PDH puts OB deliveries on diversion again
By Debra Moore
UPDATED: The meeting for Thursday, June 9, is at noon, rather than the regular 4 p.m. meeting time.
As of now, any expectant mom who planned to deliver her baby at Plumas District Hospital will be diverted to another facility.
That announcement was made during a special board of directors meeting held June 3. It came less than a year after the hospital found itself in a similar situation due to staffing issues last August, when the hospital went on diversion for a couple of months.
JoDee Read, the chief executive officer of PDH, said she appreciated everyone attending the June 3 meeting on short notice, and said the topic would be discussed further during the board’s regular monthly meeting scheduled for Thursday, June 9 at noon.
Read said that OB nursing staff “don’t feel that one labor/OB registered nurse is safe,” during a delivery. The standard is to have two labor/OB nurses present during a delivery, which hasn’t always been possible at PDH. “This isn’t new news,” Read said. “This feeling has been made very public.”
She told the board that OB services would be on divert through the morning of June 7 at 7 a.m., but she expected the diversion to be extended through Sept. 1. Read said during the meeting that patients who are scheduled to deliver within the next three weeks had been given options, which included the hospitals in Reno, Truckee, and Chico. (PDH is the only hospital in Plumas County that had still been delivering babies.)
The diversion wouldn’t prevent someone from showing up at the hospital’s emergency department, where staff will “receive training in the event someone presents for imminent delivery.”
Dr. Jeff Kepple, who provided OB services at PDH in the past, asked for clarity on what the nurses wanted.
Bunny Goodrich, a traveling nurse who is currently manager of the OB department, said, “Whenever we have a laboring patient in house, that we have another labor/delivery nurse in house,” so that they can be available for the delivery.
When Kepple asked if the additional OB nurse could be available on a 10-minute standby basis, Goodrich said, “That would be perfectly acceptable, but we don’t have the nurses.” She explained other hospitals “usually have multiple labor and delivery nurses available because they are cross trained.”
As of now, PDH has two staff members and two travelers trained in deliveries. There isn’t always someone available to provide dual coverage.
Director John Kimmel asked what other critical access hospitals offer.
“In other critical access hospitals, they have enough deliveries to keep a fully staffed Labor and Delivery,” she said. “When you have one L&D nurse, and something goes awry, there is no one.”
CEO Read said that the hospital would need about seven travelers to continue services and provide the coverage. “Recruiting that many folks in that window of time is a barrier,” Read said.
But even if the nurses are found, the board was told about the difficulties in training them and then the constant turnover.
It was reiterated that nurses are worried about the danger to mothers and their babies if there aren’t two L&D nurses present. They are also concerned about liability, but said the most important aspect is patient safety.
“If we are truly talking about patient safety; I’d much rather have them in our hospital than on the road,” Dr. Kepple said. “I did OB for 20 years with one L&D nurse.”
Dr. Mark Satterfield, who works in the hospital’s emergency department, and also used to deliver at the hospital, said, “From a public health perspective, this is really a public health disaster for us.” He worried about the amount of time it takes to get to another hospital, as well as the diminishing skill set in emergency situations if there is no longer an OB program at PDH.
He also wondered about how the situation in the emergency department compared to this situation because doctors there are faced with situations that are outside their expertise. “What I’m hearing here is that I shouldn’t be in the ER working if I don’t have the right nurse there … We don’t have perfection. Should all rurals just close?”
Kepple echoed Satterfield’s concerns. “If we don’t have generalists in our small towns, we might as well as close down,” he said, and discussed the trust, longevity, and rapport that’s developed with patients over time. “As Dr. Satterfield said, we give care on our skill set. We are giving the best care we can … it’s a lot better than what the care would be if we dropped it.”
Director Bill Wickman, who attended the meeting when the OB nurses shared their concerns, said he heard stressful stories and that it was “an eye opener for me.”
Director Valerie Flanigan, whose own children were born at PDH, said she “would hate for anyone to have to go somewhere else, but it’s all about patient safety.”
Dr. Paige Lewis had a different perspective. “I’ve been here six years,” she said. “There definitely would be bad outcomes if patients had to be shipped.”
Flanigan, asked “What else can we do?”
There was some discussion about the possibility of establishing a birthing center. “Perhaps a birthing center could help maintain and then rebuild the program until it returns to the hospital someday,” said Darren Beatty, the hospital’s chief operating officer.
But he also worried that “if we shut it (the OB program) down, PDH becomes something very, very different.”
Those in the meeting agreed that one of the dangers of shuttering the OB program is losing young families to out-of-area providers.
“As a community member, it’s definitely something I don’t want to see,” said Director Kimmel. … “I would like to see that we go kicking and screaming and do the best we can to maintain it.”
Director Bill Wickman became emotional when he asked if the hospital would really need to be on diversion for the next three months, and he thought of all of the mothers who wanted to deliver at PDH and would have to make alternate plans at this late date.
Read said she also wanted to keep the program, and would work to that end, but for the moment diversion was needed. She said she would rather plan for three months and then come off diversion early rather than to continue extending it.
The board will discuss the issue again this Thursday, June 9 at noon. The public can attend via Zoom or in person at the administration building’s conference room.
