HOLYOKE — Holyoke Medical Center intends to close its maternity services unit, leaving Holyoke residents with no place to give birth and receive obstetric care within the city.

The decision comes after HMC temporarily closed its Birthing Center in early April, converting it to house patients from the Holyoke Soldiers’ Home as that facility dealt with a large-scale outbreak of COVID-19 that has killed at least 76 veterans. On Friday, the medical center’s president and CEO, Spiros Hatiras, notified staff and the state Department of Public Health that the hospital intended to permanently close its 13-bed obstetrics unit and 10-bassinet infant nursery.

“It is estimated that the annual loss from the maternity service is between $3-$4 million, and has been that for years,” Hatiras wrote in an email to HMC staff. “Unfortunately it is a loss that is growing and that HMC cannot sustain any longer without risking the entire organization.”

Local leaders voiced concern over the loss of a vital service in a city with a history of poor maternal health outcomes and without any other alternatives for obstetric care. In particular, the midwife practice at HMC — Midwifery Care of Holyoke — was formed in 1985 as the direct result of a state task force looking to lower the city’s infant mortality rate, which at the time was the highest in the state, with Latina women suffering disproportionately.

“It’s definitely disappointing,” state Rep. Aaron Vega, D-Holyoke, said on learning of the closure.

Vega’s own son was born at the birthing center, and his stepmother, Jane Frey, was a nurse midwife with Midwifery Care of Holyoke.

“This goes right back to the disparities that we’re constantly fighting against in urban places and western Massachusetts,” he said. “This is quintessentially that issue.”

HMC spokesperson Rebecca MacGregor said in a statement Thursday that the hospital is working with local and state officials on the closure, and with other local hospitals to ensure access to care. She said the hospital had not yet heard concerns from any city leaders, but “would be open to speaking with them directly.”

Midwife exodus

Almost all of the original Midwifery Care of Holyoke nurse midwives had already left the practice by early 2019, however. In interviews with the Gazette, two former nurse midwives, two former nurses and the practice’s longtime office manager said they and other coworkers were subject to “bullying” and micromanagement by administrators.

“It became a very hostile work environment where we couldn’t practice our profession, essentially,” said Sara Eggemeier, who worked as a nurse midwife from 2011 to 2019.

MacGregor declined to make Hatiras, the medical center’s CEO, or Marc Zerbe, president of the hospital’s medical staff, available for an interview, stating that the medical center “has no comment towards your questions of former disgruntled employees.”

The closure comes amid the COVID-19 pandemic, which has significantly decreased revenue for hospitals, including Holyoke Medical Center. And it is not the only closure that a city hospital has announced in recent months. In early March, Providence Behavioral Health Hospital said it planned to do away with 74 inpatient psychiatric beds this summer. Those plans are on hold after the state DPH found on May 15 that the services are “necessary” to the area.

HMC will now also go through the same DPH process, including a public hearing, before it can close its birthing center, which Hatiras said it plans to shutter by Oct. 1.

During the public hearing over Providence’s closure plans, advocates stressed that many in Holyoke lack adequate transportation, which makes traveling out of the city for medical needs difficult. Several city officials and former HMC employees said the same concerns apply to Holyoke Medical Center ceasing maternity services. HMC maternity patients are currently delivering at Mercy Medical Center in Springfield.

“No prenatal care is the highest prediction for premature delivery. And if people can’t get access to prenatal care easily, they’re just not going to get it,” said Lisa Pack Kirschenbaum, a nurse who worked at the HMC birthing center from the day it opened its doors in 1993 until it temporarily closed this April. “We had many people that walked to their prenatal appointments.”

In his message to staff, Hatiras said that despite its best efforts, HMC has been unable to increase its number of deliveries. He said that without a “critical volume,” further investments in the service are not financially feasible, citing the medical center’s lack of a neonatal intensive care unit as a reason parents choose to give birth elsewhere.

But several former employees say that there were other reasons the number of deliveries dropped. Those that questioned management were told to find employment elsewhere, they said. Pack Kirschenbaum said morale declined when a beloved physician was let go in 2018 and got even worse after the departure of the midwives in early 2019.

“The administration is the cause,” she said. “It was so different. The politics were different, the way women were cared for was different.” 

An office nurse and the longtime office manager, both of whom are Latina, alleged that they were discriminated against and that Hispanic or bilingual employees were replaced with employees who do not speak Spanish.

The deteriorating work atmosphere led to an exodus of midwives and other employees, ending an institution cherished in the region, the five former employees said. Of the practice’s 10 midwives, eight of them — most of whom had been with the hospital for a decade or more — either resigned or were let go between late 2018 and early 2019.

Nina Kleinberg, a nurse midwife who had worked at the practice from 1988 until she was suddenly let go in January 2019, said she was told not to come back to work despite having announced plans to retire in April.

“I got that after 30 years of spotless service, leaving two generations of patients wondering what happened to me,” she said.

The resulting situation came at the expense of patient outcomes, said the midwives interviewed. At a practice that once touted its low rates of intervention, the hospital’s rate of C-sections was most recently 29.8%, according to a survey the hospital submitted in June 2019 to the organization The Leapfrog Group. That number was 19.7% in 2015, when midwives attended almost all of the vaginal deliveries, according to Kleinberg and Leapfrog data. Leapfrog’s target for all hospitals is 23.9%.

Damaris Ramirez, who first worked at the practice 15 years ago as a medical assistant, left the practice and then came back in 2017 as an office nurse. She said that for most of the practice’s history, the vast majority of all staff spoke Spanish. But in recent years, she said, the portion of employees who spoke Spanish plummeted, and that those in charge “weren’t thinking about the community they were serving.” As a Latina, she said she felt higher-ups discriminated against her, and that she was ultimately pushed out.

“There was a level of discrimination,” Ramirez said. “You don’t want to think that’s the case, but it was.”

Luz Pacheco, the office manager since 1990, said that she felt that racial discrimination was part of why her job was eliminated. She said she was told she needed a master’s degree for the position she had held for decades, but that when the job was posted online there was no mention of a master’s degree.

Recognized need

When Holyoke’s Providence Hospital announced the opening of its downtown prenatal clinic in 1985, it marked a significant step in addressing Holyoke’s infant mortality rate, which at the time was the highest in the state.

The expanded prenatal clinic at 210 Elm St. was the culmination of two years of work by the Holyoke Infant Mortality Task Force and the state Department of Public Health. There was a large disparity in infant mortality rates between the minority and the white population in Holyoke. Advocates argued Latinas were being deprived of adequate prenatal care due to the long distance that uninsured women and those on Medicaid had to travel to Providence, which was located close to West Springfield and had few Spanish-speaking staff members.

One of the members of the Infant Mortality Task Force was Orlando Isaza, a longtime activist in the city. He said an essential part of the task force’s work was bringing in nurse midwives — medical professionals who not only attend births but also provide care during pregnancy and the postpartum period.

“It was one of the main and first things that we talked about in the Infant Mortality Task Force as being something needed and wanted in the community,” he said. “It was a major improvement in health care for the Latina women and young mothers in the community.”

At the new, centrally located prenatal clinic, almost all of the staff spoke some degree of Spanish, and many social services were provided onsite. And nurse midwives were hired to provide care for the women.

The nurse midwife practice incorporated in 1994 as Midwifery Care Associates and affiliated with Baystate Medical Center in 1996 shortly before Providence closed its obstetrics unit, keeping an office on Appleton Street in Holyoke. Then, in 2001, the practice affiliated with Holyoke Hospital — now Holyoke Medical Center on Beech Street — and became known as Midwifery Care of Holyoke.

Conflict brews

In recent years, however, administrators began to clash with the midwives, Kleinberg said.

In 2017, HMC administrators announced that the hospital’s midwifery and obstetrics practices would be combined. They named Marc Zerbe head of women’s services. Then, in 2018, a physician who former employees say was very supportive of the midwives was suddenly let go. Friction developed between midwives and doctors over medical management decisions, and midwives were simply told to be “team players,” Kleinberg said.

“For 30 years, we were practicing independently and had amazing outcomes, and overnight we were all of sudden completely micromanaged,” said Eggemeier, the former nurse widwife.

Kleinberg and Eggemeier both said that the change in culture resulted in administrators disciplining midwives who spoke up to advocate for patients. For example, Eggemeier said that in September 2018, Zerbe reported her to Hatiras after she raised concerns in the operating room about the intense pain a patient was experiencing during a C-section. She said that once the mother’s bleeding appeared to be under control, she simply asked if the team could pause and help the patient get comfortable, as the patient and her family were clearly distraught.

That incident and another ultimately resulted in Eggemeier being disciplined for “lack of appropriate communication,” according to documents Eggemeier shared with the Gazette. Concerned that she was disciplined for speaking up for a patient, she resigned on Nov. 16, 2018. 

Following Eggemeier’s resignation, the midwives shared their dismay over how Eggemeier was treated in a private email chain. The emails, which were shared with the Gazette, were all sent from personal email accounts but were forwarded to Hatiras, who called a mandatory all-staff meeting the next day. Kleinberg said Hatiras yelled at them and said that nobody was “irreplaceable.”

One midwife gave administrators her three-month notice of resignation on the spot, Kleinberg said. Two more gave notice in the week following the meeting, and another was let go as a “per diem” midwife, she said.

“The way the practice had been with the midwives, once they left everything changed, from the top down,” said Kirschenbaum, the longtime nurse at HMC’s birthing center. 

Community members reacted with frustration over the exodus of midwives and the proposed closure of the unit.

“I find it unbelievable that something that has that kind of value and significance to the community is being chiseled away,” said Isaza, the former member of the Infant Mortality Task Force, about the midwives’ departures. “It responded to some of the deep concerns among some of the people in the community regarding the lack of, and limitations, of health care services in the community.”

Ward 4 City Councilor Libby Hernandez said she gave birth at HMC more than a decade ago, and that her sister gave birth to her son there just three months ago. Hernandez said her sister didn’t have access to transportation, but was able to walk to the hospital because of its downtown location. Hernandez said she was concerned about the loss of accessible, quality maternal care in the city.

“Also, with midwives you establish a relationship with them,” Hernandez said, noting that the ongoing support midwives provide throughout pregnancy, during labor and after birth is very important. “They’re losing also that, and especially for Latina women, single mothers, those who are impoverished, it’s very important.”

Vega said he too is worried that those without access to transportation will be harmed the most. He said that when DPH looks at the situation from Boston, they may think, “Springfield’s just five miles down the road.”

“But it’s not just five miles down the road for a lot of families,” he said. “I think it’s going to have a big impact in the city.”

Vega also said that the closure is a result of the profit-driven health care system of the United States — a sentiment echoed by Kleinberg.

“It’s an indictment of a health care system where decisions are made based on money and not on public health,” Kleinberg said.

Dusty Christensen can be reached at dchristensen@gazettenet.com.]]>