Hospital board seeks more info on OB credentialing

By Bob Buckel | Published Wednesday, June 26, 2013

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Since 2009, Wise Regional Health System has only allowed specialists to deliver babies. If you weren’t a board-certified OB/GYN, you were not granted that hospital privilege.

It was no surprise, then, that in March, when WRHS was in the process of acquiring the former North Texas Community Hospital in Bridgeport out of bankruptcy, the hospital’s Medical Executive Committee declined a petition seeking to change that policy.

Since its inception, NTCH had allowed Family Practice doctors to handle labor and delivery. Most of the 1,000-plus babies born there were delivered by FP physicians.

Now NTCH is Wise Regional Bridgeport, and all labor-and-delivery has been moved to the Decatur campus. But the FP doctors who requested OB privileges have not gone away – nor have they gone silent.

Jeff Alling, Brad Faglie, Lara Pierce and Shawn White, all of whom delivered babies at the Bridgeport hospital, continue to look for a compromise that would allow them to deliver their pregnant patients at a Wise County hospital.

Last week, discussions began through a mediator that both sides hope will lead to an agreement acceptable to all those involved.

Dr. Faglie spoke briefly to the WRHS board at its meeting Monday evening, and the meeting ended with a board resolution that may lead the two parties closer to a resolution.

“The prior recommendations of the Medical Executive Committee to the Board of Directors on obstetrics privileging failed to adequately advise the board on this important issue,” the resolution, read by board member Mark Duncum, said. “Specifically, the recommendation failed to address whether the 2009 requirement for a residency in Obstetrics continues to be an appropriate standard. Next, the recommendation failed to address whether the current requirement of 100 deliveries for residency-trained obstetricians every two years continues to be appropriate.

“Therefore, I move the Executive Committee or its designee be authorized to form an OB Advisory Committee for the purpose of specifically addressing these issues and advising the Medical Executive committee, with the expectation that the MEC will consider the work of the OB Advisory Committee and make further recommendations to the Board with respect to obstetrical privileging within the next 60 days.”

Wise Regional Marketing Director Shannon Puphal said the goal is to determine what WRHS’s privileging standard should be – for all applicants.

“The Medical Executive Committee previously provided the recommendation for exceptions to be made to the privileging requirement for specific FP/OB’s, and they did not feel that exceptions were appropriate, based on legal input,” Puphal said. “The board needs a recommendation from the MEC to act on any changes to the privileging standard.”

The MEC is made up of independent physicians who are not employees of the hospital.

Puphal said the board is asking the OB Advisory Committee to take a closer look at the 2009 policy “to determine if it is in the best interest of the hospital and the community as a whole, to make changes to the policy and then advise the MEC, so that it can either make a recommendation to change the policy entirely (for all) or leave the current policy in place.”

Wise Regional CEO Steve Summers said the 60-day time period was designed to give the committee time to talk to representatives of all the interested parties and arrive at a recommendation to resolve the issue.

Wise Regional has not been sued over the issue, he noted. Both sides are hoping for a mediated settlement.

“I’ve been instructed by my attorney not to bring up the issue,” Dr. Faglie said as he addressed the board briefly Monday night. “I have learned a lot of things recently, and I’m coming to understand just how hard your job is,” he said. “I’m starting to appreciate that.”

Dr. Faglie, who is serving as president of the newly-reorganized Wise County Medical Society, said he hopes the “fragmented” medical community will come together and work with the hospital to improve health care throughout Wise County.

“We want to build this health-care community,” he said. “Primary care can support a very specialist-based model, and that’s our goal. We want to be here for the singular issue of building up this health-care community, beyond the OB issue.”

Last week the Texas Tribune ran a story that was picked up in the New York Times regarding the issue. Although it focused on the Wise County conflict, the story noted that the same clash has played out in communities all over the United States as urban and suburban hospitals have moved to a more specialist-based model, while rural hospitals scramble just to attract doctors and keep their doors open.

The article cited a 2012 study by the Journal of the American Board of Family Medicine that found the number of family physicians providing maternity care had declined from 23.3 percent in 2000 to 9.7 percent in 2010. The study attributed the decline to “malpractice costs, lifestyle concerns, lack of institutional and community support of family physicians delivering babies” and changes to family medicine residency requirements.

Wise Regional put out a notice in March encouraging expecting mothers whose doctors were not granted privileges to transfer their care to one of the three OB/GYN specialists who work at the Decatur facility. So far, 17 have done so, Summers said. The rest were invited to make arrangements through their physician at another hospital, or simply continue seeing their doctors, then come to the Wise Regional emergency room when they go into labor.

None of the family doctors’ patients has had to deliver in the emergency room, he said. All were moved to the labor and delivery unit and taken care of there.

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