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On August 12th, Health and Hospitals Corporation closed the Labor and Delivery service of North Central Bronx Hospital, saying that pregnant women would now use the service at Jacobi Medical Center. But Jacobi already has an overstretched labor and delivery service, raising concerns about women’s access to safe and respectful maternity services for women in the Bronx.

For over 20 years, North Central Bronx Hospital had a national model of excellence in maternity care provided by nurse midwives. In 2002, the program received the American College of Nurse Midwives’ award called With Women for a Lifetime for innovative and compassionate midwifery care practices. But beginning in 2009, this successful model was undermined as services were dramatically cut back, midwives were laid off and the midwifery model of continuity of care was completely disrupted.  According to Choices in Childbirth, this resulted in a 90% increase in Cesarean sections between 2008  when it had the lowest rate in the city at 15.9% and 2012, when the rate had doubled to 30%. The benchmark set by the WHO is 15%.

As a nation, the U.S. outspends other nations on maternity care, largely because of this high Cesarean section rate and the cost of delivering in hospitals rather than childbirthing centers. And it continues to perform poorly in the ranking of developed nations on outcomes such as maternal mortality and infant mortality. Overwhelming evidence supports a midwifery model of care as the way to achieve excellent clinical outcomes while reducing the cost of maternity care.

So why isn’t the city–and the nation–moving in this direction? Tonight on Healthstyles, producer and moderator Diana Mason, RN, PhD, discusses this question with Elan McAllister, the founder and executive director of Choices in Childbirth, a non-profit organization that is a national leader in consumer advocacy and outreach for women and their families; and Nan Strauss, an independent researcher and consultant on maternal health issues who was formerly with Amnesty International USA and authored its report, Deadly Delivery: The Maternal Health Care Crisis in the USA.

So tune in tonight to WBAI, 99.5 FM (www.wbai.org) at 11:00 PM; or, to listen to the interview anytime, click here:

Healthstyles if brought to you by the Center for Health, Media & Policy at Hunter College, City University of New York.

On August 12th, Health and Hospitals Corporation

This post was written by CHMP Senior Fellow Charmaine Ruddock, MS directs Bronx Health REACH, a coalition of 50 community and faith-based organizations, funded by the Centers for Disease Control’s REACH 2010 Initiative to address racial and ethnic health disparities.  

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There is much happening around healthcare now. Next week Tuesday, October 1st starts the open enrollment into the new Health insurance Exchanges or Marketplace, and even as this is to happen Congress’ House of Representatives passed legislation a few days ago that requires that Obamacare or the Affordable Care Act be totally defunded or they will shut down the Federal Government next week.  And, while all of this is happening there are local concerns in many health advocate circles that here in New York, specifically in the Bronx, we are also facing a healthcare crisis of our own.  On the very Tuesday that open enrollment begins, a group of health activists comprised of doctors, nurses, community organizers, patients and union members will draw attention to the very pressing need for access to safe, quality healthcare in the Bronx and similar communities all across New York in a community meeting titled Winning Healthcare Justice for Our Community.  Please come out and be part of this effort to make sure that all New Yorkers can, when needed, get the best healthcare.

written by Charmaine Ruddock

 

This post was written by CHMP Senior

by Rosemary Gibson, Senior Advisor, The Hastings Center and Author, Battle Over Health Care: What Obama’s Reform Means for America’s Future

Hospital budget cuts became viscerally visible earlier this month when Vanderbilt Medical Center announced that nurses must now perform housekeeping duties — cleaning patients’ rooms and bathrooms.

In case you missed the video of the internal announcement secretly recorded by a nurse that aired on  Nashville’s WSMV television station, here it is.

http://www.wsmv.com/story/23364976/vanderbilt-medical-center-to-have-nurses-cleaning-up?autoStart=true&topVideoCatNo=default&clipId=9280584

It is hard to think of a worse way to demoralize professionals who want to practice at the top of their license.  Invoking Florence Nightingale’s name as a spoonful of sugar to help the budget medicine go down is no salve for deep wounds of disrespect.

For patients, they are at greater risk, an inevitable outcome as nurses spend less time at the bedside.

All of this begs the question, “Where does all the money go in hospitals, who is getting it, and what are they really doing with it?”

The direction of the budget axe is being determined by an unspoken battle between labor and capital.

Nurses, pharmacists, housekeepers and increasingly, doctors, are employed labor.

Medical equipment and supplies, medical devices, drugs, computers and information technology are the products of capital investment.  Companies that manufacture these products need constantly increasing revenue to keep stock prices and earnings per share headed north.  Stockholders and other investors – their unforgiving owners – demand bigger, better, quicker returns.

Consequently, companies are programmed to take more money for themselves, which leaves less for everyone else, especially nurses.  I wrote about the uncanny parallels between the health care industry and the banking sector in Battle Over Health Care: What Obama’s Reform Means for America’s Future.  Both have price bubbles, toxic assets, too-big-to-fail syndrome, and privatized gains and socialized losses.

Implicit tradeoffs between labor and capital are made every day.

Companies have to create a stream of so-called new, innovative products every year to pump up earnings per share.  As nurses know, new is not always better.  It might be worse.  A steady torrent of new stuff: equipment, technology and a bevy of consultants causes money to trickle up.

Meanwhile, hospitals are not exactly shopping at the equivalent of Costco and getting a competitive price.  And they buy too much that ends up in landfills.  A hospital supply chain executive at a large public teaching hospital estimates that at least 10 percent of hospital purchases in inventory are expired.  Good for Wall Street investors.  Bad for people taking care of patients.

To correct the misallocation of the public’s money, transparency of billion-dollar hospital budgets would shed light on where all the money is really going.

In the meantime, we cannot let the material abundance of a few create a chasm of indifference to the plight of many.

by Rosemary Gibson, Senior Advisor, The Hastings