Iliana DeJesus (left) and Mariana Kuperman were among 50 people supporting Chestnut Hill Hospital’s Obestetrics program, which could close after it’s reviewed this month. (Jimmy J. Pack Jr.)

In the early afternoon of April 5, despite unseasonably chilly weather, about 50 men and women — most in street clothes, though a few were in scrubs — gathered in front of the main entrance to Chestnut Hill Hospital.

The rally was organized by community members to express their support for the hospital’s obstetrics program, which is being reviewed by the Chestnut Hill Health System.

Children, some who took their first breath within those hospital walls, ran around the feet of the demonstrators, while speakers supporting the hospital’s obstetrics program took their stand on a two-step stool in the middle of the crowd.

Answering those speakers was Brooks Turkel, the short, well-dressed chief executive officer of Chestnut Hill Health Systems, the hospital’s operator.

Listeners gathered in close, hoping for an answer as to why the obstetrics program was being reviewed and the likelihood of the program closing.

Turkel thanked those present for their efforts and for the many e-mails he has received. He agreed that the city’s obstetrics options are in crisis. Malpractice insurance and low health care reimbursement from insurance providers is hurting the already financially strained OB program, he said.

Turkel said he was unsure about the future of the hospital’s OB program, pending review. But he alluded to a larger problem looming in the distance: the future health of the hospital as a whole.

For years, the hospital’s administration has been seeking a state waiver that would allow Chestnut Hill Hospital to perform angioplasty, a standard type of heart surgery, according to Maria Iaquinto, the hospital’s spokesperson. The latest application was made in early 2006, she said.

Turkel told the large group that without a healthy hospital and a full range of programs, specifically angioplasty, the hospital could not fund programs that are not moneymakers, such as obstetrics.

“The health of the hospital, allows us to provide these [OB] services,” he said to the audience.

After he stepped off the stool, the real need for the angioplasty program became clear as he spoke to a questioning community member.

“If we cannot take care of heart disease appropriately, there will be no hospital,” Turkel said.

* * *

On April 4, it was announced in a press release that Traditions Management was purchasing Chestnut Hill Rehabilitation Hospital and Springfield Residence, an assisted living community in Wyndmoor, from Chestnut Hill Health Systems.

Traditions Management is a company based in Florida that operates health care and assisted living facilities in Pennsylvania, Virginia, Florida and Iowa. The sale will be finalized May 1.

Turkel said the sale was made not because of need, but because he wanted a company that could spend the time and money investing in the facilities while the Chestnut Hill Health System administration could concentrate on the hospital.

The sale will bring millions of dollars to the hospital — though the exact amount was confidential — and Turkel said it would be invested in the hospital.

The sale was not discussed openly at Thursday’s rally, although if demonstrators were aware of the sale it might have been brought up as an option to help save the OB program.

As of Monday, no decision had been made about the hospital’s obstetrics yet.

“Anything could come out of the review,” said Iaquinto, who said last week that the program could be changed, remain the same or closed as part of the review.

Although there was talk among hospital employees that a decision would be made at an April 7 meeting of the hospital’s board of trustees, Turkel said at the rally that the review will not be complete for another six to eight weeks.

But the fear of community members and hospital employees is that the obstetrics program will follow the trend of other hospitals in the region by closing the door on the program.

In the past decade, hospitals around the area have closed their OB programs, tightening options and space for the city’s childbearing patients.

In October, Maternity Care Coalition, an organization that supports pregnant women and their families, released a report called “Childbirth at a Crossroads.”

The report found that the Southeastern region of Pennsylvania has 25 percent fewer maternity care facilities than it had in 1990.

Since 1997, 13 hospitals in the Delaware Valley have ended their obstetrics units, reported the MCC.

Adding to that number, Jeanes Hospital, owned by Temple University Health Systems, announced that it would be closing its OB program in May.

Spokesperson for Temple University Health Systems, Rebecca Harmon said one of the reasons for the closure is because the hospital’s delivery numbers have nearly doubled in the past two years due to other closures in the area.

“We received an explosion in volume,” said Harmon. “We didn’t physically have the room for patients.”

Abington Hospital, which already delivers about 4,500 babies a year, according to spokesperson Lisa Durst-Hestnar, is preparing for the flood of clients expected when Jeanes closes.

“[The potential closing] has a real effect on this city, not just in this community,” said Kathleen Furin, director of the Maternal Wellness Center in Mt. Airy.

Even Turkel recognized the city’s problem.

“There is no question in my mind that this is a crisis,” he said during his brief speech at the rally.

With OB programs closing and options narrowing for Philadelphia’s childbearing women, community members have asked, why would Chestnut Hill Hospital, which already has a glowing reputation in its obstetrics, not take advantage of the situation and expand its program?

Since 2000, the number of obstetricians in the region has dropped by one-third, according to Priscilla Koutsouradis, spokesperson for the Delaware Valley Healthcare Council of The Hospital & Healthsystem Association of Pennsylvania.

Since 1980, graduating medical students choosing obstetrics and gynecology has dropped almost 50 percent, reported MCC.

William McCool, director of the midwifery graduate program at the University of Pennsylvania School of Nursing, said OB programs have one of the highest malpractice insurance rates because OB patients get the “greatest payouts.”

“It’s not an easy profession,” he said.

Before, the stress and difficulty of the job was worth it, but with the incredibly high malpractice rates in the Philadelphia area, “the costs are not worth it,” he said.

Former obstetricians have either changed practices or moved away, Koutsouradis said. Or private practice obstetricians that used hospital affiliations to deliver babies are now being hired by hospitals because they cannot afford malpractice insurance.

But hospitals don’t make money from their OB programs, Turkel said, and hiring an obstetrician and paying his or her malpractice bills hurts an already strained program.

“[Obstetrics] is a financially challenged program,” Turkel said. “The malpractice rates are untenable, and it’s driving providers from the practice.”

But there are other financial difficulties in obstetrics. Low reimbursement from insurance providers, particularly the federally funded Medicaid, is not covering hospitals’ costs.

The low reimbursement rate is a problem across the board in health care, but OB is one of the lowest, McCool said.

Hospitals usually receive 77 cents from Medicaid reimbursement for every $1 of inpatient hospital service they provide, Koutsouradis said, and she would guess OB service receives less than that.

McCool explained that hospitals are reimbursed the same amount for a 22-hour labor delivery as for a two-hour one.

He said because birthing does not usually involve surgery and extensive use of medical equipment, the insurance claim is limited.

“But the manpower output for a woman in labor can involve hours of care, even longer than the time needed for most surgeries,” he said. “So there can be an extensive output of work hours in OB care with few opportunities for billing for this time.”

Turkel said the low reimbursement from the private insurance providers is partially the result of competition.

If one hospital can afford to provide a service at a certain amount of money, the insurance providers expect all hospitals to provide the same service at that amount. So if, for example, a blood test at one hospital costs less than another, an insurance provider will reimburse only the smaller amount, justifying that if one hospital can do it, then another should.

“Insurance companies say they are maxed out on money for a procedure, but the providers say it’s still not enough,” McCool said.

Reimbursements are also delayed by the paperwork insurance companies now require of hospitals and care providers, said Turkel.

According to McCool, insurance providers add paperwork to the reimbursement process to delay the distribution of money. By keeping the money in the bank, the larger companies, such as Aetna and Independence Blue Cross, can make millions of dollars in interest alone in one day.

* * *

Turkel commended those that attended the rally last Thursday for their effort and outspokenness, but he urged them to direct their calls to Harrisburg.

“The governor needs to hear you care,” he said, but not just about obstetrics.

He also encouraged them to reach out to insurance companies and state legislatures to make reimbursement simpler in the private sector and to increase Medicaid funding.

State legislatures cannot step into the private sector yet, but Turkel alluded to the possibility of legislative influence on the private insurers with the potential merger of Independence Blue Cross and Highmark.

Governor Ed Rendell is trying to help on the state level, McCool said, but the governor is receiving a lot of resistance.

“I think his ultimate goal is to put forth an effort toward reform, which will then force the Feds’ hand to step in and deal with this crisis on a national level,” McCool said.

Learn about the childbirth crisis through our Maternity Care in Southeastern PA pages, or visit our Maternity Services Advocacy pages to find out how communities are advocating and how you can take action!

MCC's full Childbirth at a Crossroads report can be viewed here.