Penn Highlands Elk, a hospital in St. Marys, is ending its labor and delivery services on May 1. The nearest hospital to offer those services is in DuBois, which is about a 45 minute drive.
WPSU’s Sydney Roach talked with Marley Parish of Spotlight PA about her reporting on the widening rural health care gap in the state. Here's that conversation.
Sydney Roach
Marley Parish, thanks for talking with us.
Marley Parish
Thanks for having me.
Sydney Roach
This is one of the latest examples of the loss of health care services in rural Pennsylvania. UPMC Lock Haven downsized to an outpatient emergency department in February last year. Bradford Regional Medical Center moved its acute care and surgical department to its sister hospital in upstate New York in 2021. I want to ask more about that overall trend, but first, why is Penn Highlands Elk closing its labor and delivery services?
Marley Parish
So, the reason that Penn Highlands has put out to the public is that this service transition which ultimately right now only applies to birth services. So prenatal postnatal care still offered at Penn Highlands elk when this change takes effect in May. But the reason that Penn Highlands is telling the public is that this change will ultimately offer patients a higher level of care. They have stressed that is not about finances, and it's not a decision based on their bottom line. But yeah, ultimately, Penn Highlands is telling the public that this is just a transition that they're doing to offer patients a higher level of care at their hospital in DuBois, which has a neonatal intensive care, which is a NICU for short.
Sydney Roach
But even then, why now? Have you found anything in your reporting to suggest otherwise?
Marley Parish
So, it's kind of interesting because publicly and in private meetings with local elected officials as well as state lawmakers and federal lawmakers, Penn Highlands is outlining how Dr. Steven Koch, Elk County's only OBGYN, is overworked. They've stressed that they would need four OBGYNs to alleviate some of his workload. They've also cited that birth rates are declining in Elk County, averaging around 100 to 150 births a year. They've also said that people in Elk County are already going to Dubois to give birth. And at that hospital in Dubois, they average about 1000 births a year, per Penn Highlands. They haven't necessarily said this is why we are doing this at this point in time. However, CEO Steve Fontaine, during a February hearing before lawmakers focusing on health care challenges in rural areas, also outlined financial challenges that rural hospitals are facing from the statewide perspective. So they really are talking about, you know, financial challenges from a broad perspective.
Sydney Roach
In my own conversation with the city manager, he seemed frustrated with the decision and he said the city is "working on ways to improve the situation." Could you tell me more about the coalition of business owners who are lobbying lawmakers and hospital leadership? What kind of solutions are they looking for, and is anything likely to come of that effort?
Marley Parish
Penn Highlands organized an invitation-only private meeting at the end of February with local officials, some members of that business coalition that ultimately are starting to meet and push Penn Highlands officials and the board and the CEO Steve Fontaine to think about ways to address the, you know, expected gap that's going to happen when the service goes away. Some officials have asked Penn Highlands if they really considered every alternative before deciding to just close the services altogether, such as a birthing center. And I've heard from them that ultimately, they didn't really feel like that was something that Penn Highlands was considering and that they are just really looking to refer people to DuBois. The group of business owners are really trying and were hoping that Penn Highlands would ultimately reverse the decision. I talked to some people about, you know, where their work stands, and they're still trying, but ultimately, they're not hopeful that Penn Highlands is going to say "We've changed our minds, things are gonna continue after May 1."
Sydney Roach
You report that Elk County will be the sixth in the region without a facility delivering babies. You cite a 2022 study from the Center for Rural Pennsylvania that predicts 18 counties will become maternity care deserts by 2025. What exactly is a “maternity care desert” and why is this particular service going away?
Marley Parish
It is an area where a person will have to travel a certain distance to access birthing care, as far as, you know, delivering a baby in a hospital or another birthing facility. It also can include resources such as access to an OBGYN for the care that a person would receive before they give birth and after. But put simply, it's an area that doesn't have these local immediate options and people have to travel to get there. And the reason why these areas are becoming more common, especially in rural Pennsylvania, health officials will say that, you know, a reimbursement rates from insurance plans through Medicaid and Medicare don't cover the cost that it takes to give birth and the care that that requires. Also, demand is a part of it. You will see that the Center for Rural Pennsylvania released its population projections last fall and rural areas in Pennsylvania predominantly are expected to see population numbers go down by 2050. And so the demand might not be there. And local officials fear that if the services like what is expected to happen in Elk County continue to go away that those numbers are only going to decrease further.
Sydney Roach
As we mentioned earlier, maternity care isn’t the only declining service in rural communities. You end your story with a quote from Clearfield County Commissioner Dave Glass, who says “we live like this every day, not just in health care.” What other service gaps have you found in your reporting on rural affairs?
Marley Parish
Yeah, something that I hear a lot about from people who live in rural communities is this feeling of being forgotten or overlooked. They have seen everything, you know, from food, access to health care, not just birthing services. But I mean, some counties in Pennsylvania don't even have a hospital. They would have to go to and rely on a health center that might not offer the same range of cares that you would find at a more robust hospital. Obviously, something that you hear a lot from people in rural communities is they're worried about moving to the area and being able to have adequate housing. If they need medical care, they don't necessarily want to have to travel 45 minutes to an hour to access those services. If they have a family, where are [they] going to send our kids to school? Where are [they] going to work? Where are [they] going to shop for food? What are [they] going to do? So I mean, it has really covered all of the bases as people just witnessing things fall away, piece by piece, and it's just ultimately it's that fear from local officials and even residents where, if the services continue to go away, people aren't going to want to move to these areas.
Sydney Roach
Marley Parish, thanks for talking with us.
Marley Parish
Thanks for having me.
