City leaders in Fosston, Minn., are prepared to take back control of their hospital if Essentia Health follows through on plans to permanently end scheduled baby deliveries.
Mayor Jim Offerdahl said the loss of baby deliveries would be profound for an isolated community on the northern border of the White Earth Reservation, but he has deeper concerns. The shutdown of labor and delivery units in other small hospitals across Minnesota has led to an erosion of other medical services. In Fosston, Essentia recently stopped providing dermatology and started sending blood samples out of town for blood sugar tests, delaying results, Offerdahl said.
"Maybe some of these large health care organizations will pay attention and maybe rethink what they are doing," he said.
The dispute has been simmering since June 2022, when Duluth-based Essentia announced that it was suspending baby deliveries at the Fosston hospital due to a lack of doctors and nurses with training and experience in obstetrics.
Essentia considered the move temporary at the time. The community of 1,400 people between Crookston and Bemidji responded with "We Are Fosston" T-shirts and events to try and make their community enticing to new doctors and nurses. But the health system eventually decided to make the move permanent, and filed a required notice of the change earlier this year with the state of Minnesota. A public hearing on the closure was scheduled Tuesday evening.
The health system in a statement said that the closure was necessary because it was facing declining birth numbers and struggling to recruit providers to Fosston. Essentia is continuing prenatal care locally but scheduling births at its hospital in Detroit Lakes, which is 65 miles south of Fosston.
The Chartis Center for Rural Health counted 22 hospitals in Minnesota that stopped scheduling baby deliveries from 2011 through 2021. Mayo Clinic's hospital in New Prague is the latest, announcing that it will stop scheduling baby deliveries on Feb. 9 after aggressive recruitment efforts failed to secure new specialists to the hospital. A hearing on that closure is set for Feb. 6.
"We are delivering fewer than 100 babies per year at the New Prague hospital, and our teams need to have frequent opportunities to deliver babies to maintain their skills. In addition, we have reached a critical physician staffing shortage. Our New Prague site has only one obstetrician remaining," said Dr. James Hebl, a regional vice president for the Mayo Clinic Health System.
Fosston has unique leverage in its dispute, though, because a local nonprofit retained ownership of the hospital in 2009 when it hired Essentia to run it. Offerdahl said the city plans to return operation of the hospital to that nonprofit, First Care Medical Services, if it can't reach an agreement through arbitration by which Essentia restores labor and delivery services on its own.
"Every day that goes by ... more mothers are put at risk, having to travel well over an hour to deliver their babies," he said.
Declining birth numbers can be a problem for small hospitals, leaving its doctors and nurses with too little experience to keep their obstetric skills sharp. Insurance costs also go up for low-volume hospitals, preventing investments in other areas of health care. However, research by the University of Minnesota's Katy Kozhimannil has found negative consequences when rural hospitals shut down their labor and delivery units. Emergency deliveries increase in these hospitals when mothers go into labor and are too far from their planned birth centers, she said. Preterm births also increase, because prenatal care options also decline in communities where hospitals stop scheduling deliveries, she said.
Most rural Minnesota hospitals have aligned over the past two decades with health systems such as Essentia and Mayo, which can provide access to medical specialists and lower-cost medical supplies and electronic recordkeeping. Only 38 of 128 Minnesota hospitals were independent in 2019, and nearly half of them were designated by the state as financially distressed.
None has switched back and taken independent control of their hospitals. Fosston leaders are confident they can do it. Evan Fonder, owner of Nord's Pharmacy in Fosston, conducted research for the city by talking with leaders of successful independent hospitals across the state.
"They were very candid that, 'Hey, it's harder today than it was. But if you're well run, it's still very doable,'" said Fonder, who is chairman of a charitable foundation that supports the local hospital.
The Fosston hospital has a history of financial strength, posting revenue gains every year since 2018, and could affiliate with other health care systems in the region besides Essentia. The hospital reported 70 to 90 births per year prior to the COVID-19 pandemic, and Fonder said he believes those totals are high enough to support an obstetrics program and provide enough experience to its doctors and nurses.
Surrendering the obstetrics program could have downstream impacts, he added, because new mothers often choose the hospitals and health systems where they give birth for other family health care needs.
"That slowly ... signs a death warrant for your hospital" as it loses patients in other areas, he said. "So, we're taking a risk by going independent again, but it's probably no worse than the alternative."