Grady Memorial Hospital in Delaware is closing its labor and delivery unit, diverting patients and babies to other OhioHealth hospitals that are farther away.
The facility is hardly alone. More than 20 other hospitals in the state have taken similar steps.
Among the reasons: fewer babies, not enough staff, costly to operate, etc.
All of this is happening in a state still grappling with high maternal and infant mortality rates. What's the answer?
We're talking about the issue on this hour of All Sides.
Guests:
- Jack Slemenda, reporter, Delaware Source
- Bianca Holder, manager, Maternal Infant Health Initiative, March of Dimes Ohio
- John Palmer, public affairs director, Ohio Hospital Association
Transcript
This transcript is generated with AI. To ensure its accuracy, review the audio file.
Amy Juravich: Welcome to All Sides with Amy Juravich. It's an all too familiar scene playing out across the US. Labor and delivery units closing. In Ohio, where the number of preterm births continues to rise, the number of closures has surpassed 20. Grady Memorial Hospital in Delaware, part of the Ohio health system, is the latest. Residents, health officials, and city leaders are pushing back, raising concerns about accessing care, and questioning whether it's even legal. Joining us now is Jack. Jack Slemenda, a reporter for The Delaware Source, an independent news organization, and he's been covering the story. Thanks for joining us today, Jack.
Jack Slemenda: Alright, good morning, Amy.
Juravich: So give us a sense of Grady Memorial Hospital's role in the Delaware County community. Am I, I'm understanding right, it's the only hospital in the county, is that right?
Slemenda: Correct, yes, it is the only hospital in the county. It is also the, they serve a lot of people from the Morango County area as well.
Juravich: Okay, so Ohio Health announced in early June that it would close its labor and delivery unit effective July 31st Was this expected was it hinted at in any way or did it come as a surprise to Delaware County and people who go to Grady?
Slemenda: Sure, I think it was kind of expected. Over the course of a couple of years now, there has been an increase in births over at Dublin Methodist and Riverside Methodist hospitals, both Ohio Health products as well, and Marion General as well. So both, all those hospitals have been having an increase in the services and have seen some upgrades, whereas Grady really hasn't, and it's kind of resulted in Grady, you know, slowly making its way to what we have today.
Juravich: Okay, so Delaware is known as the second fastest growing county in the state now. It lost its top ranking to Union County in the most recent census data. But despite that growth, I mean, Delaware being such a fast growing county, Ohio health officials say that Grady wasn't seeing this uptick in babies being born there. Do you know what statistics they're citing to basically justify the closing by saying there's less babies.
Slemenda: I'm not super privy to that, actually, to be honest with you. That is something that we haven't really looked at a ton in our coverage.
Juravich: Yeah, Ohio Health issued a statement that said there was a 23% decline in labor and delivery volume at Grady But I guess it could be both Fewer babies, but maybe also You mentioned that the services didn't really keep up, you know, Ohio health may be invested in other places Is that what you were finding?
Slemenda: Yeah, that's what we found a lot was that these other hospitals in the Ohio Health Portfolio have been have been expanded, whereas Grady has not been. And that's a lot of different reasons, one being that Grady sort of a landlocked building and there's not a ton of opportunities to expand it physically. But these other hospital's have seen several upgrades in their services over the course of numbers of years.
Juravich: My understanding is that at Grady, though, there will still be some services provided to pregnant women. Do you know what will continue? Just maybe not the labor part.
Slemenda: Sure, the entire inpatient maternity ward is going to close on Friday. So there will not be, effectively what that means is there will no longer be babies born inside the city of Delaware. Effectively is what we're seeing there. There's still going to be, you know, your typical emergency room services at that hospital. But this is the first, well, this is not the first service to close at Grady. They've seen retractions in their radiation oncology program as well, but to name one, the emergency room is definitely one that will stay at the hospital, but it's kind of an uncertain future for what's next.
Juravich: You're listening to All Sides on 89.7 NPR News. We're talking about the closing of Delaware's Grady Memorial Hospital's maternity ward, the labor and delivery unit, effective July 31st. And our guest is Delaware source reporter Jack Slamenda. So the reaction to the closing was pretty swift. It was a crowded and lively Delaware City Council meeting back on June 22nd. One of your colleagues covered that. What were residents saying? Some people there were medical personnel also. What happened at the city council meeting?
Slemenda: Sure. Well, I could tell you that I've covered Delaware City Council meetings for a while now, and I've never seen chambers that packed. It was it was a really eye opening experience to walking into that that room that day. I sat in the room next to my colleague, Brittany, who wrote that story, and we observed mothers, nurses, members of the Ohio Nurses Association. They all spoke during the public comment portion of that meeting. And basically we're just saying that this is something that is so detrimental to the community. Not only for mother's safety for getting ready to give birth, but also the fact that there's relationships that these nurses have built with these mothers, and it's something that they care deeply about and something that it's just sad to see, it's sad to have them walk away from it. So the public comment was definitely a striking portion that ultimately led to Councilwoman Lindsay Griffith authoring a resolution. Calling on Ohio Attorney General, Andy Wilson, to basically enforce this 2005 affiliation agreement that Ohio Health signed with Grady.
Juravich: OK, yeah, and we'll get into that agreement in a moment. But in the story on the Delaware source, an ER nurse at Riverside basically spoke up in this meeting and said, from her perspective at Riversides, she said, we're not prepared to handle your community. And that comment is at odds with what Ohio Health is saying. Ohio Health said in a statement to all sides, saying that staff at all other Ohio Health Riverside, Dublin, Marion. They're looking forward to serving more moms from Delaware County. Do you feel like there was conflicting information there about moms going other places?
Slemenda: Yeah, there's definitely conflicting information. I think that we've heard from inside even this week that it's chaotic inside Grady. It's chaotic in terms of they've been, we've that they're accepting patients this week and that there's no longer going to be anybody on schedule for this unit after Friday. That's chaotic to say the least in my opinion. So it is definitely conflicting information where. There's just uncertainty inside Grady and there's uncertainty for nurses at the other hospitals of what's going to happen next, especially if you're considering the fact that patients are still coming into Grady this week and the unit is done tomorrow.
Juravich: Yeah, and that's interesting because when you know babies don't really abide by you know rules or dates or hours so it you know it can take it can take five minutes for a baby to be born or you know or be in labor a long time. Yeah. You had an exclusive interview with Dr. Tom Hubbell and he's a doctor who spent decades working at Grady Memorial as a family physician. He also served as chief of staff. And he's questioning the legality of this. So you kind of mentioned that. There's an agreement between Ohio Health and Grady when they kind of became one. What is he questioning regarding the legility?
Slemenda: Sure, he's questioning the fact of whether or not that Grady can step away from this hospital in a sense. He's questioning that fact of whether or they can take away some of these core services that are outlined in this hospital and still be upholding the affiliation agreement, if you will. A constant message that we've heard from Ohio Health is that they're continuing to uphold the spirit of the agreement. That's something that... In my conversation with Dr. Hubbell, he referenced a lot. He doesn't view that the spirit of the agreement is being upheld when you're taking away a core service like the inpatient maternity unit. That's been something that's been really, really key to him and is why he called upon the attorney general to further investigate this affiliation agreement to make sure that this is upheld properly.
Juravich: So we had the chance to talk with Dr. Hubbell earlier this week. Producer Erin Esmont Rabinowitz interviewed him, recorded his comments, and by his count, he has delivered about 1,000 babies in Delaware. Let's listen to him.
Dr. Tom Hubbell: Definitive agreement between Ohio Health and our hospital included the provision that certain core services would be continued indefinitely. And that was absolutely a sticking point in the discussion. And I'm quite certain that our board would never in a million years have approved the position without that promise.
Juravich: Mm. And so, Jack, stick with me for a second, because we have a statement here. So we reached out to Ohio Health to invite someone from either Grady Memorial or Ohio Health on today's show. They declined, but Ohio Health provided a two-page statement underscoring their commitment to moms and babies and also detailing this 2005 agreement that's in question. I can't read the whole two-paged statement, obviously, but quoting from the statement, it says, in 2005, Ohio Health entered an agreement with the Healthcare Foundation of Delaware County. Even though that organization no longer exists, it was dissolved in 2021, we continue to meet the spirit of the agreement and deliver a level of services that the community needs. The agreement states that certain services are to be maintained subject to adequate demand. Okay, so Jack, Dr. Hubbell submitted a letter to the attorney general's office. He's waiting to hear back, but basically they're disagreeing about this. So Ohio Health is saying, services maintained subject to adequate demand. And now they're saying there isn't that demand for maternity. Is that what's happening?
Slemenda: Yeah, that's definitely what Ohio Health is saying. But what I found really interesting in my conversation with Dr. Hubbell was that Grady was actually planning on building a replacement hospital to Grady even before the 2005 Ohio Health Affiliation Agreement. Dr. Hubble outlined to me during our interview that the demand for babies and increased care in a larger hospital was there in 2005 and it certainly hasn't gone away. Um, he explained to me that over the course of a number of years, uh, he and himself, himself and others being on the board, that they had pre-construction meetings with Ohio health to build a new hospital. And at some point, how will Dr. Howell explain to me, that those conversations dried up. Uh, and it's something that he doesn't really have a clear answer as to why, but clearly the conversations for that, for a new hospital to replace Grady with all of these services intact. Those conversations were there and the demand for them was there.
Juravich: And so what is Dr. Hubbell, and you also mentioned a Delaware City Council person, what do they want the attorney general to do here? Just look at it. Yeah.
Slemenda: Well, with Ohio, the Ohio attorney general being the, you know, the most, uh, the, the official, uh the, uh largest figure of enforcing this type of law here, um, he it's, it's called upon him to look at it in terms of, uh is there any legality to this? Is this something that he can step in and, and make sure it is upheld because it, it involves, you, know, public interest and involves a charitable organization such as public Ohio health. So. They're calling upon him to look at it, say, okay, these core services clearly are outlined in this affiliation agreement, and I need to uphold this. We need to keep Grady as is, is what they are generally asking him to look at, yes.
Juravich: And according to Dr. Hubbell, he told us that the attorney general back in 2005 had to approve the agreement in some manner. Do you know anything about that?
Slemenda: I do not know a ton about that. I have seen copies of the affiliation agreement, but I'm not aware of much discussion with an attorney general back in 2005.
Juravich: Well, this is drawing some attention. The closure drew the attention recently of the medical doctor who happens to be running for governor of Ohio, a Democrat. Dr. Amy Acton showed up in Delaware and you covered her appearance. What did she have to say about this closure of the labor and delivery unit?
Slemenda: Sure, she attended a community rally that was designated to saving Grady, is what the meeting was for. And one of the comments that she mentioned to me that kind of stuck out to me was that she mentioned her relationship with knowing Andy Wilson as the Attorney General and his role as a father. And she asked that he look at this affiliation agreement from those eyes basically of looking ended from that role. And understanding, and she had said that she was confident he would do the right thing.
Juravich: And so basically, right now, do we know if moms are being told to go to other hospitals or are they transferring newborns to different places if they happen to be in the hospital right now because they were born maybe this week? Do you know or that's a part of what you're unsure about as of now? Sure.
Slemenda: Sure. That's definitely some topics that we've been trying to get answers about this week. But like I said, it's been pretty chaotic inside that hospital this week, we know, like I said, that they have been, you know, taking in a few patients this week but and then we have confirmed that you know that they are not, there's no one on schedule in that unit after Friday. So in terms of where everyone's going, it kind of a little bit up in the air, which is definitely a scary, scary thought.
Juravich: Yeah, so it's probably if you have an Ohio health doctor, they're telling you to drive to a different Ohio health hospital, right? If you're OB, something like that.
Slemenda: Sure, I mean, the fact that there's still been inpatients though, that doesn't necessarily make that sound like it to me, where everybody's getting turned away or some people are coming
Juravich: Or maybe the message hasn't been distributed to everyone or something like that, yeah.
Slemenda: That's also possible.
Juravich: All right. Well, we've been talking about the closure of Delaware's Grady Memorial Hospital's maternity ward, effective July 31st. And our guest has been Delaware source reporter Jack Slemenda. Thank you so much for your time today, Jack. Thank you. And coming up, we're going to talk about the state's maternities deserts and what it means for health outcomes. That's when All Sides continues on 89.7 NPR News.
You're listening to All Sides. I'm your host, Amy Juravich. Ohio received a letter grade of a D for the number of babies born premature in the March of Dimes 2025 annual report card. Several counties received a latter grade of F. The report notes the steady rise in preterm births, the number or maternity deserts, and other metrics that measure the health of babies. Access to care is now a worry for residents of Delaware County, which just saw its only hospital, Grady Memorial, part of the Ohio health system, shut its labor and delivery unit. Joining us now is Bianca Holder, manager of the Maternal Infant Health Initiative for March of Dimes Ohio. Welcome to All Sides, Bianca.
Bianca Holder: Hi, thanks so much for having me, Amy.
Juravich: So, I cited that letter grade of a D in the intro. This is from a national report. It compiles state-by-state information. How are letter grades determined, like what information is used to give us a D?
Holder: Yeah, so it basically means that babies that are born 37 weeks or less gets, they basically get put into a data collection and it just shows what state is actually doing worse versus what state's actually doing best. So for Ohio, we received a D which is actually a increase from last year where we received AD plus. So we actually... Have not improved our rates compared to last year.
Juravich: Okay. And what does the number of preterm births tell health officials? Like for Ohio, the percentage has risen each year for the last 10 years. So that's not an encouraging trend line. What does it mean if we have preterm births increasing?
Holder: Yeah, so you might be thinking even what causes preterm birth too. So some health conditions that cause preterm birth or make people more likely to have preterm birth in Ohio specifically is smoking, hypertension, unhealthy weight, diabetes, and then hypertension in pregnancy. And so it shows that there are a lot of poor health outcomes specifically that are causing preterm in Ohio.
Juravich: Does the report break it down by race or income level or anything like that? Yes, it does.
Holder: And so, for example, black and Pacific Islander are three times more likely to have a baby born preterm than their white or Asian counterparts.
Juravich: And a new report is due out soon. Can you give a preview of that? Does Ohio's score improve or do we not know yet?
Holder: Yeah. So, um, our, our newest report that's coming out in August is our maternity care desert report card. Um, and so we, when it comes to the preterm birth grade, that comes out in November every year. Um. And so the, the, the newest report card comes out in August for our maternity care desert report.
Juravich: Okay. So how does, um, Ohio do in previous maternity care desert report cards? Is that, is that a D too? I I'm getting my letters mixed up now.
Holder: Yeah. So when it comes to the maternity care desert report, there is no grade. It just or so gives an overview of what happens in our state. So for example, in 2024, when the last report card came out, 14.8% of Ohio counties are maternity-care deserts. And so, but I actually think this new report card is going to have a spike just because of, for example. What we're talking about today with possible closures in Columbus and so I actually think there will be an increase in the number of counties that have maternity care deserts.
Juravich: Yeah. With Delaware's Grady Memorial closing its labor and delivery unit effective July 31st, does that mean it's now a maternity desert?
Holder: It doesn't necessarily mean it's a maternity desert, but I think it just shows that we are hitting a dilemma because now when you think about all the people that are going to this hospital to give birth, now they have to figure out another hospital they have go to. That could be 30, 40 minutes away from them. And so that is the dilemma more so than it being a maternary care desert.
Juravich: Okay, do you know what defines a desert? Is it a certain number of miles or without maternity care?
Holder: Yeah, so there's two different ways to define a maternity care desert. One is a lack of birthing centers, birthing hospitals in a county, or which usually means zero to one, but normally it's just there are no birthing hospitals in the county. And then another one is that there are zero to one OB providers in that county.
Juravich: Hmm. Okay. And some counties in your report, because the report breaks it down, it gives letter grades to the state and then counties and cities. Do you know counties that don't have OB-GYN doctors? Is that why some of them got an F? Maybe they don't have a doctor at all or it's in that zero to one category.
Holder: Yeah, so Southeast Ohio is a huge maternity care desert. And so that includes, for example, like Vinton County, let's see, I'm trying to think, Meigs County, Noble, Perry, those are all maternity-care deserts. And so those are counties that don't have either an OB provider in that county or they lack a birthing hospital. Either or, or probably both.
Juravich: Yeah it most likely is both. You're listening to All Sides on 89.7 NPR News. We're talking about Ohio's maternity deserts and the closing of Delaware County's Grady Memorial Hospital labor and delivery unit. And we're talking with Bianca Holder from the March of Dimes Ohio. So you have a map that shows travel time when maternity wards close. How much further do patients need to travel? Can you talk about that a bit? I don't know if you know exactly if someone in Delaware County where they need to travel or that kind of thing.
Holder: Yeah, so I don't have specifics on Delaware County. However, when it comes to maternity care deserts, it's usually means that someone has to drive 30 to 40 minutes away to their nearest birthing hospital. In the past couple of years, they've had videos come out specifically about a report card of women who shared that they're nervous to give birth in their car. Because they're driving 30, 40 minutes away to receive care. And that's horrifying. No one should feel like they have to give birth in their car or on the side of the highway because they don't have access or aren't near a birthing hospital. And so that is something that's like very, especially here, I live in Northeast Ohio. There's hospitals everywhere. I'm just thinking, how could that be? But in, for example, Southeast Ohio, And then also just in Columbus with the recent hospital closure, there is just so many issues that can rise from the hospital closure.
Juravich: Can a direct line be drawn between the travel time and the health outcome of a mother and a newborn?
Holder: Yeah, when we think about just in general hospital closures and especially in like rural and smaller communities, it's not just hospital closurs that are causing this issue. It's workforce shortages, it's financial pressures and declining birth volumes that contribute to maternity unit closures. And then it's also just the fact that we're not putting in investments that strengthen the entire maternity care system. So it's more than just one hospital closure. It's a system change that needs to happen for there to be long-term solutions, just because there's been, I believe, 15 hospitals in Ohio in the last three years I have closed, specifically birthing hospitals. So there's a trend that we're seeing, but we have to also look at things through a bigger point of view to think, wait, this is an entire maternity care system that we need to change. Not necessarily just the hospital, a representative.
Juravich: Ohio Health was not able to join the show today, but they provided a statement, and a part of that statement says, quote, that nationally we're seeing more medically complex pregnancies and women should have access to a hospital that is highly equipped to handle any scenario. So I think what they're getting at here, because Ohio Health issued a two page statement, I can't read that on the radio, but what they are getting at is they've invested a lot of money in labor and delivery at. Dublin Methodist Hospital at Riverside. They're building a huge new tower for Riverside Hospital that is completely dedicated to women. And so they're saying that women are having these complex pregnancies and these places are where it can be handled. So that's where they want the women to go. But a place like Grady hasn't received those investments. And so maybe that's not the best place for these pregnant women with complex pregnacies. Can you talk to me about that? Are you seeing similar things with more medically complex pregnancies?
Holder: Yeah, I definitely think there has been more medically complex pregnancies. There's been a spike in hypertension during pregnancy with preeclampsia and that can cause preterm birth. That can cause issues with mom during the whole pregnancy where she has this spike in her blood pressure. So that means that she is either on bed rest or she has to take low dose aspirin in order to really lower her. High blood pressure. And then when we think about baby as well, being born preterm, there's so many complications that come with that. It comes with respiratory issues. It comes not being able to just be with mom right away, having to go to the neonatal intensive care unit for weeks or months at a time. And so there's definitely been a spike, which is why I think with our grade in Ohio, that's something that we're seeing, is there's not an improvement in our grade. And it's because of a lot of these chronic health conditions.
Juravich: Can you see Ohio Health's point where if they invested all of this money in certain hospitals, the women should go there to access this high level of care, right?
Holder: Yeah, and I think in theory, I think that's a great idea, but I think there's a lot of stigma around hospitals in general. I think a lot of women of color specifically struggle to believe that their voices are heard in a hospital setting. And so there's a lot of fear and even just generational fear as well. You know, grandma is telling their grandkid, no, don't go to that hospital or don't trust this hospital system because they didn't treat me right. And so there's a lot of other factors, I think, than just saying, oh, we built this beautiful hospital. There's just so many other factors we have to look into to why they're choosing not to attend those hospitals as well.
Juravich: Here we have a cut from Dr. Tom Hubbell. He's a long-time family physician who worked at Grady Memorial for decades and in an interview with our producer Erin Esmont Rabinowitz, he is speaking to that trend that we're talking about. Let's listen.
Dr. Tom Hubbell: If you look at what Dublin provides, in-house anesthesia, perineal center, an eight-bed neonatal ICU, in- house OBGYN, in house midwife, Grady doesn't have any of those things. And patients know that or they learn it. And they choose to go where there's more service available. Could Grady have that? Absolutely.
Juravich: So I think what he's getting at is like a chicken or an egg scenario, right? Like he laments that Grady didn't keep pace with other hospitals, because he says Ohio Health didn't invest in Grady. They invested in other places. So then people go other places to give birth. So then Grady's closing their labor and delivery unit because there's less babies being born there. But I mean... Where does the balance come in from your perspective of where a hospital system, not just picking on Ohio Health, but a hospital where they invest money and where they don't, and it ends up being like an urban and rural divide.
Holder: Mm-hmm Yeah, that's a really great question. I think that a lot of times when, especially depending on where people live, a lot times it is transportation issues. When I look at more low income women, when I look women who are on Medicaid, transportation to get to these nicer hospitals, I mean, it could become a burden for them or they have other children and they're not able to travel with them or who's gonna take care of their kids. And so I definitely think that when it comes to. What women pick or what they don't or things like that. It all also depends on like financially or where they're at low income wise. And so I definitely wish that all birthing hospitals would be able to pour money into making like very high tech, very birthing friendly hospitals. But I just think depending on where you live too, there's a lot of stipulations about what can or cannot be.
Juravich: So Ohio Health, in the statement they issued, it addresses its investment in care in the Delaware County community. And it says that it's adding more OB-GYN physicians to the area and adding a specialty gynecologic surgeon that will practice at Grady Medical Office Building. And then they're renovating the first floor of Grady's Medical Office building to create a destination clinic for urologic and gynecological surgery. I'm having trouble with all those words, you know. But you get the point is basically what they're saying is they're investing in women's health care, urology, gynecology. So basically they're closing the labor and delivery unit. They may not be delivering babies in this hospital and caring for newborns, but they are focusing in on some women's specific needs. I mean, tell me about that, you now, that maybe one hospital can't do it all in this day and age, but they're invested in certain things. What do you think of investing in? The women, even if they're not delivering the babies.
Holder: Yeah, I think any investment in women, pregnant women is worth it. When I think about this, I'm thinking about our mom and baby mobile health centers that are in Columbus and Southeast Ohio right now, and how it just shows that there is a need for, especially prenatal care and just comprehensive prenatial care as well to catch some of those issues. So I definitely think it's worth it that they're able, I'm really glad to hear that, that they are actually still. Investing and creating an opportunity for women to go seek out prenatal care as well. But I think that the issue is if women have to travel super far still for their labor and delivery, that's where things get dicey. But I definitely think that's, for example, where the mobile units kind of can come in handy as well, where they can send out referrals to different hospitals, where can get to know the doctors as well when they get birth.
Juravich: Okay, so the March of Dimes has two mobile units. One of them serves Franklin County and Delaware County. Do you foresee more Delaware residents needing the mobile unit from the March of Dime if they can no longer go to Grady Memorial Hospital? I mean, I don't think your mobile unit is delivering the babies though, right, I know. Yeah, no.
Holder: Yeah, no, they're definitely not delivering babies, but they are doing a comprehensive prenatal care, postpartum care, infant checkup, they're doing vaccinations. They even usually have a social worker on board as well just to give that more comprehensive care. I definitely think that Delaware County, I wouldn't be surprised if there's an uptick with the amount of patients that start coming to the mobile clinics just because they might feel more comfortable. And even just it's easier to go there than drive further away to their prenatal appointment. So I am definitely gonna keep my ears open to hearing from the Ohio Health team what they think and if there is an uptick of patients.
Juravich: Just to end on what has March of Dimes Ohio been doing legislatively, you know, advocating at the State House? I mean, are lawmakers alarmed to get a D letter grade and continuously get the Ds? Some counties get Fs. Is there any response?
Holder: Yeah, that's a great question. So every year March of Dimes hosts a advocacy day called March for Change. It's normally in March or April and we are able to go to legislators and really talk with them and have a sit-down conversation with them and share our stories of why we're passionate about moms and babies. And so every year we're able to talk about different bills that are currently in the legislator and they are surprised. Every time I hand in the report card and point to that letter, they're just like, what are we doing wrong? And so that gives me some hope that I do think a lot of it has to do with education and letting them know that Ohio is not doing well when it comes to policies, when it come to how we're supposed to actually shape the maternity care desert and as well as a preterm birth in Ohio. And so we advocated this year for a couple different bills. One was a behavioral health screening bill. One was to regulate midwifery and hospital transfers. One was, to designate Ohio doula awareness week. And then another one was a paid leave policy. So we are just on the ground, just trying to make sure that moms and babies are first and foremost in what we do in Ohio. And so those conversations have been crucial.
Juravich: We've been talking about Ohio's maternity deserts and the closing of Delaware County's Grady Memorial Hospital Labor and Delivery Unit with Bianca Holder from March of Dimes, Ohio. Thank you for your time today. Thank you so much for having me. Coming up, we're gonna talk at, we're going to look at the hospital's perspective when it comes to labor and delivery services statewide. That's when All Sides continues on 89.7 NPR News.
You're listening to All Sides. I'm your host, Amy Juravich. It's an all too familiar scene playing out across the US. Labor and delivery units closing. In Ohio, where maternal and infant mortality rates and health outcomes are already worrisome, the number of closures has surpassed 20. Grady Memorial Hospital in Delaware is a part of the Ohio health system and is the latest closure. What are some of the factors leading to these decisions? Joining us now is John Palmer, Public Affairs Director for the Ohio Hospital Association, a statewide membership organization comprised of Ohio's 251 hospitals and 17 health systems. Welcome back to the show, John. Thank you, Amy. Okay, so I wanted to start by asking you about that number of closure of labor and delivery units. It's 23 since the year 2020, so Delaware's Grady Memorial being the latest. Ohio health. Cited low birth rates at Grady as the reason that they closed that labor and delivery unit. What are some reasons you're hearing from hospitals around the state who have taken similar steps? Are they all saying fewer babies being born?
John Palmer: Yeah, thank you again, Amy, for having me and for focusing on this topic. I think nationally, to start there, there's been over 500 hospitals in this country that have closed labor and delivery units between 2010 and 2022. So Ohio is not an outlier by any stretch of the imagination. But in Ohio, even going back to 2017, there've been 28 closures of labor and delivery. And, you know, it's attributed to a variety of factors. The driving one is utilization and demand. We're just seeing that shift happen in recent years. It's a reflection, I think, in some of the communities where health priorities are shifting. We're seeing more aging communities, and so that's shifting hospital resources and services to staff up and expand to help accommodate those particular aspects that are happening. Consumer choice, a lot of who are seeing consumers, mothers, making decisions based on their care journey and depending on what their situation may be, if it's expected to be a kind of standard normal birth versus something that might present complications, making choices to deliver at a particular hospital that might not necessarily be in their community. So yeah, demand, consumer choice are the primary driving factors there, too. There's also a workforce element there, too.
Juravich: You mean staffing? Staffing OBGYNs is the primary.
Palmer: Care coordinator lead for these labor and delivery units.
Juravich: Are we low on OB doctors?
Palmer: Unfortunately yes, I mean nationally there's I think a shortage with reports close to in the thousands right now and Ohio is no different. I think you know preparing for this interview looking on the job board there's close to about 200 openings right now for OB-GYN doctors in Ohio not just in hospitals but another care settings there too. So it's great so we're combating a shortage we also got a workforce that is at retiring age two. And, you know, we have heard examples from our members where, you know, they're down to just a few OBGYNs and they're at retirement age. And they've been trying, and one example for the last 10 years is trying to get a new OBGYN.
Juravich: To replace them, yeah.
Palmer: So, it's, yeah.
Juravich: Yeah, so reflecting on the loss of maternity units, not just Grady Memorial, but others around the state, we have a little piece of audio to play from Dr. Tom Hubbell. He's a longtime family physician who worked for decades at Grady Memorial.
Dr. Tom Hubbell: Less care is not going to help, more remote care is not going help, we need to expand services, not contract.
Juravich: So how do you respond to that? That services need to be expanded? Because he's basically saying, referring directly to Grady, investments weren't made to improve the labor and delivery units. Those investments by Ohio Health were made at other hospitals. So therefore people are not delivering babies there, because other hospitals have more services. What do you say to that when he says we need to expanding services, not contracting them?
Palmer: There's definitely, you know, two sides of that coin. Yes, labor delivery units have been struggling in different areas for the various reasons I mentioned. The other side of the coin is hospitals are making investments. And so when we talked about maternal health, you know that journey begins with that primary care specialty OBGYN encounter where they're working with the mom and providing that care leading up to that delivery. And we are seeing hospitals make those investments in various ways with providing OBGYNs, but they're also. Rehabbing facilities in some cases around the state. We've seen some new beds added. We're seeing some more interactions with Community health with mobile units and getting out and providing that care So it's kind of been a mix in that bag with labor and delivery units Equipped because here in the state we we license those units in the State there's four levels of a licensure for maternity units. Level one is the basic kind of standard care all the way up to level four, where it's handling complex cases where there could be high risk issues during delivery. So.
Juravich: So prior to it closing this week, was Grady Memorial Hospital's labor and delivery unit a one?
Palmer: Do you know that's a good question? I believe so
Juravich: You believe so? Okay. So, okay.
Palmer: I don't have all of those memorized.
Juravich: Okay, no, I didn't expect you to, but just to give an example. So, so we're seeing state of the art maternity care being built in the city. You know, OSU's Wexner Medical Center just opened a new tower that includes some amazing labor and delivery facilities. Ohio Health is building a new Tower as a part of Riverside Hospital, and that tower is focused entirely on women's health. So these services are being expanded, but it seems like only in the city center, is that true?
Palmer: Yeah, not necessarily like, you know, I'll go on to say Mount Carmel Health at St. Ann's and Westerville is expanding, but you get out to areas like where Henry County Hospital in Napoleon, Ohio is updating their facilities with OB-GYN services. Mary Rutan opened up a new OB service, not necessarily labor and delivery. Mercy Health and Lima with St. Rita's has opened up some new services and expanded beds and then even down in the Cincinnati area. Pickerington has a new hospital and that has a maternity unit as well that Ohio Health provided. So, it's not happening very drastically, but in the context of, you know, where we're seeing utilization changes, consumer choice influencing, and then workforce challenges. In Southeast Ohio because I know that's been brought up in the earlier segments. Marietta Health System working with Akron's Children's for a new women's and babies hospital that will be down in Belpre and Southeast Ohio area that expected to open here soon. So that's just some examples of where we're seeing some investments happening and just reallocation of maximizing resources to meet those needs that we're see.
Juravich: And you said that you grade the labor and delivery units based on how the complex services they offer. So something like an OSU Wexner Medical Center with their brand new tower or Riverside's new tower, would that be more in the three to four range? Just trying to like understand the number.
Palmer: Yeah, so level four is your comprehensive care. So it delivers the highest level comprehensive care, most complex medical surgery, and critically ill maternal fetal patients. So that's where if during the course, there's something identified with the pregnancy and it's worked out like, hey, we might have to look at delivering at this particular facility based on your situation. So yeah, level three is where you're handling, not as much complex, but certainly there's situations where they'll take that on. But yeah, for the most part, most of the hospitals, we have 83 Ohio hospitals offering labor and delivery today. And the most of those are a level one hospital.
Juravich: Okay, you said 83 hospitals are offering labor and delivery, most are level one, but we have 88 counties. So that means there are counties without, and now Delaware County will be one without a labor and deliver unit. I guess what I'm asking is, do we have too many hospitals trying to provide too many services? Even though Central Ohio is growing, birth rates aren't expected to dramatically increase. Can every hospital do everything? I like or should it I don't is there an answer to that?
Palmer: Well, hospitals are very focused on community assessment. And they do community health needs assessments where they're looking at a variety of factors, where there's huge needs in different areas, whether that's behavioral health, mental health. A lot of people might not realize here in Ohio that about 14% of our population have three or more chronic conditions. And so they're trying to manage things from asthma to heart disease to cancer and diabetes. And those require a lot of healthcare work there too. And then you have the aging population that's requiring more outpatient type services. Some metro areas are growing more than others. Rural areas is definitely seeing a shift too with declines, but aging as well. And that's creating a lot need to shift and prioritize services that hospitals are trying to meet. But no, it's every day they're looking at where they can. Deploy the services to meet their mission of care.
Juravich: You're listening to All Sides on 89.7 NPR News. We're talking about hospital closings and the closing of labor and delivery units with John Palmer of the Ohio Hospitals Association. How do hospitals respond to the concerns with access to care, longer travel times? Not to mention how it relates to health outcomes, you know, having to drive 40 minutes to deliver your baby. For some women, that could be dangerous.
Palmer: You know, hospitals definitely recognize that. They have services in place. If a patient is struggling, whether that is with transportation, could be situations with housing. It could be other access to medications, whatever the case may be. If it's specialty care too, where they can help connect into other partners and resources that might be available at a city level, a county level, or more regional level there too to help those patients. You know, every situation is unique and requires a certain amount of interaction between the patient and the caregiver to help meet those. Items that might be coming up
Juravich: Well, let's talk about profit margins in the bottom line here. I mean, these are for-profit businesses. They have to shift priorities. They want to make a profit. Are labor and delivery units expensive? Do they not make money off of them?
Palmer: You know, there's situations with, when you go around, yeah, a fair portion of the deliveries that happen in Ohio, a big portion of that is at the Medicaid level. I was just looking with, last year there was 123,000 births. Compared to 2018, there was 131,000. But the majority of those have been.
Juravich: Medicaid.
Palmer: A portion of it Medicaid, but for the most part, there's also on the commercial side as well too.
Juravich: Do they not make money off of Medicaid births, like do they break even with a Medicaid patient?
Palmer: Usually when it comes to government programs on Medicaid and Medicare services, we get reimbursed below the cost of care, which is always an item and element that we're constantly focusing on.
Juravich: So is that a part of the issue, too, whereas if the labor and delivery unit is costing the hospital money and it's expensive, and then they're putting these investments in more sophisticated labor and deliver units, they can't do it all everywhere?
Palmer: Yeah, it really just comes down to where we have, you know, a certain amount of resources from staffing to the equipment to the facilities and where we can put together quality care to meet those healthcare needs. That might mean maternity services, that might mean a labor and delivery, might mean a behavioral health unit. It might mean building out the ICU, a med surge bed. So. It really does reflect on more of a local level, but then, yeah, the way we're constantly working to make sure that people have healthcare coverage, making sure that they have the coverage that meets their particular healthcare needs, ranging from diabetes to labor and delivery.
Juravich: And are we, we're relying on each hospital to, to figure this out. It's not, is the state going up to hospitals and telling them like, you need to build a labor and delivery unit in Pickerington, we need one. We need one near Marietta.
Palmer: Yeah, you know, I think there is those conversations obviously happening at a regional level or even a statewide level. I think everybody would love to have a certain level of care. And you know the phrase like, oh, we have a general hospital and you know well, what does that mean exactly? Well, you have an ER, you an ICU and all those services are important. Those are the 24-7 access points that a lot of communities need and depends upon We've seen that time and again with. Trauma situations and incidents that occur all over the state. But in some cases where there's no activity happening in regards to maternal health or labor and delivery, it doesn't make sense to have a level four trauma center in that particular area, not necessarily. So hospitals are very in tune with where they need to make that impact.
Juravich: We have been talking about labor and delivery units at Ohio hospitals and we've been talking with John Palmer, Public Affairs Director for the Ohio Hospital Association. Thank you for your time today. Thank you. And this is All Sides on 89.7 NPR News. I'm Amy Juravich, thanks for joining us.