Maternity ward's closure divides community

By Ginny Privitar
PORT JERVIS — Bon Secours Community Hospital in Port Jervis opened its New Life Center in 2001 with much fanfare. This modern maternity ward was greatly needed, the hospital said at the time. New York State agreed and issued the necessary permits. But 12 years later, in January 2013, the ward closed, stranding many pregnant women in need of delivery, especially those without the means to travel elsewhere.

Even before applying to the department of health, hospital administrators let obstetricians go and told staff the maternity unit would close. Blueprints for the renovation were dated Aug. 15, 2011, two months before the hospital submitted its Certificate of Need to the health department.

Many in the community believed the ward was closed long before it actually was. A Milford woman gave birth in a Citgo station on the way to Wayne Memorial Hospital in Honesdale, nearly an hour from home, because she believed the ward was closed.

A group suing the New York State Department of Health and Bon Secours to close the ward say the hospital closed the ward because it was used by too many women on Medicaid. Hospital administrators say its decision had nothing to do with money. They gave two reasons for the closure: the number of births had declined, and the hospital was unable to recruit qualified obstetricians.

Deborah Marshall, vice president of public relations at Bon Secours, said the hospital filed a Certificate of Need with the department of health based on the recruitment problem. But, she said, “It was not the basis of the approval. Our numbers (of births) had actually reduced.”

Many residents in the area served by Bon Secours are poor. Many do not have cars. A high percentage of pregnancies are among teenagers and women unable to afford pre-natal care, which results in many high-risk pregnancies. The most serious high-risk pregnancies need hospitals with advanced equipment and services, like Orange Regional Medical Center in Middletown, about 25 minutes away.

Port Jervis lacks public transportation, and there’s none to Orange Regional Medical Center. The quickest way to Middletown is Interstate 84, which climbs to 1,275 feet as it crosses the Shawangunk Ridge. But in severe weather — fog, heavy rain, ice, and snow — delays on the ridge are common, and cut Port Jervis off from the rest of Orange County.

Dr. Fred Nichols served at Bon Secours for 12 hours a week before becoming chief of obstetrics at Newton Medical Center in Newton, N.J. He started in 2010 and continued until his termination on Jan. 10, 2012. He told The Pike County Courier that his contract with Bon Secours stated he was not allowed to deliver babies except in emergencies. On at least one occasion lasting more than a week, no obstetricians were on call at all, according to Deborah Marshall, vice-president at Bon Secours. Expectant women and others in the community told The Pike County Courier they were under the impression that Bon Secours was not delivering babies while the maternity ward was still open. Patients, staff, and community members who opposed the closure said all of this led to confusion in the community.

Bon Secours is the closest hospital not only for those who live in Port Jervis, but also those in Milford, Matamoras, and Dingmans Ferry, Pennsylvania; in Montague, New Jersey; and in Deerpark and Sparrowbush, New York.

A decision to close
In October 2011, in a Friday night email to staff, Bon Secours’ CEO, Phillip Patterson, announced there would be cuts, according to Dr. Nichols and a former employee of the maternity unit who does not want to be identified. Earlier that same day, the hospital submitted its request to close the maternity ward to the New York State Department of Health. Just before Christmas 2011, the hospital issued pink slips to two staff pediatricians and one obstetrician. At the same time, other obstetricians with privileges at the hospital were told the hospital would no longer offer obstetrical care, and that women would be redirected to Orange Regional Medical Center.

Administrators said the hospital needed at least 500 births a year to maintain the staff’s skills. Fewer than that, they said, would expose the public to risk by inexperienced staffers. But a search of the preceding 29 years showed the hospital never had 500 births a year. The average for the period was 282 births a year. At Bon Secours, births dropped off steeply — by 35 percent — from 2009 to 2011 (see sidebar).

The department of health never stipulated the 500-births rule. Many in the community, including some hospital staffers, attribute the drop in births at Bon Secours to the hospital’s pulling back resources — and that these numbers in turn were used to justify closure (see sidebar). Several staff members said they had many years of obstetric experience and continued to upgrade their skills yearly. Yet the hospital planned to transport women in labor to Orange Regional Medical Center, or, if they could not be transported, have them delivered by the emergency room staff at Bon Secours, which has far less obstetric experience. Bon Secours must provide obstetrics training to its emergency room staff, and designate space in the emergency room for deliveries that cannot be transferred, according to the state's closure requirements.

Long-term plan to eliminate obstetrics

At the Nov. 28, 2011, meeting of the Port Jervis Common Council, Jeff Riley, senior vice president of Bon Secours said the “closure of the OB service line” had been under consideration for a “bunch of years.”

Riley wanted to address what he called “rumors” and to present the hospital’s position. He later said he did not know that the hospital needed to inform the community of its decision and allow a 45-day public comment period.

Many members of the Port Jervis community sent protest letters to Albany, including Mayor Russell R. Potter and the city council, the board of education, the Town of Deerpark Supervisor, the director of the Tri-State Pregnancy Center in Pennsylvania, and the executive director of Maternal and Infant Services Network of Orange, Sullivan and Ulster Counties, among many others. Obstetricians Hugh Forbes and Fred Nichols, nurses, public officials and community activists went to Albany at the invitation of the department of health to give their reasons why the ward should not close. Two hundred petition signatures and more than 50 letters against closure were presented. Supporters of the maternity ward met with senior officials from the department of health with oversight over the hospital. Attorney Michael Sussman of Goshen offered his services pro bono to the fight against closure. The group adopted a name: Citizens for Our Healthy Community.

Most people watching the case believed the department of health would forbid closure. In a May 29, 2012, letter to Deputy Health Commissioner Richard Cook, Fred Kelly, the chairman of Bon Secours, says the hospital realizes the Certificate of Need application to close the maternity unit will be turned down, and that Bon Secours’ boards “are unanimous in their disagreement with this decision.”

Over the next six months, the department of health entered a period of private negotiations with Bon Secours. The closure plan was not made public, and the community was not allowed to give input.

A sudden reversal
Then on Dec. 21, 2012, Cook’s successor at the department of health, Karen Westervelt, approved Bon Secours’ closure plan. The department of health offered no reason for its decision. Westervelt was not available for comment.

Administrators moved swiftly toward closure. The maternity unit was dismantled and remade into private medical and surgical rooms. The waiting room for family members was removed.

The Emergency Medical Treatment and Active Labor Act aims to prevent hospitals from transferring uninsured or Medicaid patients to public hospitals without screening them first. But determining the line for “safe transfer” can be difficult, according to Dr. Nichols. The law says a pregnant woman who presents in active labor must be admitted and treated until delivery is completed. But the law also allows that the line between true active labor and “false" labor, or very early labor, is difficult to know.

Mary McCourt says her daughter Erin delivered twin boys at Bon Secours on Nov. 25, 2011. “The two boys’ heads were locked, and they had to do an emergency C-section,” she said. “They were both full-term babies. If she had to go to Orange Regional Medical Center, I can’t say that both of the boys would have survived. If you’re in labor and having a problem, 5 or 10 minutes can make a big difference.”

The closure plan comes with conditions. For the next two years, Bon Secours must pay, through Middletown Community Health Center in Port Jervis, which provides prenatal care, for the travel expenses of women in labor and family visits after the babies are born. Travel vouchers are not well publicized. Middletown Community Health Center is responsible for letting patients know about the vouchers and for making disbursements.

Deborah Marshall said Bon Secours is partnering with nonprofits to put outreach programs in place. But, to date, no programs have been scheduled.

The designated delivery area outside the emergency room can only accommodate normal deliveries, not C-sections. So far, no babies have been born in the Bon Secours emergency room.

The maternity unit closed on Jan. 20, 2013. Administrators said it was a difficult decision, and that they had hoped to place its 15 maternity nurses elsewhere in the hospital or in other Bon Secours facilities. They say women in labor can be safely transported by ambulance or taxi over the mountain to Orange Regional Medical Center.

On April 12 attorney Michael Sussman brought suit against the state and the hospital asking the court to force Bon Secours to resume maternity services. The complaint states: “In allowing those services to be closed and discontinued, the (department of health) ignored overwhelming community sentiment and...endangers the health, welfare and safety of...thousands of...women in the catchment area of the hospital.”

Women want deliveries close to home

Chelsea was due mid-December 2012. At the beginning of November, she said, Bon Secours told her they would not be delivering any babies because they didn’t have enough staff.

Chelsea lives on a mountain in an isolated area. She was concerned about the 40- to 45-minute trip to Orange Regional Medical Center. So she decided to have labor induced at Orange Regional Medical Center on Dec. 18. But she went into labor on Dec. 11 and went to Bon Secours to make sure it was true labor. After a long wait, an ambulance transported her Orange Regional Medical Center. “It was a long painful night," she said.

Jane was pregnant with her third child. Her due date arrived and labor had not started, so she went to Bon Secours and asked for a Cesarean section. She was high risk because of diabetes. The delivery by Dr. Hugh Forbes went fine. Her daughter was one of the last babies born at Bon Secours.

“If I do decide to have any more kids, I want Bon Secours maternity to be there,” she said. “Otherwise I would have to drive at least 30 minutes away and find someone to watch my kid. It’s ridiculous that they closed when there are a large number of people that need that unit.”