On March 1st, Care New England (CNE) informed the staff of the Birthing Center at Memorial Hospital of Rhode Island in Pawtucket that their unit would be closed on March 14th. By March 3rd, Director of the Rhode Island Department of Health (RIDOH) Nicole Alexander-Scott blocked Care New England from closing the unit until a "reverse certificate of need" plan had been processed and decided upon by RIDOH. Dr. Scott also called for three meetings to collect public comment between March 14th and 17th, with written comments accepted through March 25.
Resistance to the announced closure was immediate, led by the United Nurses and Allied Professionals (UNAP) and a newly formed community group, the Coalition to Save Memorial Hospital Birthing Center, with well-attended pickets outside CNE's offices in Providence on March 10th and outside Memorial Hospital on March 23rd, hundreds of supporters turning out for public comment hearings on very short notice, and thousands of petition signatories.
The Birthing Center at Memorial Hospital actually serves two communities. One is the local community in Pawtucket and Central Falls, which is predominantly low-income and at-risk of being under-served and marginalized. The second is the community of women and families who do not necessarily live in the immediate vicinity of the hospital but seek out the Birthing Center for its intimate, personal character, emphasis on mother-friendly care, and close collaboration with and respect for dulas, midwives and home birth.
Many women and men who spoke at the public meetings echoed Rachel Chiartas: "I wouldn't have chosen anywhere other than Memorial Hospital to birth my second son. I was preparing for a vaginal birth after Cesarean, and I truly felt without a doubt that this was the only place I felt comfortable birthing outside my home. To think that other Moms in years to come may not have this warm, comfortable environment as a place to safely birth their children is truly sad and heartbreaking to me."
While one would hope that the strengths of Memorial's Birthing Center could be implemented in other, larger, Care New England hospitals, there is a fundamental difference between an institution which is based on the mother and child moving through a sequence of units each with its own set of specialized, expert caregivers, and a single, intimate unit, as at Memorial, where mothers work with the same group of doctors, nurses, and other support staff throughout the entire birth process and beyond into family care.
In particular, several midwives who have privileges at Memorial expressed concern not only about the short term issue of obtaining midwife privileges at other area hospitals before the Birthing Center closes if CNE is granted a short timeline to do so, but also because they feel that at Memorial they have a stronger working relationship with the hospital staff and more freedom and flexibility to work as they and their patients wish than other area hospitals provide.
UNAP lawyer Chris Callaci challenged the validity of the hearing process itself, stating, "The public had one week at best to prepare to comment on a non-existent plan to close a birthing center." He also argued "that CNE violated state law and regulations by repeatedly announcing the closure of the birthing center prior to these proceedings, and getting (RIDOH's) prior approval." Callaci further cited the affiliation agreement between CNE and Memorial which stated "no elimination of clinical services is envisioned during the first three years after the formation of the new hospital," pointing out that we are still six months short of the three year mark.
Other reorganization plans
While attention has focused on the closure of the Birthing Center, the board of directors of Care New England also announced on February 29th the planned closure of one medical/surgical inpatient unit and the intensive care unit. As no closure date has been set for these units, no hearings have yet been scheduled. According to Michael Dacey, MD, president of Memorial, the changes planned at the hospital will create a largely outpatient facility with a wide assortment of primary care and specialty services on site, as well as an Emergency Department, orthopedic and outpatient surgical services, and a small inpatient unit.
Memorial Hospital's financial problems predate their affiliation with Care New England in 2013. According to Dacey, the hospital spent down $50 million from its endowment between 2009 and 2013. He reports it is currently losing $3 million a month.
One obvious issue is a lack of advertising and community outreach. It is ironic that hearings over closure may be the best publicity the Birthing Center has seen in years. Care New England could have shot a great commercial using the glowing of testimony of parents, midwives, residents and others about the unique culture of care and attention to patient choice provided by the Birthing Center.
Based on hearing testimony testimony, it seems like the only way a person ends up at Memorial is if their family has always gone there, if they hear about it through word of mouth, or through extensive internet research. It is hard not to wonder how many more births per year the Center could have attracted with something as simple and targeted as underwriting messages on Rhode Island Public Radio promoting their flexibility in supporting each mother's birth plans. It is easy to understand why a significant investment in marketing the Birthing Center has not happened since CNE took over Memorial, since adding births at Memorial would likely subtract them from CNE's other hospitals in the state.
Like many other public institutions, such as schools, Memorial seems to have suffered from a long period of complacent management which failed to adapt to a more aggressively competitive, and rapidly consolidating, environment. Closing the Birthing Center, taken as an isolated case, is perhaps the rational economic decision, driven by market forces, but it is really more "efficient" to allow a program which is successful and unique in the most important dimension -- quality of patient care -- to wither away due to poor management? Perhaps it is inevitable, but we do not have to accept that it is wise or right. We do not have to quietly assent to the stripping away our community assets and opportunities for fulfilling work which leaves literal and figurative holes in our urban landscape and social fabric. We can do better.
See our interview on page 6 with Rita Brennan, RN, president of United Nurses and Allied Professional (UNAP) Local 5082 at Memorial Hospital of Rhode Island and longtime maternity nurse in the hospital's Birthing Center.