Horizon reverses decision to close URVH labour and delivery department

·5 min read

Horizon Health announced Saturday it would keep the Upper River Valley Hospital labour and delivery unit open, despite announcing its closure less than 24 hours earlier.

Still, the hospital's obstetric staff and area residents want a further explanation for this weekend's turmoil.

In an update to its late Friday announcement of the permanent closure of the unit, Horizon Health posted a statement Saturday afternoon reversing that decision.

"Further to yesterday's statement, Horizon Health Network will continue to provide labour and birth services at Horizon's Upper River Valley Hospital (URVH) in Waterville," the update stated.

However, the Horizon update extended the temporary closure of the unit, with no timeline as to its reopening.

"As a temporary measure, due to COVID-19, expectant mothers from the Upper River Valley area will have access to reliable, safe and quality care during labour and birth at Horizon's Dr. Everett Chalmers Regional Hospital in Fredericton."

Horizon's announcement late Friday to permanently close the Waterville-based hospital's obstetric unit met a massive groundswell of backlash from Upper St. John River Valley residents. The health authority released the public announcement a few hours after Horizon Health's interim president and CEO, Dr. John Dornan, delivered the bad news to URVH staff late Friday afternoon, Nov. 5.

Area residents quickly developed plans for significant protests in opposition to the decision.

"We appreciate the public's understanding, patience and flexibility during this time," Saturday's Horizon statement read. "Services are expected to return to the Upper River Valley area in the coming weeks."

The surprise decision to close the unit appeared to take local MLAs by surprise.

Before Saturday's Horizon release announcing the closure's reversal, Carleton MLA Bill Hogan indicated in a short statement the decision was on the way.

Hogan emailed the following statement to the River Valley Sun around 2:40 p.m. Saturday, Nov. 6.

"Like many of you, it was a surprise, and I was upset by the announcement regarding the URVH yesterday. I'm pleased to see that Horizon found a way forward in keeping labour and delivery at our hospital," wrote Hogan.

New Brunswick Agriculture, Aquaculture and Fisheries Minister and Carleton-Victoria MLA Margaret Johnson also issued a statement on social media Saturday afternoon.

"Folks, as I mentioned before, I was shocked and dismayed when I heard about the changes at Horizon regarding Labour and Delivery services at URVH," she wrote. "I am pleased to see that further consideration has Horizon finding a new way forward to keep L & D at our hospital."

While welcoming Horizon's abrupt change in direction, Dr. Allison Boyle, Head of Obstetrics at the Upper River Valley Hospital (URVH) in Waterville, said concerns remain.

Boyle said she received a personal email from Dornan Saturday afternoon, asking to meet next week to review his concerns and discuss possible solutions.

"I will meet with him, and I am thankful that he is at least open to dialogue, but this does not mean it's over," she said.

Boyle said it sounds like the URVH labour and delivery unit won't open until the Horizon CEO has a chance to discuss options with her and URVH's obstetrics team.

"I am worried he is still trying to push forward his agenda, but I won't know for sure until we meet," she said.

In a letter sent late Saturday afternoon to Dornan, Health Minister Dorothy Shephard and colleagues, the URVH obstetric physicians question the CEO's actions.

"We are writing to express our grave concerns about the misinformation that was presented by our CEO, Dr. Dornan, with regards to the obstetrical program at the Upper River Valley Hospital," wrote the doctors to open the letter obtained by the River Valley Sun.

They said the CEO, when asked, failed to provide "direct evidence" URVH didn't meet the standard of care.

The letter noted that Dorman's first line was that URVH did not meet the required "standard of care" without an obstetrician or neonatologist on staff.

"You did not post a job advertisement for an obstetrician at URVH because you felt it wasn't feasible," the physicians wrote to the CEO.

The letter questioned Dorman's comparison of URVH to urban centres, which have both family physicians and obstetricians on call.

"That was your first mistake," the letter stated. "The Upper River Valley is composed of rural communities. We have a different standard of care. You cannot compare a low-risk centre to the tertiary centres."

The letter outlined the "well-established" standards governing low-risk birth centres.

"A low-risk centre is required to have a qualified birthing professional (i.e. family physician), a physician with privileges to perform emergency cesarean delivery, anesthesia, and appropriately trained nursing staff," the URVH obstetric physicians wrote."

Under those standards, they wrote, an obstetrician and neonatologist are not required.

"URVH has a full complement of competent staff," they wrote.

The letter questioned the CEO's poll of urban New Brunswick doctors about whether they would practice rural obstetrical care, saying many responded they would be "uncomfortable."

"This was your second mistake," the URVH physicians stated. "You again compared urban and rural centres. You did not ask rural family medicine providers if they were comfortable with obstetrical care."

Suggesting the CEO said he was unaware of any Canadian hospital operating similarly to URVH, the letter listed more than 50 rural communities with a similar care standard to the Waterville hospital.

The letter added some of these hospitals sit more than 300 kilometres from the closest obstetrician and neonatal intensive care unit.

The URVH doctors asked Dorman to review the Society of Obstetricians and Gynaecologists of Canada's joint position paper regarding the recommendations for rural maternity care. They explained the position paper recommends women living in rural and remote areas have high-quality maternity as close to home as possible.

They said the paper also cites evidence of good outcomes within an integrated perinatal care system with local access to operative delivery and when women are not required to travel far from their communities.

A complete copy of the letter is attached.

Jim Dumville, Local Journalism Initiative Reporter, River Valley Sun

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