Doctors say cutting rural obstetrics poses risks to women, babies

The Olney Hamilton Hospital board of directors confirmed their decision to build a new hospital with no obstetrics services at their June 28 meeting, a plan that doctors say will create a dangerous “maternal care desert” for Young County women and their babies. OHH is the only hospital in Young County that provides obstetrics care.

The Texas Medical Association warned in 2022 that the failure of rural hospitals to offer obstetrics services was creating “maternal care deserts” especially in rural communities in west Texas.

In most rural U.S. counties with populations of fewer than 50,000 residents, the maternal mortality ratio was 23.8 deaths per 100,000 live births compared with 14.6 in large metropolitan counties with a population above 1 million, according to the most recent data from the Centers for Disease Control and Prevention from 2011 to 2016.

“We’ve shown that the farther women have to drive to get maternal care, the higher the morbidity and mortality rates become,” said Dr. Jennifer Liedtke, a member of the Texas Medical Association’s Committee on Reproductive, Women’s, and Perinatal Health.

At a special-called meeting on June 5, the OHH board – minus board members Lyndsey Miller and Dr. Jeremy Johnson, who was delivering a baby – approved a plan to shrink the hospital footprint by 14,000 square feet after learning from Guide Architecture of Dallas that the costs for building the critical access care hospital had risen from $550 per square foot to $720 in less than a year due to inflation, OHH Administrator Michael Huff said. The rising prices for labor and materials put the project $9 million over budget, Mr. Huff said.

In November, Olney voters overwhelmingly approved a $33-million bond issue to build the new hospital. Hospital officials said in a series of public meetings that the new facility would attract more medical staff and services to the area, and would be paid for by tax revenue from new wind farms and a hydrogen plant in the hospital’s taxing district.

The revised hospital plan calls for a one-story structure instead of two stories, and removes one of two planned operating rooms, the nursery, and two labor, delivery, recovery, and postpartum [LDRP] rooms, Mr. Huff said. State regulations require hospitals that deliver babies to have two operating rooms, he said.

Dr. Johnson asked fellow board members at the June 28 meeting whether they “feel as a board we have talked about all other options and this is the best course of action.”

Mr. Huff and OHH Board President Dale Lovett said they are looking for additional funding to try to add obstetrics services back into the plans but would proceed with construction in the first quarter of 2025, with or without them.

“We have to move or die and that is a critical break point,” Mr. Lovett said. “Those [concerns] were discussed. They are heartbreaking and they were not ignored.”

Mr. Huff said the revised plan prioritizes services that earn the hospital money, such as wound care and pain management, rather than services that are not fully reimbursed by Medicaid or private insurers, such as childbirth. He also said that only 20 percent of the hospital’s patient load is women of childbearing age.

The hospital said it averages “just over 2 deliveries per month,” a figure that doctors say vastly underestimates the need for prenatal care in Young County.

“I thought we wanted more [obstetrical] services at the hospital so we could capture more of that revenue, and now you are limiting physicians like me and [Dr. Chantel] Taylor,” Dr. Johnson said. “I have always been told that we were a break-even operation so if that was not truthful then let me know. … This is a service. … What is a bigger factor in people’s lives [than] helping them bring their child into the world?”

Dr. Taylor, who delivers most of the babies born at OHH, said in a separate interview that she provided prenatal care to about 50 women last year and that about 40 percent of them were transferred - “out of an abundance of caution” to hospitals that do highrisk deliveries.

She said the problem with the hospital board’s calculation is that women will show up at OHH’s emergency room for preterm labor, late-term miscarriages, and other potentially life-threatening complications, with no staff or equipment to save their lives or their babies’ lives.

Dr. Johnson told the board as much, recounting a call he received a day earlier from an emergency room physician who was treating a woman in preterm labor at Graham Regional Medical Center, which cut obstetrics services in 2015.

Dr. Johnson said he advised the ER doctor, who had little to no obstetrical experience, to deliver the baby and transfer the patient and her baby to a hospital that has a nursery. “Our [emergency room] has a mother-baby machine to check on contractions and the baby in utero,” he said.

He could see that scenario playing out at the new hospital.

“Currently, we are prepared for any obstetrical emergency but the longer the hospital goes without obstetrics the more dangerous it gets due to lack of experience. After three to five years of not doing [obstetrics], it will most likely be considerably more dangerous to have your baby at OHH. That is the natural progression: the more you do something the more prepared you are.”

Dr. Taylor said OHH administrators discussed asking her to deliver her patients at Seymour Hospital – a 40-minute drive each way. That drive would take her away from her Olney patients for at least a half day for each daytime delivery and put her in hazardous driving conditions for nighttime or bad weather deliveries – a scenario she did not contemplate when she was hired.

She also fears that patients who cannot afford to take off work or to drive to Seymour or Wichita Falls for weekly prenatal visits during their last trimester, will forgo those visits and risk their health and that of their babies.

The Olney City Council and the Olney Economic Development Corporation have prioritized housing development to lure young families to the area.

Mayor Rue Rogers and OEDC Executive Director Tom Parker both declined to comment on whether the decision to cut obstetrics would affect that community goal.