By Liora Engel-Smith
When Brittany Bullock left Martin General Hospital with her new bundle of joy earlier this month, she couldn’t help but feel sad. The birth of her second child, Emery Ann, went exactly as planned and the newborn, who took her first breath on Sept. 16, was well.
But Bullock, a resident who herself was born in the Williamston hospital, couldn’t shake the realization that her daughter is among the last babies to be born at the labor and delivery unit.
The Quorum Health hospital announced in a press release earlier this month that it was discontinuing labor and delivery services effective Oct. 21 “to better meet the community’s long-term needs.” The hospital will continue to provide inpatient and outpatient gynecological services, the release said, but there weren’t enough births in the unit to keep the maternity services going.
Instead, the release said, Martin General has set its sights on accommodating the region’s other needs, including behavioral health and cardiology.
With birth centers at three Vidant facilities in a 35-mile radius — in Washington, Tarboro and Greenville — the hospital said, pregnant women in the region still have options.
An EMT by training, Bullock said it wasn’t that simple. Every minute matters in labor, she said, and longer trips to a hospital could pose risks to mothers and their babies.
“Anything can happen in 35 minutes,” she added. “I mean, anything can happen in five minutes. It’s just like a blink of an eye and you can lose both lives.”
The second-floor ward at Martin General is more than a convenience, she argued. It is a medical home where providers know her well. On the day of the cesarean section, she added, one of the nurses even showed up before the morning shift began to greet Bullock. The impending change to the hospital kept coming up during Bullock’s three-day stay.
“The nurses kept saying stuff like, ‘We enjoyed you … and we’re sorry that this had to happen.’”
A common refrain
Martin General Hospital isn’t the first to curtail costly, but essential services. Rural communities across the state have been contending with similar cuts for years.
A FY2017 survey by the North Carolina Healthcare Association found the state had 30 rural facilities that offered maternal or neonatal care. By comparison, 50 urban hospitals across the state offered these services in 2017, the survey found.
At least three of the rural maternity service providers listed in that survey no longer exist. Two Mission Health units in western North Carolina shut their doors in 2017. And in January, Cape Fear Valley Health said it would not reopen its Bladen County birth center following extensive damage from Hurricane Florence.
Martin General is the second hospital in the area to reduce the services it offers this year. Last month Vidant Beaufort, a hospital just one county over, closed its behavioral health unit.
Rural hospitals with maternity and neonatal services are green. Four rural hospitals who have either discontinued or will discontinue their maternity services are red. Urban hospitals are blue. Note: This map has been updated thanks to feedback from our readers on an additional labor and delivery unit closure. This map collates NC hospitals who had 25 or more deliveries in FY2017. We updated names of hospitals that have since changed, with the old name in parentheses. The data comes from North Carolina Health Association, who surveyed hospitals for the information. When hospitals didn’t respond to the survey, fields remained blank. Urban/rural designations are based on definitions from the Centers for Medicare and Medicaid. The American College of Obstetrics and Gynecologists define OB level 1 as basic care, OB level 2 as specialty care, and OB level 3 as subspecialty care. Data source: N.C. Healthcare Association. Map credit: Liora Engel-Smith
In an emailed statement last week, Martin General’s interim CEO John Jacobson said there weren’t enough births for the hospital to offer labor and delivery services feasibly. Almost half of the deliveries from communities around the hospital happen elsewhere, he added, leaving the unit with only three deliveries per week on average, Jacobson wrote. But the hospital has to staff the unit around the clock, even when there aren’t births.
Jacobson did not say how much the hospital will save by discontinuing its maternity services, but as a report by the Commonwealth Fund pointed out, the cost of providing these services has increased, outpacing health insurance reimbursement rates.
In his statement, Jacobson alluded to “limited resources,” but did not delve into the financial constraints and the role they played in the decision to discontinue maternity services at Martin General. A Medicaid cost report obtained from the N.C. Department of Health and Human Services shows that the for-profit, 43-bed facility lost just over $3 million from May 2017 to April 2018.
Martin General’s parent company, Quorum Health, lost more than $200 million in 2018, according to its federal Securities and Exchange Commission filing. As of 2018, the most recent SEC filing said, Quorum had a debt of $1.2 billion.
The Brentwood, Tenn.-based organization, which operates 26 hospitals in 14 states, closed one hospital and sold 10 others since 2016, according to a March story in Becker’s Hospital Review. The same report also said that Quorum intended to sell some of its underperforming hospitals, reducing the number of health care facilities it owns to roughly 20.
Jacobson did not indicate in his response if Martin General was one of those underperforming hospitals or if any other service reductions were on the horizon.
“We’re excited about treating patients locally for important health care needs such as behavioral health and cardiology services,” he wrote in response to a question on the topic.
The hospital’s continued viability is important to the county, said Martin County Manager David Bone.
So when Martin General asked the county board of commissioners to amend the lease that allows the hospital to operate in the county-owned building on South McCaskey Road, the commissioners agreed. The commissioners voted unanimously to amend the lease at a Sept. 11 meeting.
“We understand that this is an emotional decision, there’s a lot of emotions involved — the [Labor and Delivery department] has provided great services over the years and we’re not discounting that,” he said. “ … Unfortunately, you can’t take financial aspects out of it.”
Voicing concerns
Vickey Manning, social work supervisor at the Martin-Tyrrell-Washington District Health Department, spoke against the impending move at the September meeting.
In a phone conversation earlier this month, Manning said the health department cares for numerous pregnant women, many of whom are either uninsured or on Medicaid. She said the department currently serves about 50 pregnant women from Washington and Martin Counties, and a number of them planned to give birth at Martin General.
The women the department typically cares for will likely struggle with longer trips to hospitals out of the county, she said. Some women prefer to receive their prenatal care with the doctor who would eventually deliver their baby, but she worried low-income women may not have that option because of the cost of travel or the increased time commitment for out-of-county appointments.
Medicaid recipients, she said, can use county transit to get to medical appointments, she said, but that option may not work for everyone. And public transportation may compound the time commitment, especially if women have to leave well in advance to catch a shuttle.
“My concern is if we have a woman who, let’s say has a preschool child, and she does not have childcare,” Manning said. “Well, if she has an appointment now, she’s gotta go to Greenville or Tarboro or Washington for her prenatal appointment and her child cannot ride on that transit with her [because] he’s not a patient.”
Taking to Facebook
As news of the decision to discontinue labor and delivery services rippled through the community, local women formed a Facebook group in protest. As of last week, “fight for mgh ob/gyn!!” had just under 700 members. Alongside calls to action, questions and comments, members shared birth stories and photos of babies born at Martin General.
Williamston resident Cindy Bembridge joined the group, even though she figured the hospital probably wouldn’t change course.
“The main concern, I think, in the community, is what’s gonna happen in a true emergency if they don’t have something available,” she said. “If a mom goes into labor at 29 weeks and she’s here in Williamston. 30 minutes is gonna make a big difference.”
Bembridge has other worries, too. Though the hospital said it will continue to provide gynecological services, the Williamston resident wasn’t sure if her doctor would remain with the hospital after Oct. 21.
Bembridge said keeping her doctor was important to her. She was the one who delivered Bembridge’s daughter, Carly, who is now 12, and performed surgeries on Bembridge, and screened her for cancer once a year.
“These doctors, it’s not like they live somewhere and they come here from (elsewhere),” she said. “The doctors in that office live in the community too … it’s just a sad situation.”
In his statement, Jacobson said that “a number of employees” from the unit accepted other positions in the hospital and fewer than 10 full-time employees chose to leave Martin General.
But as of last week, Bembridge did not know if her doctor was staying or leaving.
“I personally will follow her wherever she goes,” she wrote in a Facebook message. “[I]f it’s close by.”
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