24/7 surgery will remain at Sitka Community Hospital, but childbirth’s future — from July 1, 2018 and beyond — remains unclear. Critics argue that uncertainty itself is detrimental to the hospital, which should either focus on building up the obstetrics program by adding more providers like midwives, or drop it altogether. (Emily Kwong/KCAW photo)

Sitka Community Hospital will keep its obstetrics program going through next summer.

At its regular meeting Thursday night (10-26-17) the hospital board appropriated $700,000 to extend obstetrics to the end of the fiscal year, while it hammers out a deal to ensure that Sitka Community Hospital patients and doctors can deliver babies at SEARHC’s Mt. Edgecumbe Hospital.

Downloadable audio.

Childbirth is getting a second life at Sitka Community Hospital, after the board last spring passed a preliminary budget that would have closed the program at the end of September.

24-hour surgical coverage was also to be scaled back to a business-hours only clinic in the same budget — but the hospital administration found a way to move forward with affordable ‘round-the-clock coverage using a combination of staff surgeon and locums — doctors who regularly rotate in from elsewhere as relief.

But obstetrics was never about the money, according to hospital CEO Rob Allen. So many staff and hospital resources are involved in childbirth that it’s not expected to be profitable.

“The one point I’d like to make yet again is that this is not a money issue, or about our bottom line. It’s more related to the risk assessment, and the difficulty in attracting and retaining good OB staff.”

Also at Thursday’s hospital board meeting: CEO Rob Allen announced that he’s offered to extend his contract for six months. The lifelong Sitkan was hired in January 2015 to manage the hospital when it was in the throes of a combined leadership and financial crisis. His term was expected to be a month or two. Six weeks later, as the organization stabilized, the board offered him a one-year contract, which has since been renewed. His current deal will see him at his post through April, 2018. (KCAW photo/Robert Woolsey)

That’s because Sitka Community Hospital doesn’t deliver that many babies. Only 15 deliveries are scheduled between now and the end of the fiscal year on June 30, 2018 — none at all in December. That’s an entire unit idle for a month, in a demanding field of medicine that requires doctors and nurses to perform many deliveries to remain proficient.

Debbie Mendoza, a travelling OB nurse in Sitka since September, told the board that the administration’s position on safety, combined with the board’s budget strategy, was creating a self-fulfilling prophecy.

“In order to get more nurses in here they need to be promised that there’s going to be an OB. That they’re going to have a permanent job here. If you keep telling them, No we’re not certain, you’re not going to get anyone in here. And this is my perception: That this board has already made up their mind that there’s not going to be an OB.”

Although feelings in the room were running high, the board had not convened to debate the merits of OB. It’s probably fair to say that no one on the board is a fan of closing the program. For them it was a matter of appropriating the $700,000 to extend obstetrics or not.

But assembly liaison Richard Wein, a former surgeon at the hospital, felt that continuing the program for 9 months without a clear path to resolution was sending the wrong message to the community.

“Well what I’ve seen over the last two years is kind of this, Well maybe, kind of, we’ll try, and it has been a great deterioration on all services here at the hospital. And so my notion is that you really state, We’re going to take this time to build the program, or say, We’re looking to end it. Because these are significant amounts of money that are going into this, and we’re just in the same doggy-paddle in the ocean here, and it can’t continue.”

Ending OB, however, means making sure that SEARHC’s hospital can take Sitka Community’s deliveries — and grant courtesy privileges to the couple of practitioners at Sitka Community who do childbirth. The idea being that Sitka Community would offer all prenatal services right up to the delivery itself.

SEARHC vice-president Dan Neumeister wrote a letter offering to do just that, but the board wanted a more detailed agreement worked out before considering the idea further — especially since it would mean that Sitka Community physicians would participate in SEARHC’s normal rotation and call schedule for labor and delivery.

Hospital staff present, however, were not keen on the idea. This is obstetrics coordinator Vicki Akin.

“We’re not changing anything for these women either, through this motion. They can see (Sitka Community’s) Dr. Roesel for 12 OB visits and then go over there and have some unknown from SEARHC deliver their baby. That’s not the experience.”

Akin said she supported both medical deliveries and a midwifery childbirth model — and so did some other hospital staff including Beth Kindig and Sharon Sullivan, who told the board that midwives should be folded into the discussion of SEARHC privileges. If midwives were not granted privileges, Sullivan said, “We can see who they are, and we can also see who you all are, and your values about women and babies.”

Fearing that including midwifery would create a barrier to finalizing an agreement with SEARHC, the Sitka board voted unanimously to ask CEO Rob Allen and board member David Lam develop a detailed agreement that would see Sitka Community’s childbirths moved to SEARHC — if needed.

But Lam — also a physician — said that he favored midwives. “When Rob and I go over there (to SEARHC), I’ll ask them about it.”

Art on the wall outside Sitka Community Hospital’s labor and delivery rooms. The hospital will retain its obstetrics program in the short term, although the administration hasn’t written it into the current budget. (KCAW file photo)

The board of Sitka Community Hospital on Thursday (9-28-17) postponed action on closing its obstetrics program until it receives a detailed financial analysis.

Meanwhile, the administration of the hospital now favors keeping ‘round-the-clock surgical coverage, but under a different model than the past.

Downloadable audio.

The next Sitka Community Hospital Board meeting is scheduled for Thursday, October 26, in the lower level classroom at the hospital.

During budget discussions earlier this year the administration of Sitka’s local hospital proposed ending childbirth and 24/7 surgical coverage as of the end of the first quarter of 2018.

That actually means Saturday, September 30, 2017.

Both proposals triggered a serious discussion about the future role of the hospital, and some pushback — including one former doctor’s decision to run for an assembly seat this year.
But the hospital’s financial office has been short-staffed due to illness recently, so the move to close OB has now been delayed for at least a month or more, while the hospital board awaits more information on the cost benefits.

Nevertheless, the hospital board at its last meeting (9-28-17) had an extensive conversation about the service. Board member Connie Sipe took the pragmatic corner.

“The trend is we’re aging. We’re not reversing that trend. It’s not going to change. If we lose 30 families a year because they can’t give birth here and they stop coming to Mountainside, that’s not great. But do you know what that is? That’s seven-tenths of one-percent of our population. A third of them (or maybe half) were probably Coast Guard and weren’t going to be here in five years anyway. And what our population is, and where the need is, is aging in this community. And maybe we just can’t have a dilution of all of OB between two providers when we have other pressing, pressing needs for chronic care, for elder care, and cardiology care, and other things that we need. And the idea of somehow trying to convince people — for me it’s a practicality decision rather than one based on studies.”

The proposal to end medical OB services has kick-started a conversation in the community about whether the hospital should establish a birthing center, or a midwife-run OB clinic.

The hospital board did not appear to warm to the idea, mainly because their providers haven’t. Roger Golub is a staff physician. He said that the hospital couldn’t create a program of any kind for only low-risk deliveries, without an agreement for someone else — like the Southeast Alaska Regional Health Consortium across the bridge — to take the high-risk deliveries.

“Until — and unless — you have SEARHC committed to that, the whole thing’s a non-starter.”

In any event, Sitka Community Hospital will continue with medical deliveries through the fall, with 24/7 surgical coverage provided by traveling doctors. The expense of obstetrics, hospital CEO Rob Allen told board members, was “of concern,” but the facility has had a strong month. In September all 15 of Sitka Community’s long-term beds were full, as were its 13 acute-care beds.

And the surgical model has actually worked well. Allen reported that the administration would now like to move ahead with recruiting a full-time surgeon to Sitka, who would be relieved for some period — one week per month, for example — by a traveling doctor.

The board was encouraged to hear that news, since the looming closure of obstetrics and surgery over the past few months has created instability, according to board president Bryan Bertacchi.

“The total uncertainty that we keep creating for the staff is just untenable,” he said.

On the question of whether SEARHC could back up Sitka Community if the latter opened a birthing center, Bertacchi suggested that CEO Allen go ahead and call the SEARHC administration and find out if they’d do it.

“Yes or no,” Bertacchi said, “It would really help us in our decision making.”