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RE: Fight the closing of North Central Bronx Hospital Labor & Delivery Services

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  • mchgh_lln
    done --- In nyceducationnews@yahoogroups.com, wrote: Hello Fellow Educators! Please consider signing the petition below and
    Message 1 of 4 , Sep 3, 2013


      --- In nyceducationnews@yahoogroups.com, <nyceducationnews@yahoogroups.com> wrote:

      Hello Fellow Educators!

      Please consider signing the petition below and coming to the emergency press conference (info below).  If you can pass this on to groups of parents or anyone who might be interested, please do so.  This is another example of the city's actions hurting those who are the most vulnerable.  Please, please sign and pass on.




      Hello all!

       Choices in Childbirth has been engaged with a number of community-based organizations in responding to the recent closing of L&D services at North Central Bronx Hospital.  Read below for more details.  I’ve highlighted the paragraph in the fact sheet that describes the midwifery services there and the great outcomes they’ve had over the past 36 years. 


      And if you haven’t yet, please sign the petition:



      Can you please help us get word out about this press conference?! 





      SEPTEMBER 4, 2013

      TIME: 12:30 PM





      5 Train to Pelham Parkway station


      Who we are?

      The North Central Bronx Committee is an alliance of maternal and infant health advocates, community-based organizations, health professional, and individuals who came together to fight to reopen labor and delivery services at North Central Bronx Hospital and address concerns with access, patient safety and quality of care in the HHC North Bronx Network (Jacobi Medical Center and North Central Bronx Hospital).


      What has happened in the North Central Bronx Community?

      As of August 12th, Health and Hospitals Corporation (HHC) has made a rash decision to suspend labor and delivering (L&D) services at NCBH. North Central Bronx Hospital (NCBH) website states that NCBH represents the best that a community hospital has to offer: quality care in a friendly and familiar setting”. That is no longer the case for women, future babies, and families in Northwest section of the Bronx. HHC consolidated labor and delivery staff and critical expertise at Jacobi Medical Center (JMC) to address issues of patient safety, especially in light of problems women have had delivering at JMC suggest that patient safety issues must urgently be reviewed, and certainly must be addressed before they are required dramatically increase the patients they are serving.

      HHC has stated that they will continue to provide ambulatory OB and GYN Services at NCBH, including ambulatory surgery. The NCBH Emergency Room will continue to treat GYN emergencies and urgent situations. However, we are unsure if those services will continue. Labor and delivery will be managed at Jacobi unless the patient selects an alternative site. According to HHC, they have been unable to recruit the required staff at JMC, especially staff with sufficient seniority. In addition, they are recruiting a new Department Chair, which they say will take several more months. It is understandable that labor and delivery services at Jacobi have to improve, and Jacobi is terribly short staffed. In “Robbing Peter to pay Paul” HHC and the North Bronx Network leadership are increasing the stresses on already overburdened system and further restricting women’s options in a medically-underserved community.


      What is wrong with this picture?

      Access to good quality labor and deliver services is not just a matter of public health, but a human right. This means that the health care system must provide health care services that are available, accessible, acceptable and of good quality. So, what is wrong with this picture?


      1. Closing the labor and delivery service at NCBH leaves the northwest corridor of the Bronx without these vital services. There are no perinatal services at Montefiore/Moses campus adjacent to NCB and to date all emergency OB cases are referred to NCB.

      North Central Bronx Committee-partners in formation: Choices in Childbirth; Commission on the Public’s Health

      System; Coordinating Prenatal Care Coalition; New York Lawyers for the Public Interest; New York State Nurses

      Association; Northern Manhattan Perinatal Partnership; SEIU-The Doctor’s Council; The Bronx Health Link


      2. The closure will result in dangerous repercussions for low-income women and families in the Bronx. This unwise decision creates an unacceptable gap in safe and respectful obstetric services. Last year, there were 1,400 deliveries at NCBH. HHC has stated that they will meet this demand at the neighboring Jacobi Hospital. The reality, however, is that this will result in unacceptable pressure on neighboring Bronx hospitals, including Jacobi, which already have overburdened labor and delivery floors. Low-income mothers and families will face significant challenges- decreasing quality of services, and losing community-based, women-centered care.


      3. Prior to the closing of NCBH, Jacobi was already stretched beyond its capacity. JMC was placed on divergence for L&D patients as a result of having no room to admit additional patients. A hospital goes “on divergence” when they are not enough beds or staff available in the emergency room or the hospital itself to adequately care for patients. When a hospital goes on diversion, it notifies area EMS units so that they can consider transporting patients to other hospitals that are not on diversion. Patients still have the right to request transportation to the hospital of their choice.


      4. Having to travel even further to give birth will further exacerbate existing problems. Although HHC has made arrangements for patients to access a 24-hour ambulance service operated by Empress Inc., we anticipate challenges in traveling to the five available hospitals in the Bronx. Not everyone will use the ambulance service. Perhaps they may not know about the service and that is free; may not trust that it will function; and may want to choose the hospital where they deliver.

      To get to some of these hospitals by public transportation will take over an hour. Just to travel by public transportation to Jacobi Hospital would take at least 49 minutes according to a map made by HHC. Although minutes by car are less- on the average 10 to 15 minutes, most of the population can’t afford a car or to pay for a cab.


      5. All this could have been prevented. Staff shortages at Jacobi with new hires could have been addressed early on rather than the leadership deciding to end a thriving practice at NCB and transfer all staff to Jacobi. The L&D Department and management have been delaying to meet for months with union staff to resolve the matter.


      6. The community and staff were only given two days’ notice about the closure, with little opportunity to have their voices heard. HHC has a better reputation than most hospitals for responding to community needs. They have been a vital access point for local communities that have historically been overlooked by private physicians and voluntary hospitals. However, in this case they failed to provide sufficient time for real input.

      7. Low-income, immigrant and communities of color have been hurt by the structure of decision-making on these issues. All institutions including city agencies must ensure the active role of communities, and especially women, in formulating and executing delivery and coordination of health services and access to those services. For too long, we have seen a intentional redlining of vital health services in all of the boroughs (e.g. Brooklyn Health Crisis regarding hospital closures)


      8. In other boroughs, elimination of labor and delivery services has been the first step for a hospital to shut their doors. HHC has stated, at least to us, that they are not planning to close the hospital and will be expanding behavioral health services and Dialysis services at NCB. However, we hope they don't plan on consolidating or outsourcing any other vital service. We will hold them to that promise of not closing NCB.


      9. There are still significant problems putting the health and well-being of women and their infants at risk in the Bronx. The Bronx has long lagged behind in other areas in improving key health indicators. The borough’s rates of infant mortality, and percentages of low birth weight, prematurity, teen pregnancy, and women receiving late or no prenatal care exceed — in some cases substantially — those of the city and country.


      Why this matters?

      Communities Served: Norwood, Fordham, Kingsbridge, Grand Concourse and Riverdale communities are in NCBH primary service area. The Northwest Bronx, with a population of over 500,000, is very diverse. In addition to long-standing residents, the community is home to many newer immigrant populations, including people from Korea, Albania, Cambodia, Vietnam, and Bangladesh. Much of the community is low-income or working class. See charts on poverty rates and Bronx Perinatal Statistics for the primary zip codes served by NCBH.

      In NYC, the stark reality is that people of color and immigrants are more likely to be poor. In the zip code (10467) of the hospital alone, a little over 38% of the population is African American and 48% are Latino. In the Bronx, 31 percent of the borough’s almost 1.4 million residents are foreign-born. Almost 50 percent of live births are to immigrant women. For example, the Fordham neighborhood served by NCBH has one of the highest proportions of births to foreign-born women. Source: Courtesy of Bronx Health Link- taken from the Summary of Vital Statistics 2010, NYC Department of Health and Mental Hygiene

      NCBH completed a Community Health Needs Assessment in 2013 and according to the report, out of 59,231 patients seeking inpatient and/or outpatient services, 31,565 (53%) met New York State Medicaid eligibility guidelines. Moreover 12,903 patients (22%) are not insured.

      NCBH’s patient population is also 59% female. The high percentage is partly attributed to the hospital’s specialty services in Breast Cancer Screening, Obstetrics and Labor and Delivery. However, the recent decision to eliminate labor and delivery services may change that percentage.

      Delivery of Health Services at NCBH: In Fiscal Year 2012, (July 2011-June 2012) NCBH had 8,983 inpatient discharges; 188,650 outpatient visits; and 61,506 Emergency Department visits


      The maternity service of the North Central Bronx Hospital has demonstrated that good maternal and infant outcomes can be obtained in an unselected population of disadvantaged women by using obstetric interventions only when medically indicated. However sadly, the closure of the NCBH maternity service marks the end of an award-winning, midwife-led program that has served some of New York City’s most at-risk and underserved families for the last 36-years. Despite the positive impact of the midwifery services at NCBH, HHC has consistently undermined the program. In 2009, services were dramatically cut back, midwives were laid off and the midwifery model of continuity of care was completely disrupted. This resulted in an astonishing nearly 90% increase in cesarean sections between 2008 (15.9) and 2012 (30%).


      People who are on Medicaid, uninsured and underinsured in the city are heavily dependent on the HHC public hospitals and other safety-net providers. For this purpose we define safety-net providers as serving minimum of 50% of patients who are covered by Medicaid, are uninsured, or SSI Medicare eligible. HHC hospitals provided a far higher proportion of care to uninsured patients than any other single health care provider in New York City. NCBH is no exception in the challenging payer mix with high utilization rate of Medicaid and self-pay. We know that over 50% of NCBH patients are women whom should have access to vital health services like labor and delivery.

      What must be done?


      Eliminating an excellent program that has provided quality care to thousands of women in this underserved racially and ethnically diverse community is no way to honor the lives of the women and infants who have died as result of the gaps and shortages that undermine the health care system. Disinvesting the necessary resources to prevent other women and babies from dying is not the solution. There are no acceptable excuses when we consider the fact that decision to eliminate labor and delivery services. The closure would only roll back the advances already undertaken towards reducing preventable maternal deaths, low birth rates, and other complications.


      We strongly recommend that HHC Leadership, working with Mayor Bloomberg and the NYS Department of Health, take the following actions:


      Reopen labor and delivery services at North Central Bronx Hospital.

      Align labor and delivery services across the North Bronx with evidence-based best practices that have been shown to improve maternal and infant health outcomes.


      o We urge HHC to replicate NCBH’s award-winning programs, including the Midwifery Model of Care, at other facilities in the North Bronx. This will require training and hiring new staff.


      o Develop a plan to improve labor and delivery services for the entire North Bronx community that goes beyond hiring more staff. The plan should include benchmarks that address racial and ethnic health disparities and promote (1) access, (2) high quality care, (3) patient empowerment, (4) strong health care infrastructure, and (5) responsive policy-making. e.g. Develop adequate planning protocols when considering any changes to health care services.


      o Convene community members to seek input on any changes to health care services in their communities. HHC must agree that in future the community and staff will receive notice of the problem, and that a discussion of possible solutions will be held prior to the final decision being made


      o Develop a communication and public education plan to inform patients and community members of any changes to health care services in the area.


      o Develop a plan to provide adequate notice to hospital staff, patients, and community members with regard to any changes to services being implemented by HHC.


      o Take measures to ensure safe staffing and patient safety at all health care facilities where changes are being considered.


      We believe the aforementioned actions will strengthen the health care system in the North Bronx, improve quality of services provided, ensure transparency and community engagement, and ultimately improve the health of North Bronx communities.


      North Central Bronx Committee-partners in formation: Choices in Childbirth; Commission on the Public’s Health

      System; Coordinating Prenatal Care Coalition; New York Lawyers for the Public Interest; New York State Nurses

      Association; Northern Manhattan Perinatal Partnership; SEIU-The Doctor’s Council; The Bronx Health Link

    • amt472
      Thank you all for signing the petition! I will be at the press conference/rally tomorrow. It is being organized by the nurses union so any help from
      Message 2 of 4 , Sep 3, 2013
        Thank you all for signing the petition! I will be at the press conference/rally tomorrow. It is being organized by the nurses union so any help from educators or parents would be much appreciated! Thanks again!
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