Worthy battle to keep hospital birth care

Opinion editor’s note: Editorials represent the opinions of the Star Tribune Editorial Board, which operates independently from the newsroom.

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There’s a leaden air of inevitability when a large health care system announces the closure of a core service, such as labor and delivery, at a small hospital that it operates.

But one Minnesota town is fighting back, offering inspiration to other communities as industry consolidation reshapes care across the nation, too often leaving diminished services or hospital closures behind. The consequences are especially painful in rural areas, where residents may face daunting drives to get care elsewhere.

Feisty Fosston, Minn., shows that concerned citizens don’t have to swallow these changes, which is why the town’s battle and the smart strategy its leaders put in place years ago to protect the hospital merit the spotlight and commendation. A recent announcement from Mayo Clinic Health System that it will end labor and delivery in New Prague underscores the urgency of highlighting Fosston’s situation. The details should inspire other communities to pursue alternatives or plan for this contingency.

Fosston, population 1,434, is in northwest Minnesota. Its hospital has long been a community hub, offering care and employment. The availability of hospital labor and delivery services is particularly important, according to Mayor Jim Offerdahl.

Nearby care is crucial for expectant moms, especially when brutal winter conditions can make travel hazardous much of the year to medical centers in bigger cities, such as Detroit Lakes (63.5 miles away) or Fargo (102 miles). This care is also foundational for the future, helping entice those looking to relocate a business or family to the area.

But in June 2022, Duluth-based Essentia Health — which operates but doesn’t own the Fosston hospital, according to city leaders — announced it would temporarily halt scheduled deliveries in Fosston due to “current program constraints and staffing limitations.” The Star Tribune recently reported that the change will be permanent, with an Essentia physician telling the newspaper that the system’s hospital in Detroit Lakes is better prepared to respond to complications.

That permanent change has spurred understandable local outrage. Due to farsighted wordsmithing in the 2009 contract that led to Essentia running the hospital, concerned citizens can do more than lament the change. And they are promising to do just that, recently announcing that they’ll take back control of the hospital if labor and delivery is no longer provided. The 2009 contract appears to give them serious leverage.

Evan Fonder, a Fosston pharmacy owner, chairs a local nonprofit called First Care Medical Services Foundation. It does fundraising for hospital equipment and provides other support. According to Fonder and Fosston’s city administrator, Cassie Heide, First Care owns the hospital and clinic facility from “a real estate standpoint” and holds the hospital license. In addition, it owns the clinic in Bagley, Minn.

The 2009 operating agreement requires providing “core services,” including hospital-based labor and delivery care, Fonder told an editorial writer, adding that discontinuing this means the contract with Essentia can be terminated. That’s currently the Fosston plan, though arbitration lies ahead and the resulting decision could upset this strategy.

Asked for comment, Essentia provided this: “Due to a pending dispute with the City about the terms of the affiliation agreement, Essentia will not comment on matters that will be resolved through an arbitration process.”

Fonder disputed arguments made in favor of ending Fosston hospital deliveries. Fonder notes that closure proponents cite declining births at the facility. But he said, those numbers may reflect the drop during the pandemic, when staffing strains led to diversion of services. “Prior to this, Fosston has delivered 60 to 110 babies annually and the market area for Fosston, Bagley and Oklee continues to see approximately 150 births per year total,” he said.

Fonder also contends that the community has found solutions to the difficulties of recruiting doctors and nurses to continue this care but that Essentia has rejected or undermined these efforts.

As for arguments that it’s safer to deliver to deliver babies in a hospital providing a high volume of such care, the Minnesota author of a study linking the low birth volume with higher risks weighed in. Katy Kozhimannil, a renowned University of Minnesota professor and researcher, said: “The conclusion we made was *NOT* that we should close small-volume rural units, but rather that the resources and attention to maternal health, nationally, needs to be directed to smaller-volume rural units in remote areas to support those communities and health care systems.”

Charting an independent course for the hospital poses challenges if the relationship with Essentia ended. Fonder acknowledged this business reality but noted the hospital’s strong financial record. Still, caution is appropriate.

The dispute bears watching by legislators, who should weigh policy remedies this session. The Star Tribune Editorial Board urges Essentia to work with Fosston. Ongoing collaboration will reflect well on Essentia and potentially offer a Minnesota model for continuing this vital care across the nation.

Editorial Board members are David Banks, Jill Burcum, Scott Gillespie, Denise Johnson, John Rash and D.J. Tice. Star Tribune Opinion staff members Maggie Kelly and Elena Neuzil also contribute, and Star Tribune CEO and Publisher Steve Grove serves as an adviser to the board.