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St. Francis West
maternity services
will close

With West Oahu service
ending, area women must go
downtown to give birth

---

By Helen Altonn
Star-Bulletin

Pregnant West Oahu women planning to deliver their babies at St. Francis Medical Center-West will have to go elsewhere after the end of this month.

The hospital is closing its maternity services on or before March 31, said Sister Gretchen Gilroy, St. Francis-West chief executive officer.

She cited a decline in births and escalation in costs as the major reasons for ending 10 years of maternity services at St. Francis-West.

The closure was first reported by doctors who were disturbed that St. Francis had not informed the public.

"I'm just concerned that people in the community need to know the base for their services is shifting," said Dr. James B. MacMillan III, an obstetrician who frequently delivers babies at St. Francis-West.

He said the closure of maternity services has been known for more than two weeks, "and we were expecting they would make an announcement. To protect the community of pregnant ladies out there, they need to know."

One of his patients who was scheduled to deliver there arrived Thursday night and could not be accommodated, he said. "They were too full. They didn't have any staff and couldn't take any more patients."

Luckily, the woman had time to go on to Kapiolani Medical Center for Women and Children, MacMillan said.

But some may have difficulty in the future. Patients along the Waianae Coast particularly use that hospital quite a bit, he said.

Women living in Makaha are an hour away from St. Francis-West, he noted. "For some ladies having a second or third baby, that can be a long hour."

And it will be even longer without services at St. Francis-West. "They'll have to come on downtown," MacMillan said.

Pregnant women who are not Kaiser Permanente patients or military dependents with access to Tripler Army Medical Center will have to go to Kapiolani or Queen's Medical Center, he said.

Kapiolani Medical Center at Pali Momi does not provide maternity services.

When ambulances pick up patients in labor, MacMillan pointed out, they are required by federal rules and regulations to take them to the nearest hospital with maternity services.

"So that's going to change that picture as well."

MacMillan said doctors have been informing their patients, but not all pregnant women are receiving prenatal care. "So it's inevitable that some people are going to roll up there, thinking they're going to deliver, and having to trot downtown."

If the birth is imminent, it becomes an emergency room problem, and St. Francis-West has a very busy ER, he said.

"I would hope, and I think they will, but I haven't seen any plan or details to tell us how much preparation emergency is going to make to accommodate patients out there."

Gilroy said the hospital will continue to handle emergency maternity cases and provide health education classes related to maternal-child areas.

She said the hospital's leaders and board regret that the maternity services must be suspended.

Many efforts were made and resources expanded to try to build the volume of births at the hospital, she said, including adding specialty care services for problem pregnancies and sicker infants in 1997.

"But due to a number of factors, including declining birth rates in Hawaii, the anticipated growth did not materialize."

She said 482 babies were delivered at the hospital last year, compared with 792 in 1994. Admissions for births islandwide have decreased 24 percent since 1990, she said.

Reduced Medicare and Medicaid reimbursements also are a big factor, causing all Hawaii hospitals to streamline, consolidate and cut services.

MacMillan said doctors were told each delivery at St. Francis-West cost the hospital about $10,000.

Gilroy said maternity services -- especially higher-level specialty services -- are costly unless delivered in large volume. "The basic maternity service at St. Francis-West has always operated at a loss, with losses escalating at the inception of the specialty maternity service in 1997," she said.

"Given the impact of the Balanced Budget Act of 1998 and the declining reimbursements by all other payors, St. Francis-West was compelled to make the difficult choice to suspend the service."

"It is sad," MacMillan said. "The maternity service out there was becoming an ever-growing useful service to the community."

But with the reduced reimbursements and high cost of operations, he said unless births at the hospital increased about threefold, it was "very clear ... they wouldn't get into the black. I just think the cash hemorrhage became too great a burden, and they didn't have any choice."

Gilroy said retraining was offered to the 21 full-time staff members in the maternity unit who wanted to remain at the hospital, and assistance given to those looking for other employment.