Oregon Health Authority Denies Birth Center Waiver

State health officials have denied a waiver application from Legacy Mount Hood Medical Center (LMHMC) to stop providing required maternity services. Based on a review of Legacy’s waiver application, answers to questions from state health licensing staff, and other information, the closure of Legacy Mount Hood Medical Center’s Family Birth Center, does not meet the needs of Legacy Mount Hood Medical Center patients or the community.

Legacy Mount Hood Medical Center submitted a waiver request to the Oregon Health Authority (OHA) on March 6, 2023, to close the Family Birth Center. Legacy Mount Hood Medical Center closed the Family Birth Center on March 17, 2023, while OHA’s Health Facility Licensing & Certification (HFLC) program was reviewing Legacy’s waiver application and seeking additional information from Legacy.

In addition to reviewing Legacy Mount Hood Medical Center’s waiver request, state health officials have opened a separate but related investigation into the closure of the birth center without an approved waiver.

Health care facilities are required to meet the terms of their state license and federal certification to receive Medicare and Medicaid payments through the federal Centers for Medicare and Medicaid Services (CMS). The Oregon Health Authority conducts investigations to ensure health facilities meet their state and federal requirements. If a health care facility is found to be noncompliant, they have 90 days to return to compliance or risk losing their ability to bill Medicare or Medicaid through their federal CMS certification.

Under state regulations, a hospital that requests a waiver of a licensing requirement must show that the proposed waiver maintains or improves the health and safety of the patients, meets the individual and aggregate needs of patients, and does not jeopardize patient health and safety.

 Legacy Mount Hood Medical Center sought state approval to close the birth center after Legacy’s staffing changes left the facility without enough staff to safely provide maternity services. Legacy proposed to redirect patients to Legacy Emanuel Medical Center for maternity care.

State health officials who reviewed the waiver submission found that Legacy Mount Hood Medical Center did not meet any of the three criteria required to permit the birth center’s closure. According to the state’s waiver determination, officials determined that the closure did not maintain or improve patient services. The birth center’s staff shortages were the result of management decisions, and the hospital chose to close the facility instead of placing staff at the birth center that were willing to implement management’s proposed new care model.

State health officials also found that the closure does not reflect community needs. Before its closure, Legacy Mount Hood Medical Center served more women seeking urgent obstetrical care than any other hospital in the Legacy system. It served a disproportionate percentage of patients who had limited English proficiency, fewer or no prenatal visits, limited education and greater enrollment in the Oregon Health Plan (OHP). Eliminating access to delivery services in the area would not meet these patients’ needs and could result in more complications and premature deliveries and worsen health inequities.

State officials reviewing the waiver application also expressed concerns about patient safety. With its higher numbers of urgent obstetrical cases than other Legacy hospitals, Legacy’s proposal to divert patients to Emanuel would force some patients to deliver in the Legacy Mount Hood Medical Center’s emergency department. In those circumstances, emergency physicians may not have adequate training and experience in deliveries and there would not be enough time to transport patients facing complications.

OHA’s Public Health Director Rachael Banks said, “Our goal is to ensure patients have timely access to maternity care. The closure of the Family Birth Center at Mount Hood Medical Center does not meet that goal.”

State health regulators are continuing the ongoing compliance investigation at Mount Hood Medical Center, including the closure of the Family Birth Center. Results of that investigation are expected in coming weeks.

Legacy Health released the following statement:

Legacy Health is committed to providing the highest quality care to our patients. We take any concerns about the quality of care we provide very seriously. The Oregon Health Authority has reviewed Legacy Health’s request for a waiver to close the Family Birth Center at Mount Hood Medical Center. Today, we received their decision to deny our request.

We respect the state’s authority in this decision, and we are carefully reviewing the letter provided by the Oregon Health Authority. Once we have had the opportunity to thoroughly consider the decision and consult with the Oregon Health Authority to determine our next steps, we will provide additional information. In the meantime, the Mount Hood Family Birth Center will remain on divert status due to the lack of adequate physician staffing to provide safe patient care.

Our top priority remains ensuring the safety and well-being of our patients and our staff and physicians. We want to assure the public that we are fully committed to providing the best possible care to our patients.

We appreciate the thorough and focused approach the Oregon Health Authority is bringing to this important process, and we look forward to continuing this conversation with them. We are also committed to keeping our patients, staff, physicians, partners and communities informed as we move forward and work to ensure the highest standards of care at Mount Hood Medical Center.

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