Penn Highlands Elk maternal care cuts highlight Pa.’s widening rural services gap

ST. MARYS — As a maternity nurse, Jacki Nesbitt has teared up while helping strangers give birth and supported families through loss.

It's her dream job. But when her 15th anniversary in the role at Penn Highlands Elk comes around this summer, labor and delivery services won't exist. The hospital is ending them in May.

The 38-year-old could work in another department or at a Penn Highlands hospital roughly 35 miles away. But Nesbitt doesn't want a new nursing job and is frustrated by the closure. She's also “devastated” for the patients, who will be referred to Penn Highlands Dubois, a facility with 24-hour labor coverage and a 16-bed neonatal intensive care unit.

Penn Highlands Elk doesn't have a NICU, so infants requiring specialized care would receive “a higher level” in Dubois, Nesbitt said. Still, the nurses in St. Marys are trained to transfer patients in emergencies, and as far as Nesbitt knows, transport has not caused a bad outcome during her time at the hospital.

“They have a great maternity unit over there. They have great people that work there,” Nesbitt said of Dubois. “But when it comes to labor and delivery, they can't do anything that we can't do here.”

In private meetings, Penn Highlands has told staff, local first responders, lawmakers, and community officials that the system needed three more OB-GYNS to alleviate the workload of Steven Koch, the only doctor with that specialty in Elk County. Plus, state data show the hospital's 179 to 227 annual deliveries from 2011 to 2021 is low compared to Dubois', which averaged 1,000 births a year in the same period.

The health system, which operates eight hospitals statewide, says patients will have access to “the highest quality of care and the most resources” at its Clearfield County facilities, said spokesperson Corinne

Laboon.

“For Penn Highlands Healthcare, this transition is about quality and reducing risk and not finances,” Laboon told Spotlight PA in an email.

Community members who have watched services trickle out of the area say they are confused, frustrated, and worried by the news of the planned shutdown. Residents frantically called their elected leaders, who knew little more than their constituents about the decision.

Almost a decade ago, Penn Highlands Elk sought to become a critical access hospital — a Medicare designation that limits stays to four days — to improve its financial standing. The hospital later cut its generations unit, an inpatient program for older adults, and referred patients to Dubois instead. The health system is also closing a personal care facility in Ridgway this spring.

“It feels like it's just one thing after another,” Nesbitt said.

Meanwhile, Penn Highlands is building a $70 million facility in Centre County, which already has a hospital.

Penn Highlands President and CEO Steve Fontaine, who made over $1.2 million in 2021, told state lawmakers during a February hearing on rural care challenges that inadequate payments from health insurance plans are the primary cause of hospital closures. He didn't mention the expected labor and delivery shutdown in Elk County, but detailed how financial challenges, aging patients, and staffing shortages make it hard to sustain rural health facilities.

Tax documents show the health system reported $81.7 million in revenue in 2021 and $73.3 million in expenses. During the hearing, Fontaine said post-pandemic numbers show profit declines. He testified that Penn Highlands had one of its “greatest losses” in 2023: a negative 5% profit margin.

This year is “a little bit better,” he added.

Residents think money factored into Penn Highlands' decision to cancel labor and delivery services in Elk County. But if finances weren't an issue, they question whether the closure was necessary. Additionally, as shrinking population projections loom over Pennsylvania's rural areas, officials fear these changes leave their communities without the infrastructure to survive long term.

“Everybody in rural Pennsylvania deserves access to the same services as urban and suburban residents,” Clearfield County Commissioner Dave Glass told Spotlight PA. “We aren't lesser people here.”

How it happened Penn Highlands has emphasized that the closure in Elk County applies only to labor and delivery. The hospital still plans to provide prenatal and postpartum care, exams, tests, and ultrasounds.

In late February, the health system hosted a private, invitation-only meeting at Penn Highlands Elk that brought out staff from the offices of U.S. Rep. Glenn Thompson (R., Pa.), state Sen. Cris Dush (R., Jefferson), and state Rep. Mike Armanini (R., Clearfield). County officials, municipal leaders, and community members also attended the meeting, according to several attendees.

During the meeting, Penn Highlands leadership reiterated that the decision would offer “higher quality care” for patients, detailed Koch's overextended workload, and mentioned declining birth numbers in Elk County. However, attendees questioned whether the health system had truly exhausted all options before deciding on a closure. A birth center that employed midwives overseen by physicians was one alternative floated by the group, which asked Penn Highlands to more proactively involve the community in big decisions in the future.

“I don't think it's such an outlandish idea,” Elk County Commissioner Matt Quesenberry said of a birth center. “I didn't get the impression that was an idea they were considering.”

St. Marys Mayor Lyle Garner told Spotlight PA that while he somewhat understands why Penn Highlands plans to end labor and delivery, he thinks the hospital wasn't open enough with residents.

“I don't think we should be the middleman on this,” Garner said. “They put me in a bad situation, whether I like that or not. There's a bad public opinion of our hospital, and they need to change that. This didn't help things.”

Penn Highlands Elk didn't invite some leaders in neighboring areas affected by the anticipated closure to the meeting, including Cameron County, where residents rely primarily on Penn Highlands Elk or UPMC Cole in Potter County for care. Though Cameron County has a health center, the nearest hospital is at least a 40-minute drive, Commissioner James Moate said.

“To me, that's not putting patients first. That's putting their bottom line first,” he told Spotlight PA, referring to the impact these closures have on patients in surrounding areas.

Though regular conversations between elected officials and health system leadership might not prevent closures like this, they could give local leaders a chance to ramp up advocacy for more state funding to fill service gaps, Cameron County Commissioner Jessica Herzing told Spotlight PA.

“It would certainly be nice to include the elected people that represent our constituents who make up their client base and utilize their services,” Herzing said. “So, not only are we aware of what's coming down the line, but also so that we're not blindsided by after-the-fact decisions, and then excluded from further discussions.”