Nurses union blasts CHS re: suspension of labor and delivery at Fallbrook Hospital; CHS counters statement with information

The following statement was released Sept. 12, by the California Nurses Association/National Nurses United (CNA/NNU):

"The California Nurses Association/National Nurses United (CNA/NNU) called on Community Health Systems (CHS), the giant for-profit healthcare corporation based in Franklin, Tenn. that operates Fallbrook Hospital, to reinstate labor and delivery services, which were hastily suspended with little notice on Sept. 3, 2014."

Providing fewer than 14 days’ notice of closure despite the availability of registered nurses and a doctor to continue to staff the unit, CHS ignored the demands of RNs and doctors to keep the unit open at least until an adequate transition plan could be formulated."

"The RNs’ patient safety concerns are detailed in a letter to the hospital’s chief executive officer."

"They say that the CHS plan to triage and transfer maternity is deeply flawed. Maternity patients who walk into the emergency room for care, especially those who are in active labor or who are in critical condition, cannot be safely transferred to other facilities. Without preserving the unit, vital services such as emergency C-sections will be unavailable."

"Nurses raised further concerns about nurse staffing, equipment, and patient care protocols. With only one maternity RN available as a resource, staffing will be insufficient for critical mother-baby couplets that require one-to-one obstetrics nursing care. Vital equipment, such as fetal heart monitors, will not be available in the emergency room, according to hospital officials."

"The nearest hospitals with labor and delivery units, Tri-City Medical Center in Oceanside and Palomar Hospital in San Diego, are at least a 30-minute drive from Fallbrook."

"In a meeting with the nurses the day after the closure, CHS representatives admitted that they did not have a comprehensive plan to care for walk-in patients or projections on the number of patients likely to present, and described the care plan as a 'work in progress.'”

"RNs also expressed alarm at the cavalier attitude to patient safety expressed by CHS administrators in a meeting with the nurses the day before the closure, where one CHS administrative employee told nurses to “pray that doesn’t happen” when confronted with an emergency situation.

“The Fallbrook community deserves better. A ‘work in progress’ is not a good-enough plan for a patient who presents in need of an emergency C-Section,” said Fallbrook Hospital labor and delivery RN Michele Caiola. “We have the staff and equipment to operate a fully functional maternity unit – there’s no need to take these kinds of risks with patient safety.”

“The decision by CHS to suspend labor and delivery services presents a clear and present danger to the health of this community, and should be reversed,” said Fallbrook obstetrician Dr. Lawrence Peterson.

Community Health Systems is the largest for-profit health system in the United States, with 206 hospitals in 29 states.

CHS has recently been the subject of a number of controversies, including the recent $98 million settlement with the United States Department of Justice, several Medicare and Medicaid fraud claims, and its failure to protect the persona information of more than 4.5 million CHS patients."

Fallbrook Hospital Corporation (Community Health Systems/CHS) issued this statement Sept. 15 regarding this topic:

"The safety of our patients is our highest priority in making decisions about the care we provide. The number of women delivering babies at Fallbrook Hospital has steadily declined in recent years, reflecting smaller numbers of childbearing age women in our community. As the birth rate has declined, so, too, has the number of obstetricians on our medical staff. Currently, only two obstetrician/gynecologists serve on our medical staff."

"Our process around suspending this service was thoughtful and thorough. We developed our plan to suspend OB services in cooperation with the California Department of Public Health and Fallbrook Healthcare District to ensure they had no concerns. We notified our OB nurses and physicians of the pending change and reviewed our transition plan, giving all an opportunity to provide input. Each obstetric registered nurse was individually asked, but none offered suggestions for the plan."

"We follow national standards of care and staff our ER in accordance with Title 22 guidelines which do not require an OB-trained resource nurse. Physicians and staff in our ER are trained to safely manage any patient who presents in active labor. Equipment to screen and assess mothers and/or newborns is available in our hospital including Doppler, ultrasound, and infant warmers. This is consistent with many U.S. hospitals that don’t offer active obstetric programs."

"Because our hospital has not had a neonatal intensive care unit, we have historically stabilized and transferred any high risk patients in cooperation with the Rady Children’s Hospital Emergency Transport team (CHET). CHET has both neonatal and pediatric advanced life support teams who are dispatched based on the patient’s condition. We will continue to use this affiliation when needed."