us to maintain this service in the face of that.”

The hospital’s revenue was $59 million in the fiscal year 2018, with a $3 million net income loss, according to unaudited numbers supplied to the Index-Tribune by the hospital on Tuesday.

There were 218 births in the obstetrics department in the fiscal year 2010, dropping to 148 in the fiscal year 2015 and 111 in the fiscal year 2018. This drop in the birth rate is part of a national trend.

The board was initially scheduled to also consider closing the hospital’s skilled nursing department, but Mather and Rymer Tuesday decided to postpone that vote to get more input from staff, doctors and residents. The board also postponed a budget discussion that was initially on the agenda.

The meeting took place in the basement of the hospital instead of the customary location at the City Council Chambers because the Sonoma Valley Citizens Advisory Commission was meeting in the Council Chambers.

About 20 people addressed the board, some of them with babies in arms, against a constant background of babbling and gurgles from the infants and toddlers in attendance. Among the standees were nurses from the obstetrics department, one of them briefly cradling a baby she helped deliver.

Nearly every speaker opposed closing the department.

“It is the wrong decision. You are taking the Birthplace away from the vulnerable,” said Rachael Hairston of Sonoma, who addressed the board while holding her infant daughter, Helen Loveridge.

The Birthplace has three private suites for labor, birthing and recovery, and five postpartum rooms, staffed by obstetric nurses.

Several speakers referenced the $250 parcel tax approved by Sonoma voters in 2017. The parcel tax promised $3.85 million a year for the next five years. One speaker described the closing as a “bait and switch.”

In an earlier communique to the community, Mather said that the parcel tax was not intended by itself to make the hospital sustainable.

Rather, she said, the parcel tax is needed to supplement State and Federal insurance payments, mainly Medicare and Medi-Cal, which are below the cost of providing hospital services, and keep the emergency room going.

Kate Knight of Sonoma questioned the effectiveness of the hospital’s marketing of the obstetrics department.

“I know women in Sonoma who drove to Santa Rosa to have babies because they didn’t know about Dr. Amara,” she said, referring to the department’s beloved obstetrician-gynecologist Dr. Paul Amara, as did many of the speakers.

Earlier in the meeting, Mather said, “We’ve done major marketing efforts. We created A Woman’s Place and we got a lot of patients for our breast surgeon, but we didn’t get more OB patients.”

While the hospital is struggling financially – a situation that is not unusual for rural hospitals across the country – patients, doctors and board members extolled the virtues of both the hospital and the obstetrics department.

The hospital ranks among the top 25 percent of hospitals nationally for quality, with a four-star rating from the Centers for Medicare and Medicaid Services.

During the comment period at the meeting, pediatrician Christina Sullivan said, “I’m concerned about your plan about having babies in the emergency room. I am concerned about a mom coming in in preterm labor and having only one doctor in emergency.”

Mather responded, “The budget was written with pediatricians on call.”

The hospital is by no means the only small rural hospital to contemplate closing its obstetrics department. Nine percent of U.S. rural counties lost their obstetric services between 2004 and 2014, according to a University of Minnesota Rural Research Center study.

Another 45 percent of rural U.S. counties had no hospital obstetric services at all during that time period.

“Prior research shows that greater travel distances for obstetric services are associated with higher rates of newborn morbidity and mortality,” researchers from the center said in a 2017 policy brief.

Board members said the closure was unavoidable because of the hospital’s financial situation.

“I don’t see in our numbers that we can carry departments that are not making money,” said Peter Hohorst.

Hohorst said that when the hospital built the new emergency and surgery wing, the general obligation bond that helped fund the construction did not cover the equipment.

“Our debt cost for that financing is $100,000 a month,” the board member said. “If we make no changes our cash flow will be $66,000 a month positive. If you have to pay debt service of $100,000, we are going to go downhill at the rate of $34,000 a month.”

Based on remarks from three physicians, including Amara, at the meeting regarding safety concerns about the speed of the closure, the board extended the time of the closure to Oct. 31.

Board member Bill Boerum initially moved to extend the closure to Dec. 31, but did not get a second for the motion.

Board members Hohorst and Rymer, as well as Jane Hirsch and Sharon Nevins, voted to close the department Oct 31. Boerum was the lone vote against the Oct. 31 closure.

“I offered that motion in hopes that by Dec. 31 some other financial solution would have been identified that would have allowed the department to remain open,” Boerum said in an interview after the meeting. “But primarily I offered the motion because three doctors had safety concerns.”

With the closure, Petaluma Valley Hospital and Queen of the Valley Hospital in Napa will be the closest hospitals where Sonoma Valley women can deliver babies. Amara is in the process of getting privileges to deliver babies at those hospitals.

Also, Sonoma Valley Community Health Center will continue to practice prenatal care and is working with its patients to ensure that they are able to find a hospital to deliver their babies.

“Our emergency department will continue to be there in case of emergency and we will work with our physicians and their patients to ensure that the residents are served,” Mather said.

Contact Janis at janis.mara@sonomanews.com.