The main labor room at Sitka Community Hospital. Phasing out obstetrics would help the hospital’s long-term bottom line and alleviate staffing shortages, but the idea has been met with resistance in the community. (Emily Kwong/KCAW photo)

The Sitka Community Hospital Board has a big decision to make about whether to stop the labor and delivery program and transition to a daytime schedule for surgery.

They’ll host a work session this evening for all members of the public to attend and weigh in. Prenatal and postnatal care will continue at Sitka Community, the Southeast Alaska Regional Health Consortium (SEARHC) would be the sole option for hospital births in Sitka. 

Hospital CEO Rob Allen is making this recommendation with endorsement from an outside consultant. Reducing these two programs would save the financially strained hospital some money — about $400,000. But the far bigger concern for Allen is staffing.

The hospital has been hard pressed to hire and retain obstetrics (OB) nurses because, Allen said, too few babies are born at the hospital to maintain a low-risk, modern obstetrics program. “Best practices says you need 100 to 200 [births] a year to maintain those competencies. For us, trying to do that on 40 [births] is a challenge,” he said. The hospital has shut down OB before: from 2009 to 2011 due to a lack of properly qualified physicians.

The decision rests in the hands of the board and there’s a few options on the table.

Surgery could shift from 24/7 to a weekly service, available by appointment Monday through Friday. The hospital could also eliminate the surgical position and hire an internal specialist to perform endoscopy procedures.

As for labor and delivery, if the board maintains the program, the surgical wing will have to remain open in case of medical emergency. If they shut it down, Allen wants OB to be phased out slowly (“over a six to seven-month period”) and ideally negotiate for Sitka Community doctors to deliver babies across the bridge.

“Ideally we would work out some type of collaboration with SEARHC, so our doctors would receive privileges over there. We’re in preliminary talks with SEARHC about that but there’s nothing in agreement,” Allen said.

Ultimately, Allen wants to transition away from the hospital’s current management model and divert resources towards programs that are growing – like outpatient and acute care. The changes he’s proposing are fundamental ones that affect more than the bottom line.

“I think it’s a really important discussion to have because it is such a big change. I don’t think we can do “cradle to grave” in our current model. If the board and the community want that, that’s a different level of subsidy that we’re going to need. It’s going to take more than the tobacco tax,” Allen said. Right now, hospital operations are boosted annually by $600,000 in tobacco tax revenue.

The Hospital Board’s work session begins tonight at 6 p.m. in Harrigan Centennial Hall. Administration will map out the board’s options with input from hospital staff. The board will also hear about a potential midwife training program and then open the floor for public comment.

The Hospital Board could vote on eliminating OB and 24/7 surgery as early as their next meeting on September 28th.