Point Reyes Light - August 9, 2001
Petaluma Valley can’t close obstetrics
By Gregory Foley
In a far-ranging decision that should benefit West Marin’s expectant mothers for years to come, directors of the Petaluma Health Care District last week told administrators of Petaluma Valley Hospital they cannot close the hospital’s maternity ward.
After unanimously refusing to let St. Joseph System close the Petaluma Valley birthing unit, district directors ordered that hospital administrators adhere to the conditions of their lease.
Those conditions require the hospital to provide several core healthcare services – including obstetric care.
However, a hospital spokeswoman, Jennifer Howe, afterward said that if the hospital continues to have problems finding enough nurses for the birthing unit, it will again ask permission to close the unit.
John Severson, executive director of Coastal Health Alliance, which operates three nonprofit healthcare clinics in West Marin, said this week that the decision to keep the maternity ward open will temporarily ensure that West Marin women receive proper prenatal and delivery care.
"I was very, very encouraged the [district] decision was unanimous," he told The Light. "St. Joseph’s is facing a united front. The opposition will not go away easily."
The decision to deny St. Joseph’s request is not only significant for mothers-to-be in and around Petaluma, it is also significant for about 40 West Marin women each year who are cared for before and during childbirth by Coastal Health Alliance doctors, Severson said. The alliance operates clinics in Point Reyes Station, Bolinas, and Stinson Beach. The clinics are staffed by family-practice doctors who not only rely on Petaluma Valley’s maternity ward because of its proximity to West Marin but also because of a system which allows them to be part of an on-call delivery team who delivers some 240 babies (including many from Petaluma) each year.
Local doctors belong to eight-obstetrician team
Three Health Alliance doctors – Mike Witte, Kimberly Young, and Roberto Solis – are authorized to deliver babies on a regular basis at Petaluma Valley Hospital as part of the eight-member group. Severson explained that the program keeps the doctors’ skills current and also provides an additional source of income that allows them to continue their practices as part of the nonprofit.
If they weren’t part of the eight-physician team at Petaluma Valley Hospital, "our doctors would have lost skill and income," Severson said, adding that Young and Solis would be most affected. "It would not be [financially] sustainable for them to stay if deliveries were not happening at Petaluma Valley," he said.
Dr. Young of Stinson Beach said her primary concern is for patients that live in outlying areas of West Marin – such as Point Reyes and remote coastal ranches. They would be forced to travel greater distances to receive prenatal and delivery care, Dr. Young explained.
She said that some women are already forced to drive more than an hour to get to Petaluma Valley, and should the maternity ward there be closed, women would be forced to travel to Marin General Hospital in Greenbrae or Santa Rosa’s Memorial Hospital – both of which are considerably further from many parts of West Marin.
(Novato Community Hospital has already closed its obstetrics ward.)
Effect on Latinas
Dr. Witte of Petaluma – who stopped regularly delivering babies during the past year – told The Light that in 1985 he decided as a family practitioner in West Marin to start delivering babies at Petaluma Valley instead of Marin General, in part because of Petaluma’s proximity to Point Reyes Station.
He said that closing the Petaluma maternity ward would have hurt many West Marin women, especially Latinas who often rely on their working husbands for transportation.
"Women from West Marin would have been looking at a much greater difference. Hospitals should be 20 to 30 minutes away," he said. "Closing a maternity ward does a huge disservice. It gives patients one less option for where they can go and can make the burden on some families really untenable."
St. Joseph Health System on July 19 announced that it wanted to close the maternity unit at Petaluma Valley because the unit does not have enough obstetrical nurses to meet the national standards of care. Howe, a marketing manager for St. Joseph’s in greater Sonoma County, told The Light that the unit currently has the equivalent of 4.3 nurses on staff but needs 8.4 nurses working regularly to provide adequate care.
Hard to recruit nurses
Howe said that the hospital has been recruiting nurses for the unit for more than six months but has been largely unsuccessful. "We’re really worried about safety," she said. "There are no other issues. This is purely a staffing issue."
Petaluma Valley closed the maternity ward for six weeks in February and early March because of a shortage of obstetric nurses, but administrators now assert that they have adequate staff to keep the unit open until mid-September.
St. Joseph Health System in early 1997 entered into a 20-year lease on Petaluma Valley Hospital from the Petaluma Health Care District and its publicly elected board of directors. As part of the Catholic ministry Sisters of St. Joseph of Orange from Orange County, the organization operates hospitals in California and Texas with a written mission of "improving the health and quality of life of people in the communities we serve."
Howe said that nurses at Petaluma Valley were recently provided with a pay raise to bring their salaries in line with nurses at Santa Rosa Memorial, which St. Joseph also operates.
In addition, she said that the hospital will offer more flexible work schedules to attract new obstetric nurses to Petaluma, but an overall shortage of nurses nationwide has made hiring extremely difficult.
New closure plan possible
If St. Joseph cannot recruit enough nurses in the next month, administrators plan to again ask the Petaluma Health Care District Board to amend their lease so they don’t have to keep the obstetrics unit open. She added that if the lease cannot be amended and the district chooses not to take over administration of the ward, St. Joseph CEO David Ameen "would research legal options."
Daymon Doss, CEO of the Petaluma Health Care District, told The Light Tuesday that he believes that St. Joseph has financial motives for wanting to close the maternity ward.
Doss said that St. Joseph earlier this year reported losses at its hospitals in both California and Texas as a precursor to proposed cost-cutting at Petaluma Valley and elsewhere.
"I believe this was a focused, thought-out effort that began in January," he said, noting that the district board has no intention of either taking over the unit or allowing St. Joseph to alter its lease in the near future.
Not abiding by rules
Doss said that he believes that St. Joseph neglected to follow standard procedures for proposing the closure of the ward, first by announcing the intended closure on July 19, notifying staff of the possible closure, and then gaining an essentially "rubber stamp" vote of approval from the hospital’s governing board – which included CEO David Ameen.
"They’re not even pretending to be abiding by the rules of the process."
Doss maintains that nurses at the hospital provide safe and adequate care and that certain administrative policies may have contributed to the departure of some of the maternity unit staff.
"We’re not denying that there are difficulties, but we have reason to believe that there were some management practices that contributed to the problem."
In addition, he said, the nursing staff shortage has been exaggerated. "Any [hospital] organization that has staffing one and a half months in advance is in fat city," he said.
District directors last week after voting to keep the maternity ward open agreed to hire a panel of hospital consultants to determine how the unit can be properly staffed. Doss said the review will be objective and complete.
Did hospital drive off nurses?
"We need to determine if there were management practices that drove nurses away," he said. "Our district has said, ‘Let’s take a fresh look at this and get something sustainable.’"
Doss said that the consultants will study the issue over the next two months and will report their findings to the district on Wednesday, Oct. 10.
Severson of the Coastal Health Alliance said that while the district directors’ vote was encouraging, he agrees with Doss that the matter will not be resolved until the maternity ward is fully staffed for the long term.
"I don’t feel that closing the labor and delivery unit is a mission-driven decision," he said. "But like most hospital administrators they’re looking at the bottom line."