Leaving Bedford to have their babies

“This was just dirt when we moved in,” Sam Pratt said, kicking at the concrete floor at Rockland Manufacturing Co., a hulking plant illuminated by arc welding tips and steel grinders shooting Milky Ways of sparks. It’s a place where buckets and booms for excavators, dozers, loaders and graders have been built in Bedford County for 43 years.

Mr. Pratt — all suspenders, aw-shucks hospitality and a Boston accent acquired in his youth — claims he was “lucky to get out of high school.” He also was smart enough to build Rockland into an industrial powerhouse in the Allegheny Mountains, two hours east of Pittsburgh.

The town of Bedford also has grown since Mr. Pratt’s arrival in 1974. Big regional distribution centers for Wal-Mart and outdoor recreation giant REI have opened in the I-99 commercial corridor, while the county seat of gingerbread homes and tree-lined streets has turned its historic ties to George Washington into tourism dollars.

That’s why Mr. Pratt was so alarmed at hearing that UPMC Bedford Hospital plans to close its maternity unit Dec. 1, leaving the county without a place for non-emergency childbirths for the first time in generations. The end of maternity care follows the closing of inpatient dialysis and joint replacement units at the hospital in recent years.

But this one, Mr. Pratt believes, will discourage young families from moving in, while increasing the risk for expectant mothers forced to travel to the next county to have a baby.

“When I first heard about it, I said this is horrible, horrible,” the 78-year-old Mr. Pratt said. “This isn’t better medicine. I can’t see it as anything but a setback to industrial development.”

After Dec. 1, UPMC will send pregnant mothers to UPMC Altoona Hospital in Blair County for deliveries — about 35 miles away.

Bedford area maternity hospitals

The need to consolidate hospital services — happening nationwide — and what’s happening in Bedford is testing the ties binding medicine and economic development.

Mr. Pratt and others are clinging to the county’s tiny slice of the $111 billion that hospitals pump into Pennsylvania’s economy, supporting nearly 600,000 jobs overall, according to figures provided by the  Hospital & Healthsystem Association of Pennsylvania, a Harrisburg-based trade group.

“We just think it’s a real punch in the gut,” said Lloyd Roach, 73, who moved to Bedford three years ago after retiring from a career managing radio stations.

The decision by UPMC Bedford, which employs 282 people, followed two years of careful internal review, said Susan Manko, a spokeswoman for the Pittsburgh-based health system.

The hospital plans to enhance outpatient care for pregnant women, but with only about 300 births a year, it’s tough to staff the 49-bed hospital with the necessary specialists. By comparison, about 1,000 babies are born every year at UPMC Altoona.

UPMC Bedford has two obstetricians and a midwife, who will join UPMC Altoona’s staff of five obstetricians and a midwife after Dec. 1.

“It’s all about quality,” Ms. Manko said. “This is necessary to continue our quality care, physician skill retention and future recruitment of new OB specialists to best meet the needs of all the communities UPMC serves.”

Another issue: nationwide, there are not enough obstetricians. A 2011 Ohio State University study projected a 40 percent shortage of obstetrician/gynecologists, or 20,135 doctors, by 2030.

One more reason not to stay here

Like Mr. Pratt, Bedford County Commissioner Barry Dallara worries about losing a community asset.

“It’s easy to cut something,” Mr. Dallara said. “Try to get it back. What you’ve done is given our youth one more reason they’re not going to stay in this county.”

Bedford County, which is mostly agricultural, has been slowly losing population, eroding 3 percent to 48,325 in 2016 from 49,768 in 2010, according to census data.

But critics are not hopeful about their chances of reversing UPMC’s decision, even though Mr. Pratt said he plans to “continue to beat the drum as long as we can.”

If history is any lesson, their odds of success are limited.

Despite protests that included a citizens’ march, UPMC closed the childbirth unit at the Greenville campus of the UPMC Horizon Hospital in Mercer County in 2007. Mothers-to-be were referred to Horizon’s Shenango Valley hospital 17 miles away in Farrell.

About 400 babies were born annually at the Greenville campus when it closed, down from 863 in 1983.

That was followed by OB unit closings at independent hospitals including Monongahela Valley in 2007; Ellwood City in 2013; Grove City Medical Center in 2014; and the former Jameson Hospital in 2015. Also closing its maternity unit in 2015 was the 111-bed Somerset Hospital — an hour’s drive from Bedford — which sent expectant mothers 27 miles away to Johnstown in Cambria County.

UPMC closed the maternity unit at its Passavant Hospital in McCandless in 2003, although the drive to Magee-Womens Hospital of UPMC in Oakland, where mothers were referred, was just 12 miles — a 20-minute drive. About 10,000 babies are born annually at Magee.

Hospitals nationwide fuel the trend.

St. Joseph’s Hospital in St. Paul, Minn., closed its maternity ward in September. And Cleveland Clinic in Ohio closed its labor and delivery suite at Medina Hospital in June as the national birth rate slipped 4 percent between 1990 and 2015, according to the Pew Research Center.

Waiting for her water to break

The impact of losing a maternity unit in a community — something that’s increasingly common in Western Pennsylvania and elsewhere — can be hard to quantify.

There have been attempts.

Twelve years of birth records from rural Missouri towns where hospital obstetrical services had been discontinued revealed a transient increase ranging between 4.1 percent and 31.6 percent in the number of low birth weight babies born in the year following the closings, according to a 2008 study that appeared in the Journal of Rural Health.

“Increased frequency of low birth weight infants may be an indication that adverse health effects are increased,” the authors wrote. “Loss of obstetrical services may be a major factor in the decline and failure of small, rural communities.”

A 45-minute drive separates UPMC’s Bedford and Altoona hospitals in good weather. Travel times could be longer for Bedford residents who live in some of the county’s hamlets, which Mr. Pratt said “died on the vine 20 years ago.”

Alyssa Yothers, 24, lives in Schellsburg, population 331 and a 40-minute drive from UPMC Altoona Hospital.  She is expecting her third child Dec. 19, weeks after the maternity unit at UPMC Bedford is scheduled to close. Labor began within 20 minutes of her water breaking during her last pregnancy, she said, which makes her “nervous” about making it to Altoona in time.

Ms. Yothers, a logistics coordinator at Rockland Manufacturing, said she is preparing to call the local ambulance if her water breaks when she is at home.

Middle school guidance counselor Megan Rose had both her children at UPMC Bedford, including daughter Ruby Estelle three years ago. The prospect of having to drive instead to Altoona makes her anxious, she said, especially since a friend’s baby was born at UPMC Bedford just seven minutes after she got there.

“The staff was just amazing and wonderful,” Ms. Rose, 38, said about her experience at UPMC Bedford. “But if I were looking to move here, come from a different area, would I choose to live closer to Altoona? Maybe I would choose somewhere else” rather than Bedford.

Nationally, fewer births, staffing difficulties and financial issues were among the reasons cited for closing hospital childbirth units in a study by the University of Minnesota School of Public Health in 2016. And moms-to-be bore much of the burden of the closings.

“Having to travel for obstetric care is associated with higher costs, greater risk of complications, and longer lengths of stay along with financial social and psychological stress for patients,” the authors wrote.

Money was not an issue in UPMC’s decision, hospital officials say.

UPMC Bedford’s net patient revenue rose 33 percent to $57 million in fiscal 2016, from $43 million in fiscal 2013, a period when the percentage of uncompensated care to net patient revenue ratio steadily declined at hospitals statewide, according to the Pennsylvania Health Care Cost Containment Council.

Here’s another look at UPMC Bedford’s fiscal health: In terms of three-year average annual increases in patient revenue, Bedford ranked third among UPMC’s Pennsylvania hospitals at 10.74 percent, trailing UPMC East in Monroeville, 20.01 percent; and Oakland-based Magee-Womens, 27.52 percent. The statewide average was just 4.59 percent.

UPMC Bedford provides $2 million in charity care and other unreimbursed programs for the poor, Ms. Manko said. The hospital pegged its annual economic impact at $60 million, but was uncertain how much of that sum is generated by women delivering babies.

 

The local economy and the hospital

Not everyone sees the loss of the maternity ward as a body blow to Bedford County.

Susan Koontz, the 52-year-old director of admissions at a nursing home in Everett, who was born at UPMC Bedford, said patients will miss the intimacy of the childbirth experience where “you could see the same people who took care of you at the hospital, who helped deliver your children, at the grocery store.”

“I hate to see any services cut,” said Ms. Koontz, who lives with her husband and two children on a 350-acre farm that has been home to six generations of her husband’s family. “But I don’t think it will deter anyone from living here.”

What is clear is the common vision that Bedford’s economic future is yoked to the county’s only hospital.

In an Oct. 10 letter to UPMC Bedford Hospital asking that the closure be reconsidered, the Bedford Sunrise Rotary said it had a lot in common with UPMC, including “promoting peace” and “growing local economies.”

Closing the maternity unit in Bedford will “have many negative ripple effects” for employers and prospective employers, Rotary President Michael Lamb wrote.

Perhaps nowhere are the ties between the business community and the hospital more apparent than at Rockland Manufacturing, which advertised for 20 jobs when it opened in 1974 in Bedford and saw 350 people apply.

Since then, the payroll expanded 10 times to cover 200 people as the plant was enlarged four times, putting an industrial space bigger than a football field under roof as the company switched to UPMC Health Plan to insure its employees.

That contract gives the workers access to the local UPMC hospital.

Opened in 1951 as the Memorial Hospital of Bedford County, the facility replaced two smaller hospitals at a time when the country was in the midst of the post-World War II baby boom. UPMC acquired the hospital in 1998.

Now, telemedicine technology links Bedford to UPMC’s Magee-Womens and Children’s hospitals in Pittsburgh, giving women with high-risk pregnancies access to maternal, fetal medicine specialists at Magee, while the Bedford hospital has undergone nearly $9 million in capital improvements during the past five years.

Meanwhile, UPMC is pressing ahead with plans to build three specialty hospitals in Pittsburgh at a total cost of $2 billion while joint replacement operations were phased out a few years ago at UPMC Bedford, with patients referred instead to the bigger Altoona hospital. Bedford also ended inpatient dialysis Oct. 29 after a provider pulled out because there were not enough patients — five in the last six months, Ms. Manko said.

“We’re not closing Bedford,” she said. “To the contrary, we are continuing to make it better, keep it viable to meet the needs of the community.”

Mr. Pratt still worries.

UPMC Bedford should focus on providing basic medical care rather than “lusting after corporate efficiencies,” the businessman said. “This isn’t supporting Bedford at all.”

Kris B. Mamula: kmamula@post-gazette.com or 412-263-1699