Valley Health defends planned closure of labor and delivery unit | Crain's Washington D.C.

Valley Health defends planned closure of labor and delivery unit

Krista Adanitsch holds up a picture of her family at a town council meeting in Front Royal, Virginia. Her seven children were born at Warren Memorial Hospital. | Photo by Michelle Matthiae

Many an expectant mother worries she won’t make it to the hospital in time to deliver her child.

That fear is growing in Front Royal, Virginia, where Valley Health is planning to close its labor and delivery unit May 1 at Warren Memorial Hospital, part of a nationwide trend that has seen scores of maternity wards close, especially in rural areas.

Floyd Heater, president of the hospital, said with fewer than one delivery per day, the hospital system cannot justify maintaining a top-notch labor and delivery department at Warren, and the public would be better served if operations were consolidated at Winchester Medical Center in Winchester, Virginia, 27 miles away.

“For some of us that will mean a trip of more than an hour,” said Michelle Matthiae, one of the founders of Birth Local, which is fighting Valley Health’s decision.

Front Royal has slightly more than 15,000 residents with 14,000 more in the surrounding county. But the population projections indicate the over-65 crowd will grow 45 percent in coming years, while the 15 to 44 age group is expected to grow only 6.6 percent.

Matthaie said that percentage is poised to change with the announcement of several residential developments for 1,500 to 2,000 families. But, she said, those development plans could be threatened by the hospital system’s decision.

“Our research shows the town will suffer,” Matthiae said. “People won’t want to move here. Why move here if you can’t start a family? Will businesses come? I really feel this is a horrible decision setting us back decades.”

Valley Health is planning to build a new $100 million hospital to replace the aging Warren Memorial plant, which was designed 67 years ago. About 80 percent of patient care now is provided on an outpatient basis. Heater said at a recent Town Council meeting that the current hospital’s emergency department is maxed out, and the operating rooms need modernization and expansion.

Heater said he recognizes closing the labor and delivery unit is a sensitive issue, but noted that one-third of Warren County mothers already deliver at Winchester, and another third go somewhere outside the system. Changing demographics, he said, mean the new hospital must to gear its services to an aging population.

In a subsequent interview, Heater said the decision to close Warren’s obstetrics unit had more to do with aligning resources than saving money. He said the Warren unit was pretty much a break-even proposition, and the decision to consolidate at Winchester will trim just $1 million from the system’s annual budget. Valley Health has six hospitals in northwest Virginia and the eastern West Virginia panhandle.

“Another factor is, we made a lot of investment at Winchester. We built a new wing with a 30-bed NICU [neonatal intensive care unit], and we have an emergency department just of obstetric patients. We also expanded the midwifery program,” Heater said. “When we realized a third of patients [in Warren County] already go to Winchester … [the Warren obstetrics unit] seemed like an underutilized service.”

Another factor is the difficulty in recruiting obstetric personnel to the area, a problem faced nationwide, Heater said. He also noted prenatal care still will be available at Warren.

“Being part of a regional health care system is beneficial on many levels, bringing stability to smaller hospitals, enhancing alignment with providers, quality outcomes, purchasing power and other efficiencies,” Heater said.

Winchester currently delivers more than 2,000 babies annually. The addition of the Warren deliveries will increase that figure by about 15 percent, and Heater said that should not add significantly to the cost of running the department.

As the population ages, Heater said, there will be an increased need for cardiovascular, orthopedic and other specialties. The proposed design of the new hospital allows for expansion, he added, and reintroduction of obstetric services could be considered if the demographics of the county change and technical advances make adding such services more feasible.

But Melanie Salins, co-founder of Birth Local, told the Town Council at a recent meeting that Valley Health is cherrypicking “the most lucrative services and leaving women and children by the wayside.” She said the county has seen a 20 percent increase in births in recent years and the rate is rising.

“Babies are the future of this town,” she said, calling Valley Health’s plans short-sighted and accusing the hospital group of systematically closing the labor and delivery units at its other hospitals to funnel everything to Winchester.

Businessman Greg Bodoh said closing the labor and delivery unit will have negative consequences for Front Royal, hampering its ability to attract new businesses and recruit talent. He said Valley Health is looking at its bottom line rather than the needs of the community.

A study published this March by the Journal of the American Medical Association found that the closure of hospital-based obstetric services in rural areas is a leading cause of infant mortality. Between 2004 and 2014, the percentage of hospitals in rural counties offering obstetric services fell to 46 percent from 55 percent, largely because of the costs associated with such services. The result was an increase in the number of births at hospitals without obstetric services. In more isolated communities, the number of out-of-hospital births also increased significantly.

“There is no shortage of data to show that there will be a predictable negative impact,” said Kathy Clowes of the Front Royal Pregnancy Center. “The fact that the hospital is offering classes for emergency medical services people to learn to resuscitate newborns indicates that babies are at risk.”

“Even midwives and doulas have to have a labor and delivery unit nearby,” Matthiae said. “Lives have to be worth more than money. We have to draw a line somewhere.”

April 19, 2018 - 4:20pm