N.M. Region Lacks Maternity Facilities

LAS VEGAS, N.M. — Four months after Alta Vista Regional Hospital shuttered its labor, delivery and pediatric services with only six days’ notice to patients and providers, the Las Vegas region’s only hospital is still struggling to find medical staff needed to help pregnant women deliver babies close to home.

The investor— owned hospital has offered good pay, loan repayment and other incentives to attract a pediatrician and OB— GYNs to the town, to no avail, Alta Vista CEO R. Chris Wolf told the Legislative Health and Human Services Committee during a meeting this week at New Mexico Highlands University.

“We tried hard. We met with OB-GYNs about providing backup,” Wolf told the panel. “We had no takers.”
With the loss of its last two OB-GYNs and difficulty attracting new ones, the hospital has no choice but to keep the services closed, he said.

The continued closure underscores the difficulty in delivering full medical services in the far-reaching rural areas of New Mexico and other parts of the country. At a more personal level, it means pregnant women like Margarita Montaño, whose first child was born at Alta Vista, now have to travel more than an hour away to Santa Fe, Albuquerque or Raton to have their babies.

“I met with the provider in Santa Fe one time for 15 minutes. I’ll meet him one more time for 15 minutes before my due date, which must be by C- section. That’s it,” Montaño told the legislative committeeJuly 7 at hearings on the issue. “That means my daughter will be delivered by a highly recommended stranger. By that time, I hope to have built a strong 30-minute relationship with my doctor.”

From Montaño’s home in Anton Chico, it will be an 86- mile drive to Christus St. Vincent Regional Medical Center in Santa Fe to have her baby. It would be 117 miles to Albuquerque and 138 miles to Raton.

“It seems senseless when there is a quality facility 29 miles from my home,” Montaño said. “For high— risk pregnancies like mine and other expectant moms, the hardships and challenges continue to mount, including financial hardship. Food, fuel and accommodation are costly.”

Montaño required a cesarean section to have her son at Alta Vista in 2014, but she worked closely throughout her pregnancy with nursemidwife Connie Trujillo until the delivery. She won’t have that same familiar presence this time.

Trujillo and the other two midwives at her Alumbra Women’s Health Clinic in Las Vegas have nearly 80 pregnant clients from the town and surrounding rural communities. Without a physician available in case surgery is needed, they can’t deliver babies at the local hospital. Trujillo has sought labor and delivery privileges at Christus St. Vincent Regional Medical Center, so she and the other Alumbra midwives can be with their patients on delivery day, but she has been denied due to hospital policies, she told the legislative committee.

Alta Vista is the most recent rural New Mexico hospital to close its labor and delivery services because of a lack of doctors. Since 2010, three others closed their obstetrics services: Artesia General Hospital stopped in 2010; the Dan C. Trigg Memorial Hospital in Tucumcari ceased in 2011; and Union County General Hospital stopped services in 2014.

Only 25 out of 45 hospitals in the state provide obstetrics, Jeff Dye, CEO of the New Mexico Hospital Association, told the committee.

“For various reasons, not every hospital that can provide OB-GYN services is able to,” he said. “The problems of recruiting and retaining doctors and nurses in rural areas is one of the most vexing challenges we face.”

Low reimbursements for providers in a region where most of the patients are on Medicaid and Medicare is one problem. Finding jobs for spouses, adequate housing and quality education for doctors’ children can be another problem in rural areas.

Asked by one lawmaker what kind of incentive package the hospital might offer a doctor, Wolf said such a package can reach more than $1 million for a three-year contract with loan repayment, salary, benefits and other incentives.

Rural hospitals and their providers also face a challenge because they need an adequate number of OB-GYNs to cover every day of the year, which makes little financial sense if they don’t have many babies born at the facility.

“Birthing is absolutely a 24-7 service,” said Ellen Interlandi, a nurse with the New Mexico Hospital Association. “But OB-GYNs must have downtime.”

The number of births at Alta Vista had declined to about 200 a year, Wolf said. That only warrants two OB-GYNs, but it also means each doctor is on call every other day.

The hospital lost both of its OB-GYNs and a pediatrician, along with five OB-GYN nurses in the past year. In 2015, labor and delivery services were unavailable for 80 days, and patients were referred to other hospitals.

Bill Patten, CEO at Holy Cross Hospital in Taos, said that facility recently lost an OB-GYN and is down to two. The hospital loses “hundreds of thousands of dollars a year for OB-GYN services,” he said. “At some point, we won’t be able to subsidize the service.”

Medicaid doesn’t reimburse the complete cost of labor and delivery services, so the hospitals absorb the difference. The state’s proposed cuts to Medicaid reimbursements for providers to make up a revenue shortfall at the state level will only make things worse, Wolf and Dye said.

State Rep. Deborah A. Armstrong, D-Albuquerque, asked about the ripple effect of closing OB-GYN services at Alta Vista besides the hardship on patients.

Trujillo said that because half of Alumbra’s revenues are from reimbursements for labor and delivery services her midwives provide at the hospital, she stands to lose half her revenue. Trujillo said she doesn’t know how long she can financially sustain Alumbra on pre- and postpartum services alone, along with family-planning services.

Dye and Trujillo offered several solutions to the OB- GYN shortage in rural hospitals, including allowing visiting OB-GYNs from the University of New Mexico to provide labor and delivery care at Alta Vista until doctors can be hired. Other solutions suggested were allowing nurse practitioners to take care of Medicaid patients without a physician’s supervision and requiring insurance companies to consider certified nurse midwives as primary care providers, rather than specialists.

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