Community Matters: Hospital owner risks loss of public trust

“As expressions of God’s healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.”

-Providence Health mission statement

Executives at Petaluma Valley Hospital recently announced the pending closure of the facility’s award-winning family birthing center due to “significant safety concerns” they say were triggered by the termination of a contract by a group of registered nurse anesthetists. Without reliable obstetric anesthesiology coverage, “the risk of remaining open is too high,” declared Laureen Driscoll, regional chief executive with Providence Health which owns and operates the hospital.

In a public statement last week, Driscoll said Providence had “issued a request for proposals to regional and national medical groups for obstetric anesthesia coverage, none of which have expressed interest to date.”

None? How could that be?

Is it because, as Driscoll suggests, there is a national shortage of certified registered nurse anesthetists?

Or are Providence’s efforts to attract qualified nurse anesthetist candidates intentionally deficient, perhaps because the hospital’s obstetrics unit mostly serves lower income families on Medi-Cal that pays notoriously low reimbursement rates?

In other words, was the decision to close the hospital’s money-losing birthing center really about economics as opposed to safety concerns?

It’s quite likely.

According to Karyn Karp, a registered nurse anesthetist who worked at Petaluma Valley Hospital for 15 years and was the last full-time employee with the anesthesiology group whose contract ended last month, Providence was paying her between one-third and one-half of the prevailing wage earned by other nurse anesthetists in Northern California. As a result, it was difficult for the group to recruit and retain employees. Ultimately, Karp’s firm was forced to stop providing services entirely effective January 31.

Providence has since secured a “temporary” OB anesthesia services contract with a physician anesthesiologist group that serves multiple regional medical facilities, including the operating room at Petaluma’s hospital.

But the company appears to be using the nurse anesthetist group’s contract termination as justification to slash its operating costs, contending that the best solution is to consolidate Petaluma Valley Hospital OB services with the company’s larger Memorial Hospital in Santa Rosa.

While that might save the company money, it’s not what voters were promised.

The Petaluma Health Care District sold the hospital to a subsidiary of the Catholic healthcare giant in 2020 following voter-approval of the deal stipulating that the birthing center would continue operating for at least another 5 years, through 2025, and that all other hospital services would continue for 20 years.

These legal commitments were publicly affirmed by Kevin Klockenga, the former chief executive officer of the Providence affiliate who’d worked collaboratively with the local health care district for more than a decade, beginning when Petaluma’s hospital was leased and managed by St. Joseph Health which later merged with Providence.

Following the end of the 20-year hospital lease in 2017, the health care district struggled to find another operator, but none came forth. Eventually, the district agreed to sell the hospital to Providence and voters agreed.

Since the sale, according to Health Care District CEO Ramona Faith, relations with Providence have been mostly positive.

Until now. Klockenga is gone, Driscoll is brand new to the community and the company’s jarring announcement that it plans to prematurely shutter the hospital’s birthing center has generated enormous public discontent and prompted several valued OB staffers to begin looking for other jobs, thus magnifying the crisis.

Why are they doing this?

In her letter announcing the planned closure, Driscoll cited “the low volume of deliveries” which she contends “has made it difficult to recruit physicians and clinical staff.”

But according to Faith, the level of births at Petaluma Valley Hospital has remained relatively steady for the past several years, at about 40 per month.

And while all hospitals are finding it difficult to retain staff nowadays due to fallout from the years-long pandemic and a nationwide nursing shortage, Providence’s unwillingness to pay its OB nurse anesthetists group a competitive wage was the primary cause for its contract termination.

An alternate nurse anesthesiology group as well as several qualified professionals are willing to work at Petaluma Valley Hospital’s birthing center, assuming they are paid a fair wage. That’s according to nurse anesthetist Karp.

The hard reality is that OB units nationwide lose money due to low Medicaid reimbursement rates, staffing shortages and, in some cases, declining birth rates in the communities they serve.

But only one of those conditions appears to exist in Petaluma where the majority of those giving birth at the local hospital are lower income Latina women who lack private insurance and so are reliant upon Medi-Cal.

To borrow words from the Providence Health mission statement, the people bearing the greatest burden from the birthing center’s prospective closure would be the “poor and vulnerable.”

If Providence was seeking to create a local public relations disaster, they seem to have hit the target.

But what makes the current situation even more troubling is the fact that the company is still reeling from embarrassing national and local news coverage exposing an internal program under which Providence employees were forced to wring money from patients including those who were qualified to receive free care because of their low incomes. Many patients who qualified for free care saw their unpaid bills wrongly sent to collection agencies.

It’s not easy managing a hospital today. Soaring costs and dwindling revenue streams, coupled with economic uncertainties and ever-shifting national health care reimbursements make operating a hospital in 2023 an extraordinarily difficult proposition.

But inept managerial practices don’t help matters.

For the next three years, Providence is legally required to provide obstetric services at Petaluma Valley Hospital. After that, the eventual consolidation of those services at Santa Rosa Memorial Hospital should be thoughtfully planned to ensure the needs of lower income people are properly addressed.

In the meantime, Providence executives here and at company headquarters in Renton, Washington should actively seek ways to build, not damage the public trust here in Sonoma County.

(John Burns is a former publisher of the Petaluma Argus-Courier. He can be reached at john.burns@arguscourier.com).