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Hospital shuts down services; Wise Regional unlikely to change labor & delivery policy

By Bob Buckel | Published Saturday, March 23, 2013

North Texas Community Hospital in Bridgeport announced Wednesday afternoon that it was discontinuing obstetrical services – delivering babies – effective immediately.

The hospital, which is due to join Wise Regional Health System early next week (see page 1) had already shut down its Intensive Care Unit (ICU) and stopped scheduling non-OB related surgeries.

CEO Max Ludeke said Friday that the shutdown of labor-and-delivery was part of the transition to ownership by Wise Regional. It is not, he said, related to a decision by Wise Regional’s Medical Executive Committee not to reconsider the hospital’s policy requiring OB/GYN specialization in order to deliver babies.

That decision leaves dozens of expectant mothers with the choice of either changing doctors or having their babies elsewhere.

After Wise Regional was notified that NTCH was discontinuing obstetrics services, the hospital issued a news release advising expectant mothers of several options.

“Our first priority is to ensure that all patients have continuous access to medical care,” said Steve Summers, CEO of Wise Regional. The release gave contact information for the three OB/GYNs on staff at Wise Regional and advised mothers who wish to have their babies delivered locally to transfer their care to one of them.

Dr. Russell Edwards, Dr. Doug Kyle and Dr. Renee Smith are all board-certified OB/GYN specialists with offices on Farm Road 51 in Decatur.

“Expectant mothers should identify themselves as a ‘transfer patient’ and provide their current physician’s name providing prenatal care,” it said.

Of course, those who do not transfer may still use the emergency room if needed.

“Should an expectant mother go into active labor before having the chance to transfer her care to an OB/GYN, she should go immediately to the emergency room admissions at Wise Regional Health System, Decatur campus,” the release said. “Wise Regional has a board certified OB/GYN on call 24 hours a day, 7 days a week to handle obstetric needs; and board certified pediatricians available to handle newborn care.”

Summers added, “We take very seriously the health care that has been entrusted to our hospital staff, and it is our goal to provide each patient with quality and compassionate care.”

Ludeke said patient safety was the primary reason for stopping deliveries at Bridgeport.

“It’s something we’ve been talking about for the past couple of weeks,” he said. “Our number one concern was being fully-staffed. We had some staff who were starting to leave, and we knew that OB was all moving to Wise.”

When staff members started having to work extra shifts or extended shifts, he said the decision was made to cease deliveries.

“I didn’t want it to become an unsafe situation,” he said. “Our first duty is a safe environment for our patients.”

He said it would be “inappropriate” for him to comment on the credentialing decision.

“That’s a decision for the medical staff and the board of directors,” he said. “Each hospital has to make their own decision.”

POLICY IN PLACE SINCE ’09

Wise Regional’s Ethics and Credentialing subcommittee heard a request for OB privileges on March 5 from four Family Practice physicians who have been delivering babies at Bridgeport. Those doctors – Jeff Alling, M.D., Brad Faglie, M.D., Lara Pierce, M.D. and Shawn White, M.D. – have all offered OB services as part of their medical practices for several years.

The subcommittee recommended the full Medical Ethics Committee reconsider the policy. That motion was made in Monday’s committee meeting, but it died for lack of a second according to Wise Regional Marketing Director Shannon Puphal.

“By not voting on the recommendation of the subcommittee, they left the current policy intact,” she said.

Dr. Faglie, who made the group’s case to the subcommittee, said that decision is regrettable.

“As it stands now, Dr. White, Dr. Alling, Dr. Pierce, and myself will not be able to continue caring for our obstetric patients,” he said. “Dr. Alling has been delivering long enough that he actually delivered some of the obstetric patients he has now. For a hospital to come to the conclusion that he lacks the experience and expertise to continue in his practice is unthinkable.”

Prior to 2009, family practice doctors could deliver babies at Wise Regional. The hospital amended its bylaws in April of that year to require an OB/GYN residency in order to be granted delivery privileges.

North Texas Community Hospital, which had opened the previous August, had drawn several family practice doctors to its staff for whom OB was a central feature of their practices.

Since that time, the policy has been a key difference between the two hospitals.

Puphal said the purpose of the 2009 policy change was to raise the standard of care to be more in line with metropolitan hospital systems like Texas Health and Baylor. Essentially, the Bridgeport hospital went in the direction of a rural, family-practice based medical facility while the Decatur hospital gravitated toward a metropolitan, specialist-based facility.

“The thinking was, if Wise Regional Health System is going to become a regional referral center, we wanted to be sure that we have highly-trained providers to provide OB services,” she said. “Acting on that recommendation, the board at that time approved a resolution that OB privileges be granted only to physicians who have completed a residency program in OB/GYN.”

Puphal said the same standards are applied in other areas of specialty such as orthopedics.

While all family practice doctors learn labor and delivery as part of their residency, most do not deliver babies. A longtime administrator in a neighboring hospital said for most, the cost of insurance simply isn’t justified by the relatively small number of deliveries they would do. For an OB/GYN specialist who may do 200 to 300 deliveries a year, it’s a different story.

But obstetrics is a key part of the practice of some of the FM doctors at Bridgeport.

Alling, White, Pierce, Faglie and others have had additional training in OB beyond what most family practice doctors receive. Faglie said delivering babies is a central part of his practice, and he will likely leave the area so that he can continue doing that.

“This is not a win for the community, the hospital, or patient choice,” he said. “We provide a good quality of care and our track record shows that. I personally feel that delivering babies is my calling, and I will do whatever it takes to continue doing that even if it means finding another community to work in.”

The demand, he said, is high.

Wise Regional’s Summers did not disagree – indeed, he said just a few years ago the Decatur hospital was actively seeking family practice doctors alongside OB/GYNs to handle deliveries. But, he added, the move to specialization seems to be the wave of the future.

Puphal noted that those policies are formulated by the Medical Ethics Committee, which is made up of independent physicians – who are not hospital employees – and approved by the board of directors which is also independent, appointed by the Decatur City Council. They are not crafted by the hospital’s administration.

This week’s announcement that the Bridgeport hospital is out of the baby business drew a huge response on the Messenger’s Facebook page, many from women who are either expecting or who have had babies delivered in either Bridgeport or Decatur. The reviews on the decision were overwhelmingly negative early in the day, but later on, several women offered opinions supporting Wise Regional’s policy.

Some of the Bridgeport doctors may deliver babies elsewhere – possibly Gainesville.

But for now, Wise Regional in Decatur is the only game in town, and only OB/GYNs can play.

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