ON Friday, the state House Health and Human Services Committee had a public hearing at Albert Einstein Medical Center to examine several recent maternity-service closures in Philadelphia, and on how to stem the growing loss of obstetricians throughout Pennsylvania.

Maternity programs in Philadelphia continue to disappear. Just 10 years ago, 19 existed at city hospitals - today there are only eight. Yet Philadelphia continues to have the highest birth rate in the state, while nearly a third of ob-gyn physicians in the region have left or stopped offering these vital services.

So why have more than half of Philadelphia's obstetric programs closed in the last decade?

First: declining reimbursement rates from the government and insurers for maternity services, including unfunded testing and screening requirements.

Second, the liability/malpractice environment plays a major role in reducing access to care. Court awards and settlements in Philadelphia are significant. The 21-year statute of limitations creates a long tail of exposure, escalating settlements and awards. Just the risk of an enormous jury verdict drives settlements higher.

Third, there are just fewer doctors in the city practicing obstetrics as a result of the declining reimbursement rates and the medical liability environment.

These factors make it harder to recruit and keep obstetricians.

At Einstein, we've been delivering babies for 155 years. It's the core of who we are. Yet we stand at the epicenter of the more recent closures in or around North Philadelphia, including those at Parkview, Frankford and Jeanes.

Einstein was designed to handle about 2,200 births a year. Last fiscal year, our OB department handled more than 2,800, and we're on track to deliver more than 3,000 babies in 2007.

Almost eight in 10 obstetric patients in the Einstein network are uninsured or covered by Medicaid. New patients are almost exclusively covered by Medicaid or pay out of pocket. We lose $2,000-$4,000 per delivery on these patients.

And many patients in this group are at the highest risk for bad outcomes that can lead to problems for children for the rest of their lives. Philadelphia has the distinction of having the highest infant and neonatal mortality rates and the highest rate of low-birth weight in the state.

Maternity admissions at Einstein increased 50 percent, or 1,000 annually, when Parkview ('03) and Frankford hospitals ('06) closed. Due to the closing at Jeanes in May, we plan to absorb 300-500 more admissions.

While Chestnut Hill Hospital, for now, doesn't plan to close its program, ob-gyns have already left. For the approximate 1,500 increase in admissions at Einstein from the nearby closures, we'll need a major capital investment of more than $10 million to continue our commitment.

In spite of the many challenges, Einstein continues to provide obstetric services. We provide care at local health districts and maintain 12 sites throughout the area for obstetrical care.

WE ACCEPT nearly all managed Medical Assistance plans. We are opening an office in Mayfair to meet the needs of patients who counted on Frankford's program. And we see new obstetric patients within a week.

But what can you do to help?

One first step is asking your state legislator to support the Access to Obstetrical and Neonatal Care Act. HB 1514, introduced by Rep. Kathy Manderino, and SB 966, by Sen. Jane Orie, would provide much-needed additional Medical Assistance funding to hospitals with obstetric and neonatal services caring for large numbers of low-income and uninsured women and their newborns.

The legislation is, however, just one part of what needs to be a more comprehensive strategy.

While we appreciate the state's previous allocation of $5 million for OB stabilization, we urge it to allocate $15 million in state funds and $18 million from the federal government this fiscal year to provide for supplemental Medical Assistance payments to qualifying hospitals.

We believe these sorely needed funds can help to start to assure that patients can get readily available care of the highest quality.

But the legislation is merely a beginning. Much more needs to be done. If all of us don't work together to tackle the issues surrounding declining reimbursement rates, burgeoning medical liability costs, the shortage of qualified obstetricians and neonatalogists, and the multiple secondary effects that result from these, the crisis will only worsen.

And expectant mothers and their soon-to-be newborns in Philadelphia will suffer. *