The announcement came without fanfare or hesitation about two weeks ago, when North Hawaii Community Hospital administrators declared the maternity ward full. It implemented a diversion, meaning women in active labor were advised to have their babies somewhere else, but were not turned away. If a woman insisted on having her baby at the Waimea hospital, she would do so in the Emergency Department or a temporary nursery, said NHCH CEO Ken Wood.
The announcement came without fanfare or hesitation about two weeks ago, when North Hawaii Community Hospital administrators declared the maternity ward full. It implemented a diversion, meaning women in active labor were advised to have their babies somewhere else, but were not turned away. If a woman insisted on having her baby at the Waimea hospital, she would do so in the Emergency Department or a temporary nursery, said NHCH CEO Ken Wood.
Such situations do arise. NHCH once delivered 12 babies in 36 hours, of which one was in the tub room, one in the nursery and one in an empty closet. While all were delivered safely, that isn’t the level of care NHCH wants to provide, Wood said.
The situation two weeks ago at NHCH was the same at Hilo Medical Center, which was also full. That meant the only place with the proper acute care beds to deliver a baby was Kona Community Hospital, Wood said.
Overcrowding in NHCH’s family birthing unit is a serious issue, one that’s got hospital leaders, a task force and the community working together to solve. More than 200 people attended Waimea Community Association’s meeting Tuesday about the future of the private, nonprofit hospital’s maternal health care services. In particular, testifiers were concerned about any dismantling of NHCH’s successful Waimea Women’s Center, as well as a potential loss of its long-standing relationship with midwives and their essential services.
NHCH’s model blends the expertise of three midwives with three obstetrics and gynecology physicians, who are supported by nurses staffing the family birthing unit, Wood said.
NHCH’s transparency, or lack of, with the public was also questioned. Testifiers also stressed the importance of focusing attention throughout the island on the difficulty pregnant women face in finding obstetrical care such as that offered by NHCH, which some considered unique.
NHCH delivered 663 babies last year, of which 51 percent were births to patients from outside of its service area and 91 percent were delivered by the Waimea Women’s Center. Patients are being transferred to other hospitals because of lack of beds and overcrowding at NHCH. The hospital, which estimates delivering 700 or more births this year, has 33 acute care beds and is designed to handle no more than 550 deliveries annually, Wood said.
NHCH is estimating a loss of about $7.2 million on maternal health services for 1,884 births over three years because Medicare reimbursements don’t cover the full costs. The total loss per birth is nearly $4,000, Wood said.
In March, NHCH formed the Maternal Care Work Group, consisting of three doctors, one midwife, six nurses and three staff, to address three issues: overcrowding and safety issues in the family birthing unit, as well as the overall business performance of the maternal care program. The group submitted a report to Wood Monday.
Wood said the report, described as “an informal work product with recommendations,” would not be made public. However, after gathering community input, the hospital may announce its decision, with supporting data, “in the next week or so.” Wood reiterated no decisions have been made about NHCH’s maternal health services, as of Tuesday.
For the newly formed Community Hospital Ohana Partnership, even a partial dismantling of the Waimea Women’s Center is substantial. Before such an action occurs or any decision is made, the grassroots partnership said the hospital should utilize the community as a resource in identifying possible solutions. Several partnership members, including Waimea resident Margaret Wille, presented various short- and long-term solutions, such as re-commissioning the patient rooms being used for offices and locate the offices outside of the hospital, as well as maximizing hospital beds, not reducing maternity beds and locating midwives near the obstetrics and gynecology physicians. They also urged NHCH to pressure other hospitals to provide better maternal care and to find the funding to build a family health center, which was initially contemplated.
Their solutions to solving the inadequate revenue stream included routinely collecting co-pay, making sure the Waimea Women’s Center is not being billed for services that should be charged to other departments, hiring an independent consult to review billing codes, correcting inappropriate classification of Medicaid reimbursement rates and reviewing other issues such as the improper designation of NHCH’s service area as limited to 96743, which limits access to certain programs and grants.
Among the recommendations David Gomes, a Waimea resident and 11-year NHCH volunteer, listed Tuesday for the public were: lobby state and federal officials for help; protesting in front of Kona Community Hospital and Hilo Medical Center, urging for better maternal care models that include midwifery; and helping raise funds for NHCH projects, such as the Emergency Department renovation.