Back in January, the Office of Health Strategy (OHS) recommended rejecting Johnson Memorial Hospital's (JMH) Certificate of Need request to discontinue inpatient birthing services. At the time, the OHS said JMH "had not met the burden of proving the closure’s impact on regional health care services," as CTNews Junkie put it. JMH opposed that decision, and today, the OHS released a statement saying it would, in fact, allow JMH to end its in-patient labor and delivery services.
“We are committed to prioritizing appropriate community access to high quality, affordable maternal and infant health services,” said Deidre Gifford, MD, MPH, OHS Commissioner in the statement. “This agreement permits termination of labor and delivery services at the hospital but holds Johnson Memorial Hospital accountable to the community they serve and to the State of Connecticut for maintaining access to all levels of maternal and infant health care. If an independent analysis indicates that a free-standing birthing center in the area is viable, then Johnson Memorial will need to ensure that one is built.”
According to the Center for Health Quality & Payment Reform (CHQPR), there is a crisis in maternity care in rural communities. According to a report CHQPR released in July, "More than half (57%) of the rural hospitals in the U.S. do not offer labor and delivery services,and in 10 states, more than two-thirds do not. Over the past five years, more than 100 rural hospitals across the country have stopped delivering babies." Why? It's a combination of factors that boil down to staffing and cost.
The OHS statement also outlines the details of the settlement with JMH, which requires the hospital to:
Engage an independent third party to assess the need for and feasibility of establishing a birthing center in the hospital’s service area
Support the establishment of a birthing center and coordination of care with that center should those services be identified as needed and feasible
Maintain all prenatal, postpartum, and wraparound services and staffing levels currently provided by the hospital, including lactation consulting and patient and infant wellness, as well as provide support with access to supplemental resources, including SNAP/WIC and the Diaper Bank
Advise all pregnant patients in the hospital’s service area of the birthing options available to them
Provide emergent and non-emergent transportation to any birthing person and their support person to any hospital of their choosing within a 50-mile radius for labor and delivery services at no cost to the patient or support person
Provide emergency deliveries in the Johnson Memorial Hospital Emergency Department when necessary
Support continued recruitment and professional development of certified nurse midwives in outpatient venues and commit to establishing a doula training and certification program should the Department of Public Health establish criteria for the certification of doulas in the next five years
Support the establishment of a birthing center and coordination of care with that center should those services be identified as needed and feasible
The CHQPR portrays an uphill battle to bring maternity services back to rural hospitals like JMH. It says, "Rural hospitals can’t provide labor and delivery services if they are unable to recruit an adequate number of qualified staff, but they can’t afford to employ those staff unless health insurance plans pay the hospital adequately for its services." It goes on to add, "It is often assumed that low Medicaid payments and uninsured patients are the reasons hospitals lose money on maternity services, but over 40% of births in rural communities are paid for by private health plans, so inadequate payments from private payers also threaten the viability of rural maternity care."
In 2023, CT News Junkie reported that Dr. Robert Roose, JMH's chief administrative officer, said during a hearing, "In a low-volume environment with consequently an inability to retain the qualified labor and delivery nursing staff with the appropriate competencies and providers, we can not provide those services safely.”
Today, Stafford's State Senator, Jeff Gordon also issued a statement on the matter: “These services are vital to expectant mothers and families who cannot otherwise access this care or easily be transported elsewhere in emergencies. These were key points of concern that I previously raised. I am disappointed by the negotiated settlement and that the public, town officials, and legislators were not included in the decision-making process."
Gordon also said, “I will continue to do what I can to ensure that appropriate and timely services are provided, including what must be done to bring about a standalone birthing center in the region per the settlement agreement, or if the hospital must re-open labor and delivery if a birthing center cannot be created.”