Sitka Community Hospital has decided to phase out their labor and delivery program next year. As early as April 1st 2018, all babies born in Sitka will be delivered at Mt. Edgecumbe, operated by the Southeast Alaska Regional Health Consortium. As the two hospitals consolidate baby delivery across the bridge, this is the most significant change to childbirth in Sitka in years.
Of the 100 babies born in Sitka hospitals each year, about one third are delivered at the city-owned medical provider, Sitka Community Hospital. The administration has repeatedly said that’s too low of birth count for operating a safe labor ward, which leans heavily these days on two to three traveling nurses and five obstetricians to keep it fully staffed.
“It’s very difficult for us to maintain a high level of proficiency for our staff in labor and delivery because there’s so few opportunities for them to actually perform these service,” said Director of Operations Steve Hartford.
These challenges drove hospital leadership in April to propose phasing out labor and delivery, writing it out of their FY18 budget. In September, the board appropriated $700,000 to keep the obstetrics program going through the end of FY18. This bought time for Sitka Community to negotiate for their doctors to deliver babies at SEARHC, though several mothers were disappointed to lose a continuity of care and testified against the closure of OB.
After months of discussion and a work session to take public comment, the board Monday night (12-04-17) gave the hospital the green light to combine forces on baby delivery with SEARHC.
Rather than sign a binding contract, the hospitals have settled on a letter of intent. The letter lays the groundwork for a rotation team of seven doctors between the two hospitals that would deliver all babies at SEARHC’s facility and working cooperatively on teaching prenatal classes. Sitka Community would continue to offer patients prenatal and postnatal care, but discontinue using traveling obstetrics staff .
Hartford told the board this transition would happen slowly. “It’s going to be a question of the two medical directors working out the schedule and the doctors getting cross-credentialed. That’s going to take a little time,” he said. Those medical directors are Dr. David Vastola at SEARHC and Dr. Roger Golub at Sitka Community.
The administration has rough timeline for closing OB by March 31st of 2018.
The closure has a relatively small impact on the hospital’s bottom line – about $300,000 a year – but a big impact on how babies are born in Sitka. Currently, there are 15 prenatal patients at Sitka Community. Four to five are expected to deliver before the end of March. The rest will be phased into delivering at Mt. Edgecumbe, though Hartford told the board the timing of the transition will depend on what’s comfortable for the patients.
“We’re going to meeting with them as we go through their trimester care. We’re going to be talking with them. All of that is going to be taken into account in terms of when we actually transition labor and delivery,” he said.
At least one person from the audience, Karen Lucas, found that process disagreeable. “To involve them in the politics of a transition is certainly not anything any woman would want to participate in,” she said. Also opposed to the motion was Dr. Richard Wein, a surgeon formerly employed at the hospital who now sits on the Assembly.
The transition does limit the number of choices expectant parents have about where to give birth in Sitka.
While prenatal and postnatal care will continue at Sitka Community under two full-time family physicians – Dr. Charles Roesel and Dr. Jason Koskinen – when labor begins, patients will see whichever doctor is on-call at Mt. Edgecumbe. That could be Roesel and Koskinen, but also SEARHC doctors Irbert Vega, Valerie Edwards, John Baciocco, Grace Hwang, Courtney Vickery, and Carey Terry, who is part-time.
The consolidation of OB has sparked community dialogue about what other birth options are possible in Sitka.
Childbirth educator Sharon Sullivan came on KCAW’s airwaves last week to talk about her community group “Sitka Nest.” “We have the long term vision of creating a freestanding, midwife led birth center here. We’ll also be supporting doulas in the community as they serve women throughout pregnancy, labor, and birth,” she said. In fact, several women trained as doulas this fall as Sitka Community Hospital buckled down on the logistics of phasing out OB.
If all goes according to plan, this would mark the end of a program that Sitka Community fought hard to bring back. OB was shut down due to staffing shortages from 2009 to 2011. This time around, its closure is part of the administration’s strategic plan to makeover how the hospital does business. An outside consultant, Stroudwater Associates, also recommend this course of action. “We’ve got to face these decisions to help us be a more sustainable, independent facility and [OB] is one of the key items,”
And Hartford hopes, with the door for OB closing, space will be available to grow other programs at the hospital – like long term care and rehab – though nothing has been decided yet.
With more changes coming down the pike, there’s one program that is staying put at Sitka Community: ’round the clock surgery. The hospital administration reversed their position on reducing coverage to scheduled surgeries, Monday through Friday. They’re now looking to shore up staffing there to maintain a 24/7 surgical unit.
In a previous version of this article, KCAW erroneously omitted Dr. Irbert Vega from the joint hospital rotation team.