By Zach Hagadone
Since the news broke March 17 that Bonner General Health would suspend labor and delivery services effective May 19, the story has torn not only through the local community but made national and international headlines.
From The New York Times and Washington Post to Fox News, The Today Show, ABC and CBS News, to NPR’s This American Life and the U.K.-based Guardian, the story has remained essentially the same: BGH can’t attract qualified physicians, nor replace those who have left, in large part due to the “legal and political climate” in Idaho stemming from strict abortion and reproductive health care laws that put medical providers at great risk of incurring heavy fines and potential jail time.
“Highly respected, talented physicians are leaving. Recruiting replacements will be extraordinarily difficult. In addition, the Idaho Legislature continues to introduce and pass bills that criminalize physicians for medical care nationally recognized as the standard of care,” the hospital stated in a March 17 news release. “Consequences for Idaho physicians providing the standard of care may include civil litigation and criminal prosecution, leading to jail time or fines.”
Specifically, the Boise-based Idaho Capital Sun reported March 17, Idaho’s abortion bans are among the strictest in the nation, applying broad definitions of what constitutes an “abortion” and including affirmative defenses limited to “documented instances of rape, incest or to save the pregnant person’s life.”
What’s more, should providers be found to have violated the laws, they would face felony charges, license revocation and steep fines.
Those types of laws have been particularly championed by Sagle Republican Sen. Scott Herndon, who styles himself as an “abortion abolitionist” and has lobbied hard in Boise for strengthening Idaho’s already uniquely sweeping abortion-related statutes — even unsuccessfully attempting to write into the Idaho Republican Party platform a “declaration of the right to life for preborn children” that would have banned abortion regardless of the health of the mother.
In a January ruling, the Idaho Supreme Court upheld the statutes as constitutional.
In addition to Idaho’s hardline anti-abortion legislation — which even opens providers to lawsuits brought by family members of an individual whose medical care is found to run afoul of the law — BGH also noted that demographics in its service area have steadily skewed to the older age range, with only 265 babies delivered at the hospital last year and admitting fewer than 10 pediatric patients.
According to 2021 Census data, the median statewide age in Idaho is 40. North Idaho residents are a median 45 years of age and in Bonner County, that figure is 47.9. Only 20% of Bonner County residents are under the age of 18 and 23.8% are older than 65. Statewide, those figures are 25.7% and 15.4%, respectively.
“Our low patient volume is insufficient to attract candidates for pediatric hospitalists, and we cannot afford to continue having locum tenens physicians [a term meaning providers who temporarily work in a speciality that is not their own],” BGH stated, adding later in the news release, “There are many reasons, including a nationwide decrease in births, an older population moving to Bonner County and Kootenai Health having a new, updated unit with neonatologists and OBs in-house 24/7.”
BGH Board President Ford Elsaesser stated that the hospital had “made every effort to avoid eliminating these services.”
“We hoped to be the exception, but our challenges are impossible to overcome now,” he stated.
In the near-term, Sandpoint Women’s Health stopped accepting new obstetric patients immediately, and offered a list of referrals for receiving care at bonnergeneral.org/services/maternity.
According to an email to the Reader from BGH on March 22, Sandpoint Women’s Health will continue offering gynecological services, including surgical services, preventative and wellness exams, and family planning consultation.
Longer-term, BGH will coordinate care for current Sandpoint Women’s Health obstetrics patients whose due dates are in May and after, and announced the hospital would “collaborate with Kootenai Health” in Coeur d’Alene to help provide OB care.
Included in most of the reporting surrounding the suspension of obstetric care at BGH is reference to the hospital serving Sandpoint, with a population “of more than 9,000.” In reality, BGH serves all of Bonner and Boundary counties, with a total census for both of 59,473, according to 2022 County Health Rankings shared with the Reader by BGH officials.
Meanwhile, the female population for both counties is 29,625, with about 16,568 of childbearing age.
The most concentrated populations being in Sandpoint and Bonners Ferry, that puts a sizable number of current and potential future patients a long way from the nearest hospital offering full OB services. Kootenai Health is 44.5 miles south of Sandpoint and 76 miles from Bonners. Newport Community Hospital, just across the border in Washington west of Priest River, is 29 miles from Sandpoint and 76 miles from Bonners, and a third option at Cabinet Peaks Medical Center in Libby, Mont., is 76 miles east of Bonners and 84 miles from Sandpoint.
For the many thousands of Bonner and Boundary County residents who live in more rural, outlying areas, those distances — and travel times, depending on conditions — are substantially lengthened.
In a statement posted March 18 on Facebook, Kootenai Health underscored its “longstanding positive relationship working with Bonner General Health,” and stated that, “Leadership from both hospitals are working together to identify any barriers to care for the patient population affected by this closure and are creating solutions to ensure a quality birth experience.”
Kootenai Health delivers an average of 2,200 newborns per year, according to the statement, and will make its Family Birth Center available to expectant mothers who had planned to give birth at BGH. Additionally, Kootenai Health offers a Level III neonatal intensive unit, alongside “comprehensive care from prenatal education through labor, delivery and postpartum.”
“This was a difficult decision made by our colleagues at Bonner General Health,” Kootenai Health stated, providing a link to its Family Birth Center at kh.org/family-birth-center.
The next nearest hospital to the immediate Sandpoint area, in Newport, Wash., also expects to admit more Bonner and Boundary County patients in need of OB care.
“First of all, Newport Hospital and Health Services truly understands the situation of our neighboring hospital, Bonner General Health, and we are willing to help them in any way we can,” hospital spokesperson Jenny Smith told the Reader in an email March 21.
However, Newport’s labor and delivery units aren’t staffed at this time, and are expected to be fully operational this summer — a month or so after BGH suspends its OB services.
“Once we have reopened a full-service labor and delivery unit, we will be able to take any patients sent our way,” Smith wrote. “Like many rural hospitals across the nation, nurse staffing for labor and delivery units has been a challenge, especially considering that many nurses left their home hospitals during the pandemic to pursue traveling positions.”
In the interim, active labor patients in Newport are being sent to Holy Family Hospital in Spokane. Smith said that prior to the pandemic, Newport delivered an average of 65-70 babies per year.
“We look forward to serving all of the patients in our vast service area, including North Idaho,” Smith said. “Due to our proximity to Idaho and the number of Idaho patients we serve, Newport Community Hospital is deemed an in-state Idaho Medicaid hospital. Our service area typically includes Pend Oreille County [Wash.] and Bonner County, even as far as Rathdrum.”
In addition, BGH spokesperson Erin Binnall told the Reader in an email that Newport is also contracted with the insurance provider Blue Cross of Idaho.
“Bonner General Sandpoint Women’s Health is working with each OB patient one-on-one to assist in coordinating and transitioning their obstetrical care,” Binnall wrote. “In addition, we are working closely with Kootenai Health and other entities of the patient’s choice to ensure a smooth transition.”
Cynthia Dalsing, a retired certified nurse-midwife with a Master’s of Science in Nursing, has 40 years of experience working in health care from Virginia to Iowa to the West, and came to Sandpoint in 1995, working at Sandpoint Women’s Health for five years before opening her own women’s health care practice in 2000, which she operated until selling it in 2019 following a cancer diagnosis.
She serves as District 1 representative for the Nurse Practitioners of Idaho, and while underscoring that her comments are her own and not on behalf of the NPI nor BGH, told the Reader that she is aware of 40 physicians who have left Idaho in the past year alone.
“This doesn’t count the ones who are in process or considering it. I have a hard time wrapping my head around that number,” she said.
“I totally understand why a physician would leave Idaho,” she added. “You acquire years of education and debt, grueling schedules completing a residency, and then folks who have essentially no medical expertise tell you how you can practice. They threaten you with criminal prosecution if you provide the standard of care.”
Dalsing said the political climate in Idaho is “not helping women.” More than that, “you don’t transport a woman who is in an unstable medical condition.”
“This will require women to now travel when they’re in labor,” she said. “I can’t think anyone in active labor wants to do that, nor does the person driving her. We’ll probably see some babies born between the Canadian border and Coeur d’Alene. This is not just affecting the community of Sandpoint, but our neighbors north of us. Sandpoint really does serve a larger population than the quoted ‘9,000’ population.”
News of the suspension of OB services at BGH was an emotional blow for many, as well. Dalsing said that “women who delivered at BGH feel an association with the hospital, as people who say, ‘I was born right here at Bonner General.’”
However, she fears the long-term consequences of the ongoing political climate, scaring off providers far into the future.
“Idaho is digging itself a hole they won’t be able to climb out of,” Dalsing said. “If all this nonsense is stopped tomorrow, Idaho already has a black eye, and it won’t be able to recoup this loss. Loss of health care, loss of dynamic young families moving here, out-of-control development. This is tough.”
As for the immediate future, Binnall said BGH is doing everything it can to help OB patients find the care they need.
“We will provide coordination of care to any entity of the patient’s choice,” she said.
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