The nation’s largest hospital chain HCA is gambling with the lives and health of women and newborns with its plan to end maternal-child health services at Regional Medical Center.
As of May 30, Regional will no longer provide prenatal, postpartum, labor and delivery care for expectant mothers and neonatal intensive care for at-risk newborns.
HCA justifies this unwarranted elimination of the most essential beginning of life care on what it claims is a declining birth rate. But in 2019, the number of births, C-Sections, and maternal health patient discharges was the highest in five years. Since 2014, the hospital birth rate has grown by 20 percent.
So why would HCA eliminate a cornerstone service that is intrinsic to any community?
HCA is a huge profit-seeking enterprise which views patient care as a commodity, not a public service. Birthing care is less profitable than, say, boutique elective procedures, not as lucrative to generating higher dividends for shareholders or corporate executives.
And HCA is hardly a struggling small business. HCA has made more than $25 billion in profits the past decade. It also just received an additional $700 million bailout from the federal government’s Coronavirus Aid, Relief and Economic Security Act, and an additional $4 billion in Medicare loans.
Where does this leave East San Jose residents needing birthing care close to home? In trouble.
Women in labor will have to navigate some of the state’s most crowded roads to reach HCA’s other hospital, typically a 45-minute drive in heavy traffic across town, and even longer on public transit. That risks delays in timely care, a serious health hazard for the mom, and potentially brain damage or worse for a fetus who suffers oxygen obstruction.
Many women and their families will surely still come to Regional when in labor, and be shunted to the emergency room to deliver their baby, especially since the hospital has done little to inform area residents of the closure.
But the ER at Regional is inadequately prepared to properly and safely care for laboring women, especially in the event of complications that can be life threatening to mother and child.
Birthing care is a highly-specialized clinical skill, not easily transferable to nurses in a busy ER who have never delivered a baby and do not have the clinical expertise or experience with at-risk infants.
Hospital administrators assert that limited trainings they have conducted for ER staff, and will not even be completed until the end of June, will suffice. But Regional nurses state that no emergency room RNs are trained in neonatal resuscitation to prepare them for acute neonatal clinical emergencies or potential complications of laboring patients, which is especially worrisome in a hospital that will no longer have the backup of a neonatal intensive care unit.
To make matters worse, nurses in the units to be closed report that no other RNs in the hospital have been trained to do fetal monitoring, and that the hospital does not plan to do any fetal monitoring for patients who arrive at the hospital either in labor or with traumatic injuries.
Further, the ER is the primary entry point for patients with confirmed or suspected infection of the novel coronavirus in a global pandemic that is far from over. Both mother and child will be at risk of exposure to COVID-19 patients in the Regional ER which has been a virus hot spot. The Mercury News recently cited death records showing that Regional has recorded the most coronavirus deaths of any medical facility in the county.
Who will be most affected by the closure? Some of San Jose’s most vulnerable, and medically underserved demographics – in particular, working class residents, many of them low-income women and children, as well large percentages of Latino, black and Asian-American residents.
In 18 of the 20 zip codes with the largest number of patients who come to Regional for care, median household incomes are below the county as a whole. Half would require an increase by a third or more to reach the countywide income level. Poverty rates for women in nearly half of those areas are more than 50 percent higher than the countywide rate.
In more than half of those areas, poverty levels for Latinos are higher than the county level, and more than 40 percent higher in six of them. For African Americans, the poverty rate is more than double the county level in eight of the top 16.
The city’s east side accounts for a third of the first 100 COVID-19 deaths, and in one of them, the death rate is four times as high as the wealthiest zip code, the Mercury News reported.
Now, while enduring that chilling, disproportionate rate of virus infections and deaths, many of those same residents, our neighbors, will be without close access to the most basic of family medical services – bringing new children into the world, safely, for mother and baby — without being collateral damage to HCA’s profit-centered budgetary goals.
Nurses have been rallying for weeks in social distancing protests outside Regional Medical Center, frequently joined by San Jose community leaders and elected officials who share our alarm and outrage at how HCA is abandoning many East San Jose residents.
For nurses, there is no greater priority than speaking out to protect our patients. This fight to protect laboring women and their fragile newborns will continue.
Malinda Markowitz is a registered nurse and president of the California Nurses Association/National Nurses United. She worked for 39 years at Good Samaritan Hospital in San Jose and is a San Jose resident.