Delivering the truth...

Why closing Houlton Regional Hospital's Labor & Delivery unit is the right decision

This is likely to be a post that many people disagree with, but here goes…

On May 2, Houlton Regional Hospital will close its Labor & Delivery unit, leaving pregnant women with a minimum of a 45 minute drive to the next closest hospital with these services.

Is it terrible? Absolutely. For expectant mothers. For the members of the medical team who find joy in helping to bring new lives into the world. For our community, which will find it even harder to attract young families.

But what would be more terrible is if the viability of the entire hospital is compromised by continuing to subsidize the high costs of one underutilized service.

This is the painful reality facing rural healthcare across Maine: some of the services that matter most are becoming impossible to sustain.

Several weeks ago, I wrote a letter to the editor of The County that discussed the financially precarious position in which HRH finds itself. For Fiscal Year 2023, an independent audit by Propublica red-flagged the hospital as a “going concern”, noting “substantial doubt about this organization’s ability to meet its financial obligations and continue operating for the foreseeable future.” In FY2023, the hospital had an average of just 0.2 days of cash on hand — compared to the average for non-profit hospitals of 218 days.

This is not a healthy business. And make no mistake that it is a business, not simply a service owed to the community. Working to return the hospital to a more financially stable position is going to require hard decisions. Responsible decisions.

Regarding the closure of Labor & Delivery, the hospital’s Board of Trustees has made one of those. The local birth rate — projected to be just 77 this year — falls well below the number of births needed for an L&D unit to be financially viable. This means that the hospital is losing money that it does not have to lose in order to subsidize this service.

I love that the people of southern Aroostook are rallying on behalf of healthcare in their community. Too many times I hear people say awful things about HRH, but we are incredibly fortunate to have this resource in our community. And we need to do whatever we can — both the hospital as a business and all of us as its constituents — to support its ability to continue serving the medical needs of the Houlton region.

This means speaking out about The Regime’s proposed $880B cuts to Medicaid, which will exacerbate the hospital’s unfunded mandate. With cuts to this program, the hospital, under the Emergency Medical Treatment and Labor Act (EMTALA), will be legally required to provide stabilizing treatment to more people without insurance or the ability to pay for care. In FY23, HRH provided nearly $3.5M in such “charity care.”

This means speaking out about the assault on federally-funded diversity, equity, and inclusion programs, which support health equity initiatives in underserved rural communities.

And that means supporting the hospital as it navigates an extremely challenging financial situation and works to find a path to long-term sustainability. Sometimes, leadership demands difficult trade-offs to protect the greater good. Taking a holistic view — beyond any one service — is necessary to ensure that our community continues to have access to high-quality, local healthcare for years to come.