Highlighting vulnerability of rural hospitals, Maine's Calais Regional Hospital to shutter obstetrics department
Declining delivery numbers combined with an ongoing nursing staff shortage in the state spelled fate of OB department, hospital says.
Calais Regional Hospital-photo courtesy MHA
Calais Regional Hospital in northern Maine will close its obstetrics department on January 1, 2018, and will phase out newborn deliveries by the end of 2017, the hospital has announced. The closure will leave Washington County with only one hospital that is fully equipped to deliver newborns.
The hospital said in a statement it could "no longer sustain the operation of the unit due to the declining number of births at the hospital and heavy financial losses experienced by the unit."
The hospital said deliveries have dropped by roughly 50 percent, from more than 100 births a year to just 60 last year, which averages out to one delivery a week. It also cited recent census bureau data that showed the overall birth rate in Washington County has been on a steady decline for the last 20 years.
Those declining delivery numbers and decreased use of the obstetrics department, combined with an ongoing nursing staff shortage in the state, has yielded cost increases and "significant financial losses" that can't be sustained any longer, CRH said.
CRH will be notifying patients and referring physicians so as to ensure a smooth transition, and right now there are no plans to reduce staff as a result of the closure. OB department staff will have the chance to assume positions in other departments. Meanwhile, the Emergency Department staff will be trained to handle emergency deliveries and will be equipped to monitor babies in those situations.
Maine Hospital Association Director of Communications Becky Schnur explained there are several factors in that make OB wards in the state vulnerable.
"Maine has the highest average age in the country. I believe our median age is about 44.2 years. With half our population older than 44 there simply aren't that many babies being born. Calais had 60 deliveries last year. It's hard to justify a 24/7 operation for 60 babies. In addition, many births are paid for through Medicaid. While Calais is a CAH and gets enhanced Medicaid funding, there's not a lot of wiggle room when volume drops."
Other hospitals in Maine have seen similar closures. Blue Hill Memorial Hospital shuttered its obstetrics unit in 2009, and Penobscot Valley Hospital in Lincoln closed theirs in 2014, Schnur confirmed.
The state has also seen its fair share of mergers, which Schnur said could have been closures because the hospitals were under financial pressure and likely would have closed outright had they not consolidated with other hospitals. Parkview Adventist Medical Center and Mid Coast Hospital in Brunswick merged to create Mid Coast-Parkview Health in 2015. Parkview had declared bankruptcy and its ED was subsequently closed after the merger. Goodall Hospital in Sanford merged with Southern Maine Medical Center in Biddeford to create Southern Maine Health Care in 2014 after Goodall had been struggling. St. Andrews Hospital consolidated with Miles Memorial Hospital to create LincolnHealth in 2013. The ED at St. Andrews also closed, Schnur said.
[Also: Rural hospitals tout 'affordable' cloud-based EHRs for keeping them afloat]
It's a trend that is growing nationwide and underscores the plight of rural hospitals as government reimbursements fall short of meeting the costs of services, operational costs continue to rise, and regulatory burdens threaten to overwhelm the often limited staffs employed by rural and critical access hospitals. According to the National Rural Health Association, since 2010, 66 rural hospitals have closed and the closure rate is increasing. It was six times higher in 2015 than in 2010.
The Maine State Nurses Association, a union that represents some of the nurses at Calais, called the closure a "very serious and dangerous decision," and nurses said it will leave patients without labor and delivery services not only in Calais but in at least 5 surrounding communities.
According to the union, Calais' CEO had notified employees that the hospital's management company, Tennessee-based Quorum Health Resources would be closing the obstetrics unit, drawing ire for Quorum, who has managed CRH since 1992 and charges a hefty annual fee that does not include the salaries of management personnel.
"This hospital spends over $400,000 on an outside management company based in Tennessee that has a history of reducing services to communities in order to extract more money. Resources should be spent right here, in Washington County on patients that need these services," said Emergency Department RN Beth Ingersoll, Chief Steward of the Calais-area MSNA chapter.
Twitter: @BethJSanborn
