Sitka Community Hospital CFO Cynthia Brandt (l.) and physician Charles Rozelle discuss the decision to scale back surgery — and eliminate childbirths — with CEO Rob Allen and board member Dr. David Lam. Brandt described some unexpected pressure on the hospital’s razor-thin budget: Medicare may want up to $1.2 million in a payback next year. (KCAW photo/Robert Woolsey)

The Sitka Hospital Board has prepared a budget for next year that cuts back surgical coverage to half-time, and phases out obstetrical services altogether.

Although the plan intentionally hands over childbirths in Sitka to SEARHC’s Mt. Edgecumbe Hospital, the administration at Sitka Community believes their clinic can still provide strong pre- and post-natal services.

Downloadable audio.

Note: The board of Sitka Community Hospital will present its budget to the Sitka Assembly in a special meeting 6 p.m. Tuesday, May 2 in Harrigan Centennial Hall. Public testimony will be taken.

While having full-time surgical coverage isn’t required to maintain an obstetrics service, Sitka Community Hospital pretty much had full-time coverage with Dr. Richard Wein, whose contract was not renewed in a dispute this spring.

According to CEO Rob Allen, Wein was “old school,” and was available almost all the time — by choice. Most doctors now prefer a more reasonable call schedule.

Board member Connie Sipe was doing the math.

“This issue’s really linked with the surgeon. For us to really have 24/7 surgical coverage, we probably need to hire two surgeons, and that’s a million bucks. It’s kind of this very difficult chicken-and-egg.”

24-hour surgical coverage is not necessary to run an obstetrics program. Family Practice physicians who are trained in c-sections can do the job. But Dr. Charles Rozelle was uncomfortable with the idea. He’s qualified for routine c-sections, but he described a scenario where a patient could develop problems, and require an emergency hysterectomy — a higher level of surgical practice. If that were to happen, he told the board, “We’d be clamping off arteries and riding in an ambulance across the bridge” to Mt. Edgecumbe Hospital, run by the Southeast Alaska Regional Health Consortium.

For Sipe, this did not sound extreme for a typical rural hospital.

“If we were in small-town Kansas and we were doing what we were doing, and the surgeon didn’t happen to be there, and somebody needed an emergency bleed-out hysterectomy, we’d be medevacing them as fast as we could to the next biggest hospital. And this next hospital is three miles away. Some part of me says: If we hope to continue to be in this town, and we’re always going to have this competitor, then maybe we need to figure out what financially works — what’s not perfect, I understand, for the practice — but how do we take advantage of this other resource and say, where we don’t have to duplicate them, we use them?”

Sitka Community Hospital delivers around 40 babies a year. SEARHC around 60. Sitka CEO Rob Allen says there’s no immediate savings to closing obstetrics, but it does spare the hospital having to invest around a quarter-million dollars in the future (primarily in staffing) to maintain a modern childbirth program. He’s adding this to the list of decisions he’d rather not have to make, in order to keep Sitka Community above water.

“The risk and the resources to continue on. We can lower our risk, increase our resources and use that space in other ways, and make this a stronger community hospital. I know it’s a very emotional issue. It’s a hard one. It would not be popular. I know I’d have another big target on my back, but I’m thinking long-term for the hospital, and a way to act now.”

Acting now means reducing surgical coverage and closing obstetrics, but it doesn’t mean giving up all other health care around pregnancy and newborns. Steve Hartford is Sitka Community’s head of operations.

Hartford – Most people do not select their doctor based on a hospital. They select their doctor first. They pick their doctor, then when they become pregnant that doctor will provide prenatal care. In our case, what will happen is: A person who has a doctor in our clinic will receive prenatal care, and they’ll have a planned delivery at SEARHC, because we won’t be providing that service anymore. Even if our doctors do not do deliveries at SEARHC. Their delivery will be planned at SEARHC.
Lam – You’d be hard-pressed to sell that to the public.

That was hospital board member David Lam saying “You’d be hard-pressed to sell that to the public.”

The model that Hartford and Allen envision has two tracks: In one version, Sitka Community doctors could request privileges at SEARHC, join the call rotation, and deliver their patients’ babies at SEARHC. Alternatively, SEARHC doctors would handle all the deliveries.

Lam, a physician himself, thought cooperation was essential.

“If we can actually get them to work with us to provide the service, this may be the best of all worlds for everybody. Because I agree completely: I want to keep our staffs’ hands in the full patient care cycle.”

CEO Allen disagreed that cooperation with SEARHC was required to implement the budget, but at Lam’s request, he agreed to open negotiations about what — if any — role Sitka Community’s doctors would play in delivering babies at SEARHC. Lam, in turn, voted to approve Sitka Community’s proposed budget, which eliminates obstetrics as of September 1 of this year.