John Domzalski summed up the maternity-care crisis in Northeast Philadelphia with some staggering statistics.

In 1997, Philadelphia had a birth rate of 22,019. At that time, 19 hospitals offered maternity services, with 650 available licensed beds, said Domzalski, commissioner of the Philadelphia Department of Public Health.

The following year, Nazareth Hospital closed its maternity unit. Parkview Hospital closed altogether in 2003, while Frankford and Jeanes hospitals closed their obstetrics units within the past 18 months.

Today the city’s birth rate remains basically unchanged. However, there are only eight hospitals that continue to offer maternity services in the city, with only 277 licensed beds available.

None of those licensed beds are in Northeast Philadelphia, which, according to the 2000 census, has about 70,000 women of child-bearing age.

That gap is what brought more than 75 new moms, expectant moms, older moms, doctors, nurses, advocates and politicos to a town hall meeting at St. John’s Lutheran Church hall last week to tackle a problem that continues to grow.

The crisis often means that women in labor will head to the nearest hospital, where there is no record of them. That, in turn, can make it more difficult to take care of such patients.

When patients aren’t known to the doctors and hospitals, extra medical tests and lab work must be performed, increasing costs, said Dr. Arnold Cohen, Einstein’s chairman of obstetrics.

Maternity care also is not fully reimbursed to hospitals by insurance companies, he said, with that reimbursement ranging between 67 percent and 80 percent.

"We lose four-thousand dollars on every delivery," Cohen said.

Einstein has spent on average $12.5 million annually in malpractice settlements and payouts for the past 10 years, with another $6.5 million spent on newborn cases, according to Cohen. The hospital is self-insured.

Costs for care, as well as coping with insurance reimbursements and the growing costs of malpractice insurance, are only part of the equation.
A sign on the stage at the Nov. 29 meeting said it all: Babies don’t wait. Fund services now before it’s too late.

When it’s too late to go anywhere else, a Nazareth Hospital nurse told attendees at the meeting, women often go to the nearest emergency room, where they may be cared for by nurses whose neonatal education is limited to what they learned in nursing school. Cesarean sections are also performed by doctors who may not have a specialty in the surgery, she said.

One nurse at the meeting wondered if people will even continue to make the decision to have and raise their families in Northeast Philadelphia.

A lawmaker at the session, state House Speaker Dennis O’Brien, said he is concerned about the trend of hospitals getting out of the maternity business.
"This is not a partisan issue," said O’Brien, who was joined onstage by state Rep. John Sabatina Jr. (D-174th dist.)

"There’s no silver bullet," O’Brien said, but he called for transparency of insurance and access for all constituents.

O’Brien (R-169th dist.) promised to listen and to do everything he could to convene discussions of the issue.

One of O’Brien’s colleagues in the House, state Rep. Kathy Manderino, a Democrat whose district includes parts of West and Northwest Philadelphia, has introduced House Bill 1514, which would provide $15 million in state funds — and $18 million in federal money — as medical assistance to hospitals that serve a large number of low-income and uninsured obstetrical patients.

That funding would be appropriated after the fact. Additionally, hospitals that receive the money would not be permitted to close in the same fiscal year that it is received.

The bill is expected to come to a vote this month.

While the provision to thwart closures would not have prevented Temple University Health Systems, which received similar funds in 2006, from ending maternity services in May at Jeanes Hospital in Fox Chase, a delay would have given expectant women more time to make other arrangements for pre-natal care and delivery.

Those arrangements include possibly changing insurance plans as well as finding other doctors, midwives and hospitals.

Here in the Northeast, the closest city obstetrics unit is at Northeastern Hospital. Einstein Medical Center and Temple University Hospital are also located in town. In the suburbs, Abington Memorial and Holy Redeemer hospitals in Montgomery County and St. Mary Medical Center and Lower Bucks Hospital have picked up some of the overflow patients from the closure of Jeanes Hospital’s maternity division.

While suburban hospitals can be closer for some Northeast Philadelphia women, they are closer only if patients don’t have to take public transportation to reach them. Also, some hospitals don’t accept all managed care or insurance plans.

Come March, expectant mom Allison McDonagh, who lives in Holme Circle, plans to travel to Bryn Mawr to have her baby.

"The providers are no longer here," she said.

McDonagh is a doula, a woman who accompanies a mom-to-be in labor, taking care of her emotional needs throughout childbirth.

She believes that people need to be more invested in the issue, and that it needs to be presented to them in a way they can understand.

Last week’s meeting was sponsored by the community board of the city’s District 10 Health Center at Cottman Avenue and Oakland Street, the human-services agency CORA, and many Northeast Philadelphia community groups, along with the Maternity Care Coalition. The coalition is a non-profit organization that seeks to improve maternal and child health and well-being, with outreach programs primarily devoted to high-risk neighborhoods. The organization also pursues advocacy at the local, state and national levels.

The MOMobile is its signature program, relying on vans to visit neighborhoods to deliver support and resources to pregnant women, new parents, infants and their families in eight areas of Southeastern Pennsylvania, including Philadelphia and sections of Montgomery and Delaware counties. Some of those services include providing links to prenatal care, pediatric and women’s health care, behavioral health services, nutrition programs, education and other community resources.

MCC will continue to organize and lobby officials to find a resolution for the maternity woes that confront many families.

"Either we make OB (obstetrics) profitable or we say in order to keep a hospital in this community, you have to provide services the community needs," said JoAnne Fischer, MCC executive director.

Sue Rosenthal, chairwoman of the community board at the District 10 Health Center, encouraged people at the meeting to call their state and local representatives and urge them to increase the amount of money paid for maternity services. She encouraged them to begin a phone chain, asking 10 friends to call their senators and state representatives.

"Within a day or two you have thirty or forty people calling," she said. ••

Reporter Diane Prokop can be reached at 215-354-3036 or dprokop@phillynews.com