Plumas District Hospital (PDH) is at the center of a very real crisis in Plumas County. As the only hospital in the entire county that provides OB services and 24/7 emergency surgery, this small hospital offers a lifeline for pregnant mothers who choose to live and raise their families here.
Both Seneca Health Care District and Eastern Plumas Health Care, Plumas County’s only other hospitals, were forced to end their OB programs years ago. Seneca, especially, looks to PDH to provide essential OB services.
PDH is both a designated Critical Access and Frontier hospital. Those designations point to the very real life giving and life saving services it performs in a county where access to care is precarious at best. Further, 80% of pregnant mothers in Plumas County are insured by Traditional or Managed Medi-Cal. These patients have even more difficulty traveling out of county for services. They may not be able to afford travel, or they may not have a vehicle that could negotiate the long trek safely.
The closest urban hospital that offers a full spectrum of OB and specialty services is eighty miles away. That eighty miles can spell the difference between life and death to either mother or infant during an emergency birth. In addition, roads in Plumas County can be difficult to negotiate in the best of times, especially at night and with the possibility of wildlife running into the road. Add to that winter conditions with the danger of icy roads and low visibility, which can reduce driving speeds to twenty miles per hour, and an already stressful experience can easily turn into a nightmare.
Dr. Jeff Kepple, Board Certified Family Physician at PDH, has delivered over six hundred babies at the hospital in his twenty years of practice there. He has been “involved in a multitude of emergency situations where urgent intervention has been lifesaving” for both mother and newborn, he said. It’s not an easy task to maintain an OB program that meets American College of OB/GYN guidelines for performing an emergency cesarean delivery. “This requires a surgeon, OB physician, anesthetist, surgery team, OB nurse, respiratory therapist, and ultrasound technician to be on call 24/7. Without this service, many of my laboring mothers or their newborns would have suffered disastrous consequences en route to the nearest facility,” added Dr. Kepple.
Indeed, national statistics bear out Dr. Kepple’s account. Maternal death rates are on the rise in the U.S., and this increase is most significant in rural areas. Research analysts at Scientific American found that in 2015 the maternal mortality rate in large urban areas was 18.2 per 100,000 live births. In rural areas, that jumped to an alarming 29.4 per 100,000. They attributed this to a lack of “geographical access” along with a higher incidence of underlying health conditions such as hypertension and diabetes. Preventing or managing these conditions is contingent upon access to the kind of quality health care that Plumas District Hospital provides.
Dr. Kepple is one of the good guys. He argues that it is morally the right thing to do to keep OB services at the hospital, even though by his own admission, PDH is losing around $300,000 per year by offering this service. And, that’s not because of anything in the hospital’s control. It’s a combination of the high cost of maintaining the program and the relatively low number of births (approximately 75-80/year) as rural populations continue to age. Also, for the large number of Medi-Cal patients, reimbursements are notoriously low.
Beyond doing the right thing for each individual mother and baby, however, is the reality that our rural communities will not survive if we don’t facilitate and encourage young families to move here and to have their children here. In fact, a vibrant hospital will do much to encourage young couples and young families to live here. It makes a significant difference in our ability to recruit young doctors to our area, or to draw teachers, county administrators, and the scores of people who will ensure that we have a healthy, vital community into the future.
Drs. Alexandria and Ben Hunt had their son delivered at PDH in 2015. They chose Quincy as the kind of place they wanted to raise their family. Both physicians work at the hospital. Dr. Alexandria Hunt speaks of the very robust and supportive group of young moms who meet together “for toddler dance class, library story time, Mountain Mamas exercise group, and play dates.” This is exactly the kind of community we want to foster in Plumas County.
A narrow vision might convince us that OB services are a financial burden to the hospital. A larger and more generous view demands that we ask ourselves what kind of community we want to live in, and what kind of place we want to see for future generations. And, if we can’t support and encourage young families to make Plumas County home, we are looking at a very bleak future indeed.