After months of agitating for North Central Bronx hospital to reopen its suddenly shuttered Labor and Delivery services, advocates got what would seem like a pleasant surprise earlier this month.
Labor and Delivery services would reopen. Full stop.
The flow of information ended there.
It is still unclear how, if at all, the hospital is planning to solve the staffing problem behind the closure. Neither North Central Bronx (NCBH) or the New York Health and Hospitals Corporation (HHC) that runs it have provided a reopening date and there have been no assurances about the extent to which labor and delivery services will be restored.
Most recently, officers from HHC rebuffed an invitation to explain themselves to community members at a Nov. 20 meeting organized by Northwest Bronx Community and Clergy Coalition, New York State Nurses Association and New York Lawyers for the Public Interest, among others.
HHC directed questions to Jacobi Medical Center, which would only provide links to press releases.
A sudden shutdown
Citing staffing concerns, NCBH abruptly ended its Labor and Delivery and Newborn services on Aug. 12 and consolidated them with services at Jacobi Medical Center, about four miles away. Both hospitals are part of the North Bronx Healthcare Network and NCBH, a community based hospital, is the smaller of the two.
In a press release put out the same day, HHC announced it was in the processes of recruiting a new director of Obstetrical and Gynecological services and that “Whether this consolidation should be temporary or permanent is under review.”
In early November, HHC announced that the new chair of HHC’s North Bronx Healthcare Network’s OBGYN department would be Dr. Michael Zinaman and that he would begin planning the reopening of labor and delivery services at NCBH in 2014.
Without further information, the vague promise left families and advocates with an array of concerns, including whether the award-winning midwifery program would return and whether the underlying staffing issue has been or will be addressed.
The lack of answers added insult to injury for those already demanding greater transparency from the hospital.
Staffing concerns predate closure
More than a month before the closure, on July 3, the Doctors Council SEIU sent a letter to Ross Wilson of the Health and Hospitals Corporation, requesting a meeting to “address what we believe are serious concerns over patient safety including the problem of retaining doctors.”
It described conditions such as rundown facilities at both Jacobi and NCBH, inadequately stocked rooms and broken equipment. A decrease in residential staff — the residency program has been suspended, according to the Doctors Council — added to more senior doctor’s workloads and made retention and rehiring difficult.
Soon after the meeting between Doctors Council and HHC leadership, labor & delivery services were brought to an abrupt halt. The community and staff members — who were transferred to Jacobi — were given only two days notice of the change, according the North Central Bronx Committee, an alliance of stakeholders organizing the response to NCBH.
Not only did the decision lack community engagement, it didn’t address the real issues, according to Dr. Frank Proscia, executive director and incoming president of SEIU’s Doctors Council.
“If I was in charge of HHC and I wanted to improve on the problem I was having at Jacobi and NCB, the last thing I would do is close one down,” he said, adding “The way to handle it is increase the staffing of senior positions.”
But he has seen no progress in these areas.
“I don’t think the staffing issue has been changed now,” said Dr. Proscia, noting that Jacobi is experiencing overcrowding in its labor and delivery ward.
He would like to see retainment of department chairs and a return of the residency program so that the hospital becomes a more desirable place to work for senior staffers.
He also said that crucial decisions of labor and delivery service should not be placed at the new chair’s feet.
“This is HHC’s responsibility,” he said.
A lack of services in several neighborhoods
As it stands, the Northwest Bronx lacks a single labor or delivery room and there is no OBGYN in the emergency room in case a pregnant woman is rushed there.
The North Central Bronx Committee cites an incident that occurred during the first two weeks of closure as evidence of the risk some patients face. An ambulance that was to transport a woman from the NCBH emergency room to Jacobi encountered a two-and-a-half hour delay getting there.
The group estimates that it’s a 49-minute commute by public transportation between the two hospitals and cites Census data to show that the majority of those who live in ZIP codes served by NCBH use public transportation. It refers to the hospital’s own statistics from 2013 showing that a majority of patients seeking services at NCBH services met New York State Medicaid eligibility requirements.
Concerned community members and advocates are now scheduled to meet with HHC staff on Dec. 12.
At the Nov. 20 meeting, since HHC officials didn’t show, the community members worked on their demands. Topping the list was to reopen labor and delivery services at North Central Bronx Hospital with its evidence-based midwifery model of care, and the second was to for NCB “to provide meaningful community engagement in all future decisions with clear plans and timelines.”
At the moment, it’s unclear whether either will be met.