Jobs, health at risk with OB closure?

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Twelve people will lose their jobs, the Community Health Center’s workload will increase and some pregnant residents will face increased health risks: So say opponents of the Sonoma Valley Health Care District’s decision to end the hospital’s obstetrics program.

Despite pleas from residents, the hospital board voted last week to close the department, which ods expected to sustain a half-million-dollar loss in fiscal 2018 and has had a 35 percent drop in births since 2015. Reactions to the closure ranged from resignation to rage.

“For decades, the Sonoma Valley Health Care District mission statement was ‘to maintain, improve and restore the health of everyone in our community.’ Now, they need to change that to, ‘except pregnant women,’” said Rachael Hairston-Loveridge.

She had her second child, Helen, at the Birthplace, the obstetrics department’s labor and delivery area, almost exactly a year ago.

“The impact on the community is huge. This is a bait and switch,” Hairston added. She was referring to a video, “Vote Yes on Measure E,” released in 2017 during a campaign by the hospital promoting an annual $250 parcel tax to help fund the hospital.

Text accompanying the YouTube video reads, “This money is going to provide the necessary funding for the hospital … and ensure that the Sonoma Valley community can continue to benefit from the Birthplace and many other wonderful services.”

Thirteen months after the parcel tax passed in June 2017, the hospital board voted 4-1 to close the Birthplace.

“No wonder new moms and moms-to-be and dads-to-be thought they could count on local delivery at Sonoma Valley Hospital,” board member Bill Boerum, the lone dissenting vote, said in an interview Wednesday. “In that video was a strong suggestion that it (the parcel tax) was going to help OB.”

“We feel the Birthplace should stay open at least for the life of the parcel tax,” Hairston said. The tax commenced July 1, 2017, and will end five years later. It is expected to generate $3.8 million annually for the hospital. Hairston said she hopes the petition will help persuade the board to change direction. “I hope we don’t have to file a lawsuit.”

In response, Kelly Mather, the hospital’s chief executive, said, “The parcel tax has always been about keeping vital emergency services in the community. That includes highly utilized services.”

“We believe we have made every effort we can to market and increase the volumes in the Birthplace, but at fewer than two births a week the service is no longer viable.”

Almost all of the approximately 50 people who spoke at the hospital board meeting on July 25 opposed the closure, as did those commenting on a related Index-Tribune Facebook post last week.

However, one Facebook commenter, Pamela Barca Wittig, said, “With only two births average per week, it makes sense.”

In response, “It’s easy to look at the two births per week, but this facility does more than that,” Hairston commented. “They see pregnant women throughout their pregnancies when they are sick, in distress, especially on weekends.”

The closure means that the closest hospitals for delivering a baby are Petaluma Valley Hospital, which is about 14 miles from downtown Sonoma, and Queen of the Valley Hospital, about 16 miles from downtown.

Eileen Natuzzi, a surgeon who is also a patient advocate, expressed concerns about the distance. Natuzzi maintains a home in Sonoma and her mother lives in the city.

“With traffic as it is now around Sonoma, a trip to another hospital could take an hour. In an emergency, every minute counts. What is SVH’s plan for dire emergencies such as bleeding and fetal distress?” asked Natuzzi, a member of the Surgical Economic Think Tank, a group of surgeons working toward economic solutions that put the patient and physician at the center.

Natuzzi gave a ballpark estimate as to how many local mothers-to-be might experience morbidity or even die because of the longer distance to local hospitals. The estimate extrapolates from the fact that 111 babies were born at the Birthplace in the last year through June.

“One study in ‘Health Affairs’ put obstetrical complications at 10 percent,” Natuzzi said in an email. “For 111 births that would be 10 or 11 potential complications. But not all complications are due to a delay in treatment so I would guess maybe one-third, roughly three of the pregnant women could be at risk for a serious complication due to delays in care.”

Sabrina Kidd, the hospital’s chief medical officer, addressed safety concerns in a letter to the editor of the Index-Tribune.

“Handling an emergency delivery is a required part of every ER physician’s training and something our emergency physicians and nurses are already trained to handle,” Kidd said.

Additionally, as the closure nears, the ER nursing staff will get refresher training in labor and delivery and newborn infant care, Kidd said. The hospital will run precipitous delivery mock codes and emergency neonatal equipment will be maintained in the emergency department, she said.

“Precipitous” means births happening unexpectedly, Mather said.

Natuzzi also expressed concern that the closure might be part of a paring-down of services that could eventually end in the hospital’s closure. Hospital officials are also proposing to close the hospital’s skilled nursing services and transfer its home health care services to another local nonprofit.

A North Bay economic expert seemed to share Natuzzi’s viewpoint.

“In itself, the Birthplace closure should have little effect, but if the obstetrics unit closing is a precursor to them closing the hospital, that’s a different ballgame,” said Rob Eyler, a professor of economics at Sonoma State University.

“In general the closing of a hospital that is the only real local option can be devastating to a community economically because they lose all those jobs,” Eyler said.

Sonoma Valley Hospital is the third largest employer in the Valley, with about 450 employees, according to the hospital’s website.

“We agree, and that’s why we are doing everything in our power to keep the hospital open,” Mather said. “A strong, viable hospital in this size community is not easy to maintain. We cannot continue to offer services that are losing money.”

While the possibility of a hospital closure throwing 450 people out of work is a matter of conjecture, the hospital board chair said 12 people will lose their jobs when the obstetrics department closes.

“Unfortunately, we anticipate that 7.5 full-time equivalent positions, staffed by 12 individuals, will be affected by the changes in OB,” Joshua Rymer, chair of the hospital’s board of directors, said in a blog entry the day after last week’s board meeting.

The closure will also affect the Sonoma Valley Community Health Center, said its CEO, Cheryl Johnson. “The workload will increase, based on what we are seeing right now,” she said.

In addition to labor and delivery services, the hospital performs tests such as nonstress tests on pregnant women, Johnson said. The health center is discussing possibly purchasing the equipment for the tests in order to take over those services.

“Most of it is logistics,” Johnson said. “We have to deal with logistics to make sure people get to the right place and we are respecting the patient’s birth plan.”

Hairston said she is deeply grateful to the help she got during Helen’s birth, and feels she owes it to the nurses and others who will soon be out of a job to fight the closure.

She added, “They are taking away peoples’ right to say, ‘Our child was born here.’ We are Sonoma Valley strong, Sonoma Valley proud and we won’t let them take that heritage away from us.”

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