In northern Pennsylvania, 6-county swath will soon have no maternity care
Rural hospitals continue to seek ways to cut costs
ST. MARYS — Pinned to the door of Stephanie Zuroski’s refrigerator is a curling black and white ultrasound image of her baby at 11 weeks, 1 day old.
The baby’s delivery is still months off, but her worry these days is whether she will get to a maternity hospital from her rural Elk County home in time for the birth. Penn Highlands Healthcare Elk Hospital, 20 miles away, is closing its obstetrics unit May 1, leaving a six-county area of north-central Pennsylvania — twice the size of Delaware — without hospital maternity care.
“I like being in the woods, surrounded by the Allegheny National Forest,” Zuroski, 32, said about the home she shares with husband, Nathan, 30, but “this is the downfall of living in rural Pennsylvania.”
Rural hospitals are in crisis, experts say, and shuttering maternity units is the just latest cost-cutting move to stem the flow of red ink. In addition to Elk County, maternity units in Clarion and McKean counties have closed in recent years at a time when infant mortality rates exceeded the statewide average.
McKean County, population 39,866, had an average infant mortality rate of 7 deaths per 1,000 births for the years 2016 through 2020, the most recent numbers available and well above the statewide average of 5.9 infant deaths before the age of 1, according to the state Department of Health. Infant mortality rates for the other five counties were not available from the health department.
Cameron, Clinton and Forest counties are the other areas without hospitals to care for new moms.
At a meeting Friday at the St. Marys hospital, which was closed to the public, health system executives said the hospital only had 147 births last year, far short of the 1,000 births needed for such a program to break even, according to Ridgway Borough Council member Zack Pontious, who was in attendance. Pontious didn’t think there was any chance the decision would be reversed.
“I don’t think anything’s going to change,” he said.
Meanwhile, the population of the new maternity care desert will grow to 156,664 — four times bigger than Cranberry Township in Butler County, north of Pittsburgh, which is served by four hospitals, including one offering maternity care that opened in 2021. Cranberry’s population is about 33,000.
Elk County Commissioners and other elected officials were scheduled to meet Friday with Penn Highlands’ executives at the hospital in St. Marys to discuss the closing. The meeting was closed to the public.
In a Feb. 1 news release, Penn Highlands said the closing was “designed to offer a higher level of care for mothers and newborns.”
Ryan Grimm, 31 years old and a new father who lives in St. Marys, didn’t see things that way.
“Now it’s a million times less attractive for a young family to live here,” said Grimm, who works at a nearby chemical plant. “Everything’s already 30 minutes to the nearest town.”
Elk County Commissioner M. Fritz Lecker said many people had accepted the decision by the biggest employer in the rural county of 30,477 people.
“This is a tough one when we’re trying to grow our town and attract young couples,” she said. “I don’t think it’s possible that we’re going to be able to reverse any decision. People are resigned to the fact.”
A group of Elk County business leaders were preparing to petition state Rep. Mike Armanini, a Republican from Clearfield County, to “explore options to prevent the closure of this health care service that is likely to have unpredictable and long lasting negative impacts.”
In addition to putting pregnant women at risk, the letter said, closing the obstetrics unit will “make it difficult to attract and retain women workers who are vital to sustaining our manufacturing industry, which serves as the economic backbone of this district.”
Elk County’s hospital issues are hardly unique.
More than half of rural hospitals in the U.S. — 59% in Pennsylvania — do not offer labor and delivery care, according to a recent study by the Center for Healthcare Quality & Payment Reform. Over the last 10 years, more than 200 rural hospitals across the country have shuttered maternity units because of the “serious financial and workforce challenges rural hospitals are facing.”
“It is not an exaggeration to say that rural maternity care is in a state of crisis and a crisis demands immediate action,” the study concluded.
Another study, this one from 2019 that appeared in the journal Health Affairs, found that residents of rural areas had a 9% higher risk of complications and death related to childbirth when compared with women living in urban areas due to fewer hospitals offering obstetric care.
“The effects of these service losses were most acute in remote rural communities, where residents experienced increased rates of preterm births, (the leading cause of infant mortality), out-of-hospital births and births in hospitals without obstetric units,” the study found.
The closing of the hospital unit in St. Marys comes as losses mount at Penn Highlands Healthcare.
At a state Senate Majority Policy Committee hearing Feb. 14 at Penn Highlands Mon Valley Hospital in Washington County, health system CEO Steve Fontaine told legislators that rural hospitals were teetering.
“I am here to tell you that rural hospitals are on the brink of disaster without increased support from our state and federal governments,” he said in prepared remarks. “Can you imagine how a closure of one or more of these facilities would affect local residents?”
Fontaine was not available for further comment.
The system’s decision to close the maternity wing followed an operational loss of $32.3 million on total patient revenue of $2.2 billion for fiscal year ending June 30, an increase from a loss from operations of $1.1 million for the same period in 2022. Last year, Penn Highlands, which operates eight hospitals, also closed a doctors office dating to the 1940s in the village of Force in Elk County, which drew pickets to the system’s corporate offices in DuBois, Clearfield County.
Meanwhile, those hit by the loss of medical services in rural areas continue to look for what’s causing the financial woes.
In an interview Tuesday, Armanini wondered whether the closure of the hospital unit wasn’t caused by Obamacare, the federal law enacted in 2010 by former President Barack Obama and called the Affordable Care Act.
“This is unfortunately being faced by rural hospitals throughout the country,” the state representative said. “Is this being caused by Obamacare? I believe it is crushing hospitals. We can not let this go.”
Experts say that law boosted hospitals’ revenue because it significantly reduced the number of people without health insurance by offering them government subsidized coverage. But hospital executives say that insurers’ reimbursement for labor and delivery doesn’t cover costs.
Moreover, labor costs for nurses have skyrocketed.
Preparing for a time after the Elk Hospital obstetrics unit closes, the squad at St. Marys Ambulance, a nonprofit emergency medical services provider based next to the hospital, is planning classes for crews to brush up on emergency childbirth care, said Nicholas Burdick, manager.
Medical care for emergency childbirths is part of the basic training programs for emergency medical technicians and paramedics, but 65% to 70% of the ambulance service’s calls are for people with Medicare or Medicaid health care coverage, Burdick said.
“We don’t necessarily see a whole lot of maternity issues in the field,” he said.
Still, in case of emergency, expectant mothers can expect an ambulance ride lasting at least an hour to the hospital.
“Our transport distance to the next hospital is 45 minutes to an hour farther,” Burdick said. “In Cameron County, it could be even longer, an hour to 90 minutes.”
“Nobody’s happy about it,” he added.
The Zuroskis’ home, in Highland Township, population 493, is back a muddy road off Route 948, a two-lane blacktop that ribbons through the dense Allegheny National Forest. The couple raises goats and hunting beagles. Both of them work at a century-old paper mill several miles away in Johnsonburg, dubbed Paper City, where Stephanie Zuroski is an environmental engineer.
It’ll be their first child and the Zuroskis chose the 168-bed Olean General Hospital in New York state for delivery. The hospital is an hour and 15 minutes away. Penn Highlands Elk’s maternity services will be consolidated at a system hospital in DuBois, which is only five minutes closer to their home.
“The biggest thing for me is my mom had really fast labors with my brother and sister, so I worry about a long ride,” said Stephanie Zuroski, the oldest of three children. “My mom almost had my sister in the elevator going up to the maternity ward at Butler Hospital.”
“I’m a little nervous about making it to the hospital in time,” she said.