The following is a letter drafted by the SBBC to the NYS DOH
We write on behalf of the Save Burdett Birth Coalition to give you our feedback on the community forum held by St. Peter’s Health Partners (SPHP) on February 28, 2024, at Hudson Valley Community College. It is our understanding that such a forum is a requirement spelled out in the recent guidance from your Department to hospitals contemplating closings of services, such as maternity care. We appreciated the opportunity to finally meet face to face with SPHP executives nine months after they first announced their planned closing of the Burdett Birth Center, since the previous virtual forum was completely unsatisfactory. We also recognize that they extended the length of the forum beyond the announced 90-minute time frame to take more questions and comments from the community. However, there were a number of problems with this forum that we want to draw to your attention. They reveal some important things about SPHP’s attitude toward the community and we hope to prompt your Department to encourage other hospitals holding such forums to avoid the unfortunate practices that marred this one.
Setting of the forum
First, we want to note that the moms, babies, midwives, doulas and community residents arriving at this forum were greeted by large signs (see images at right) warning against bringing weapons into the forum and against using violence, foul language or abusive behavior. Strangely enough for a crowd that included parents with young children, strollers were banned in the meeting room and people were not allowed to re-enter after taking children out to use the restroom or take breaks, creating an anti-family environment. A large contingent of armed police with riot gear were on hand, searching bags as we went into the forum. We have to wonder who SPHP thought they were meeting with, and why they expected weapons and violence at a community forum about a birth center. This greeting made people arriving for the forum feel unwelcome and over-policed, as well as fearful and racially profiled.
photo showing police at HVCC 2/28/24 loading up riot gear and tactical equipment after the event
Next, we want to flag that SPHP chose a room that was too small for the crowd and did nothing to rectify the situation. People were forced to stand along the sides of the room for the entire meeting or wait outside in the lobby hoping to eventually get inside. The SPHP organizers had left a large space of vacant floor in between themselves at the front table and the first row of seats for participants, but did not attempt to add seats to accommodate the overflow crowd. We noted that there was a vacant auditorium of larger size next door, but the meeting was not moved there.
Content of the forum
Although the forum lasted for 2 ½ hours, we learned almost nothing new from SPHP executives’ bureaucratic responses to the numerous questions, comments and expressions of concern from the audience. It was clear from the start that their minds were made up and their sole intent was to justify their decision. The only two pieces of new information that emerged were that they had set June 30, 2024, as the closure date for the Burdett Birth Center and that they had filed a lawsuit trying to halt the New York State Attorney General’s investigation into their closure plans. Their answers were dismissive of the tremendous outpouring of opposition to the planned closure being expressed by members of the audience and by the bipartisan group of elected officials who complained that SPHP and Trinity “have determined to plow ahead with their plan.” Among the many unresolved issues were several we raised in our community-led Health Equity Impact Assessment and in our critique of the closure plan for Burdett:
● Is there enough capacity at St. Peter’s Hospital and other area maternity services to absorb all of the nearly 900 births occurring each year at the Burdett Birth Center? Local midwives, nurses and doulas recounted instances of overcrowding at the St. Peter’s Hospital labor and delivery unit even at the present time, without the addition of the Burdett births. Kathryn Dupuis, a nurse who has been at Albany Medical Center for 29 years, warned that the addition of low-risk birthing people now being served by Burdett would make it difficult for her maternity service to serve the high-risk patients – “very sick patients and babies” -- who come to Albany Medical Center. “You will create more of a burden on Albany Med,” she said. “I don’t know how you can sleep at night.” In an interview with local media afterward, she said: “They’re claiming it’s not going to affect us, but it’ll be just like I said. We can barely staff what we have right now. They’re not going to increase our staffing numbers to absorb Burdett’s patients in anticipation so we’re going to be shuffling, and patients are going to suffer.” Dawn Zipp, a nurse who works at Bellevue Woman’s Center asked how SPHP planned to make sure Bellevue “can accommodate the patients who can no longer access their health care at Burdett,” noting that SPHP “never included us in the conversation.”
● Why would SPHP include in its proposed closing plan the highly inappropriate suggestion that pregnant people could have a planned induction if they were worried about getting to St. Peter’s Hospital in time? Dr. Ken Baker, who heads the ob-gyn service at St. Peter’s Hospital, told the audience that “a planned induction would allay the fears of the patient about arriving on time,” and dismissed audience concerns about higher risks of needing a c-section when an induction is used.
● How would SPHP guarantee fail-safe transportation to St. Peter’s Hospital for pregnant patients from Rensselaer County and the neighboring rural areas of Columbia and Washington County? SPHP executives said they had hired a transportation specialist “to do the forms for Medicaid,” said they had signed a contract with Tech Valley for non-emergent transportation and said transportation issues would be discussed with patients in all prenatal visits. Yet they failed to explain, step by step, how pregnant patients would actually get rides to St. Peter’s Hospital when so many of the cab and ride-sharing services in Rensselaer County are unreliable, prone to long delays and unavailable in the middle of the night. Their comments that 75% of pregnant people in Rensselaer County do manage to get to other hospitals to deliver babies without help completely ignored the challenges faced by the remaining 25% who would need help, including people with low incomes and no cars. Both the Chartis HEIA and our community-led HEIA flagged the importance of addressing transportation challenges, but these do not appear to have been meaningfully resolved.
● Why and how would the midwife-led and low intervention model of care at the Burdett Birth Center actually be recreated at St. Peter’s Hospital, which has an OB-led and more medicalized model of care? Midwives and doulas expressed doubt that the Burdett model “could be removed from Samaritan and plopped down into St. Peter’s.” It is clear, one audience member stated, “that the model of care at Burdett is phenomenal.” Why, she asked, would you shut it down instead of holding it up as a model, preserving the model at Burdett and replicating it elsewhere? We remind the Department that the model of care at Burdett was cited by Black pregnant people as key to their experience of birthing without coercion or fear.
● Is there actually a pressing financial need to close Burdett? One audience member noted that since the announcement of the planned birth center closing last June, the operating deficit at Trinity Health (the parent system of SPHP) has been reduced by 85% from $298 million to about $36 million. The $2.7 million SPHP says it would save by closing Burdett “is literally a drop in the bucket of Trinity’s annual operating expenses of more than $11 billion,” she noted, asking SPHP executives if they could now reverse their decision to close Burdett in light of Trinity’s improving financial picture. Dr. Steven Hanks, CEO of SPHP, insisted it was not Trinity’s decision to close Burdett, but rather his team’s effort to achieve Trinity’s demand of a two to three percent operating margin that can be “reinvested” in our programs. Needless to say, the audience did not find this a satisfactory answer.
We also wish to note that Dr. Hanks’ recounting of the history of the Burdett Birth Center failed to acknowledge several key facts: 1) Burdett was created as a separately-incorporated maternity hospital-within-a-hospital because St. Peter’s officials insisted on introducing at historically non-Catholic Samaritan Hospital the Catholic religious directives that prohibit the offering of contraception and post-partum tubal ligations. It was this situation that caused maternity services at Samaritan to be essentially orphaned from the main hospital and cast into an experimental venture with an uncertain financial future, due to its limited service line. 2) Community health advocates, including BirthNet, Friends of the Burdett Care Center and the MergerWatch Project, warned at the time that the projections of 1,200 births per year and resulting revenues appeared optimistic, causing concerns about the long-term financial viability of what was then called the Burdett Care Center. 3)The fact that this was a novel venture was what caused the Department to grant Burdett a limited-life Certificate of Need approval. 4) It was also the decision of SPHP’s creators to close the maternity service at St. Mary’s Hospital and transfer it into the Burdett Birth Center, where it was merged with the maternity service being ejected from Samaritan Hospital. The result was that maternity services in Troy were immediately reduced from two to one, leaving maternity care in what became a precarious situation. 5) SPHP’s own actions, such as limiting anesthesia at the Burdett Birth Center and diverting births to St. Peter’s Hospital, have contributed to the declining census at the center. Our belief that SPHP executives’ answers to questions at the forum were dismissive and misleading was confirmed when we heard Dr. Hanks’ arrogant post-forum comments in an interview with WRGB television. Asked if he thought the New York State Department of Health would approve the closing plan for Burdett, Hanks said: “They’re not intended for the department to second guess the business decisions being made by our healthcare system, so it’s my expectation that the department will approve.” This statement blatantly ignores the Department’s authority and responsibility to ensure timely and appropriate access to care for everyone in New York State, as well as advance health equity and reduce maternal mortality and morbidity. Our community-led Health Equity Impact Assessment made clear that closure of the Burdett Birth Center would have a significant negative impact on medically-underserved people. We hope that you will prove Dr. Hanks is wrong and reject their ill-conceived and unnecessary plan to close the Burdett Birth Center.
Sincerely,
Save Burdett Birth Center Coalition