On Friday, January 30, following recommendations from its liability insurer, Coverys, the Cook County North Shore Hospital board voted 5-0 to end elective OB deliveries at the hospital as of July 1, 2015.
It wasn’t a popular vote, but because the hospital failed to meet “standards of care” set forth by the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists, it left the board with virtually no other choice.
The decision followed two weeks of public scrutiny and questioning, but by the time the board had presented all of its information leading up to its decision, nearly everyone who attended one of the public meetings held to discuss the matter was reconciled to the conclusion that elective births would be removed from the hospital’s services.
Before the vote was taken Hospital/Care Center Director Kimber Wraalstad addressed the board and the five people in the audience.
She reiterated, “This is not an indictment of the quality of care provided by the doctors, nurses and the rest of the staff. The doctors and nurses have provided excellent obstetrical care since 1958.
“This issue is not about the quality of care provided but whether we can meet the expected standards of care for elective services in a hospital. Having this conversation has been very difficult because we are publicly stating and recognizing the fact that we cannot meet expected standards of care for obstetrical services.”
Emergency C-sections the primary concern
Conservative costs to bring the hospital up to Coverys’ recommendations exceed $1 million per year, said Wraalstad. “Please note that is $1 million per year, not a one time cost. These costs are predominantly for anesthesia and surgery employees and we do not even have an operating room at this time. These costs do not include the cost of surgeons needed to perform the surgery. Vera Schumann [the hospital’s financial director] estimated that an ‘all in’ cost would be close to $2 million or over $200,000 per delivery.”
Since 2002 the hospital has averaged 9.5 births per year. On average 46 babies are born to county residents in a given year, but most of those births take place in Duluth.
The Coverys’ report highlighted five areas where the hospital needed improvement, however, said Wraalstad, “The most significant and daunting issue, and essentially the brick wall that we hit even when we overcome the other hurdles involves emergency cesarean sections…”
Without bringing in specialists and upgrading the hospital facilities, the only way the hospital could remain a birthing center was if it could prove that patients could get a caesarean section within 30 minutes of the arriving at the hospital. But, said Wraalstad, expectant mothers are at best two hours away from a hospital with surgical capabilities.
No legislative help coming
In an effort to gain some time, calls were made to Senator Tom Bakk, the Majority Leader of the Minnesota Senate and Representative David Dill, asking for help. Calls were also made to Congressman Rick Nolan and U.S. Senators Amy Klobuchar and Al Franken asking for assistance.
As Grand Marais City Councilor Anton Moody said at a public meeting held Wednesday, January 28, “They have the power of the pen.”
But in a phone conversation with Representative Dill, he said legislative help wouldn’t be forthcoming, at least from the state.
“I understand the dilemma you face up there. An insurance ruling might well prevent births from occurring at the hospital.
But we [legislators] can’t tell insurance companies what to do.
“It’s a disturbing trend across rural America. Medicine is getting more centralized and business is being pushed away from rural hospitals and rural communities to bigger heath care centers like those in cities like Duluth. They are the benefactors of these rules. But this is a local matter. The vote whether or not to follow the insurer’s recommendation is entirely up to the hospital board,” Dill said.
Board appreciates public input
Some were upset that the public didn’t have more time to weigh in on the matter, but Wraalstad went over the timeline from when the hospital received the Coverys report, which was about November 1, 2014 to the time she relayed that report to the hospital board on January 22. In between Wraalstad said, there were seven meetings with the staff, which included getting additional information from Coverys.
On January 14, Wraalstad requested information from the hospital’s legal counsel and with that in hand, brought the matter to the board on January 22.
Following the vote, Hospital Board Chair Kay Olson said, “It was not a question of whether we wanted to provide elective OB services, but one of whether we can provide elective OB services safely and in a manner that meets standards of care. The board, in consultation with the medical staff, made the decision we believe is in the best interest of patients, the hospital and the community.”
Board member Tom Spence Sr. added that the board appreciated the public’s input and the work beginning to create new policies and procedures for the hospital and Sawtooth Mountain Clinic to care for pregnant women and infants.
And, as Dr. Jenny Delfs noted in a previous meeting, some babies will still be born at Cook County North Shore Hospital under emergency conditions and the staff will keep training for such births.
The motion to discontinue elective births was made by Spence and seconded by Olson, and was carried unanimously by board members Justin Mueller, Sharon Bloomquist, and Howard Abrahamson.
How can you help?
A group tentatively called Birth Partners has been formed to look at ideas presented at previous public meetings, such as forming a Doula cooperative, transportation assistance, developing a health house in Duluth, and more. If you are interested in helping implement and grow, Birth Partners:
. Contact organizers – send an email to
amy@sawtoothmountainclinic.org.
. Attend a public meeting.
. Call Sawtooth Mountain Clinic at (218) 387-2330
and speak to a Child Birth Educator.
The next public meeting for Birth Partners will be February 11, 5-7 p.m. at the Cook County Community Center 4-H Building. This will be a brown bag supper meeting. Children are very welcome; there will be lots of toys.
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