“I thought I could get more answers here than in Washington,” U.S. Sen. Tina Smith told a group Thursday meeting at Rainy Lake Medical Center about rural health care challenges.
Smith’s visit to Borderland included a rural economy tour of the community in the morning, as well as a boat tour of Voyageurs National Park and its restoration projects.
Top on Smith’s list of concerns about rural health care challenges is maternal and obstetrics, which she said in some rural settings forces families to travel more than 100 miles for care.
She toured the hospital, meeting staff and hearing about improvements made in the last few years.
“What a great facility, and the importance of this facility to this community is so obvious and such a big deal,” she told the group that included RLMC CEO Robb Pastor, state Rep. Rob Ecklund, International Falls Mayor Bob Anderson, members of the hospital board, and Koochiching County Public Health Director Derek Foss.
“If you lose your hospital, lots of other things don’t work,” she said.
In addition, Dr. Samantha Crossley, Dr. Kimberly VerSteeg, and RLMC Chief Nursing Officer Roz Snyder were a main part of the conversation.
Smith said she’s working in the U.S. Senate to put plans in place to make the federal government be a good partner as local hospitals work to protect the maternal and obstetrics care they provide.
“It’s a big issue, not only for the community, but because maternal mortality in this country is one of the worst among developed countries,” she said, adding there is more incidence of mothers dealing with substance abuse and chronic health problems such as diabetes.
Earlier in the day, Smith visited Thief River Falls Hospital, where she heard about moms not getting maternal care, which adds to the risk for both moms and babies.
Smith, a member of the Senate Health Committee, pointed to a bipartisan bill she’s introduced that would help ensure that new and expecting mothers in rural areas get the care they need.
Known as the Rural MOMS Act, the bill would direct the Centers for Disease Control to coordinate efforts to report on women’s health conditions; award new rural obstetric network grants that would establish innovation networks to improve maternal health and morbidity; expand existing federal telehealth grant programs, to include birth and postpartum services; establish new rural material and obstetric training demonstrations; report on maternal care in rural settings to identify the location of gaps in maternal care in rural areas.
Cosponsors of the bill are Sens. Lisa Murkowski, R-Alaska, and Doug Jones, D-Alabama, which Smith noted have similar rural challenges providing health care.
Smith noted that more than half of rural counties nationwide lack hospitals with labor and birthing services.
Anderson said the Falls hospital is the closest hospital for 100 miles, and Anderson and Paster added some weekends the hospital lacks coverage for birthing services. At those times, they said patients are diverted to another hospital.
“We’re committed to trying to deliver that service because we don’t want people to drive that far,” Pastor said. “Financially it can be a strain, so it’s something we’re very passionate about, but something we always have to think about safety and make sure we provide a good service. It’s challenging. We’re trying to be creative.”
He said the hospital is attempting to “work across the bridge,” adding that American doctors are able to cover for the Fort Frances hospital, but Fort Frances doctors are not to assist the Falls hospital, with Crossley and VerSteeg noting that costs of malpractice insurance are high and are not covered for what American liability is.
“I do provide a lot of c-section coverage for them,”VerSteeg said, but she said they are unable to provide service here.
VerSteeg said she’s been in practice for 15 years, working in rural Minnesota and Iowa, as well as a larger community in Iowa.
“I have never had a maternal death, ever, so my concern for rural OB is fetal death,” VerSteeg said, adding that most people here seek prenatal care, often traveling for that service. However, if an obstetrical emergency occurs, the baby may be at risk by the time they are ambulanced to a hospital with those services.
Crossley said she is a family practice doctor with obstetrics training, which she said is a changing field. Most of her calls are now about OB services.
Family practice doctors often don’t get OB training, “because people don’t see being on call every other day is a call they want to aspire to,” Crossley said.
Crossley said OB training was pushed when she was training as a family practice doctor.
Pastor said only about 13 percent of family practice doctors come out of school wanting to deliver babies.
VerSteeg said she came to the Falls also thinking OB work would come one in three calls, perhaps one in four calls because others with training would be available, but that has not happened, causing her to take more calls for OB care.
“I have three children, Sam’s got children, too, my priority is being a mom and I am on call more than half the year, and it’s becoming mentally and physically exhausting to try to be a good mom on top of that.”
She said rural settings pay less than larger communities, so there is little incentive for OB doctors and other doctors with OB training to work in rural areas.
VerSteeg urged Smith to look at reimbursement of tuition and loans to doctors who serve OB and maternal health care in rural settings. She said she’s been paying on her student loan for 15 years and still has $100,000 to pay.
Crossley, too, said offering more OB fellowships to family practice doctors could also help in getting more doctors to be able to provide OB services.
Foss also said he hears from the public nurses that say soon-to-be mothers are concerned about giving birth elsewhere when no doctor is available locally. And those who begin services here, are concerned they may not have the same doctor should they be forced to give birth locally.
“It’s a real disparity, distance and transportation costs,” Foss said.