NORTHEAST KINGDOM – Copley Birthing Center employees are speaking out, following the revelation that the hospital board is considering closing the center in an effort to save money.
Registered Nurse Sarah Chouinard returned to Copley in 2011, after several years as a traveling nurse. She was first employed by the hospital in 1998. Mary Lou Kopas is a midwife at the Women’s Center and Birthing Center. Kopas moved to Vermont from Washington state, where she was the chief of midwifery at the University of Washington medical center. Kopas grew her own practice before relocating to Vermont.
Both Kopas and Chouinard agree employees were kept in the dark throughout this process, and patients will be left at a disadvantage should the center close.
“We found out back in December that the discussion to close the birthing center was brought to the board of trustees of the hospital. We had not heard anything officially up until December, and even then the information was kind of leaked,” said Chouinard.
Chouinard says they were all shocked, because they had not even been approached by the administration at all regarding the subject. “We were just kind of in the dark. So then, of course, we tried to get information directly at that point, but it was not, it was not given up at all easily. Pretty much, we were still left in the dark.”
Having been ignored, Chouniard says they were forced to bring it to the community. “Now that we knew this was a possibility, and that no one knew what was happening or these discussions were happening, we thought the community should know and have a say in it since this is our community hospital.”
As president of the Nurses Union, Chouinard attempted to reach out to Copley Health Systems President & CEO, Joseph Woodin directly several times via email and got no response. “Even the manager of our unit was not clear as to what was going on, and I know that the midwives tried to get information. There were some meetings set up. I think that Joe did not show up to one of the meetings. Really we were just put off, as far as getting any information on that matter at all.”
“We had assumed that, had that been in discussions at all, that maybe we would’ve known in advance. They would’ve come to us and said ‘hey we are thinking about closing this birthing center.’”
Chouinard continued, revealing a little discussed second option. “Also based on that Wyman report, there were two recommendations that were made. They said either for the financial sustainability of Copley they need to either close the birthing center or expand it and grow it. Now I know that there has been no discussion about expanding and growing, only closing it.” Chouinard says in 2022, midwives presented a proposal for a satellite location in Waterbury that was not even considered or accepted.
Kopas was also in favor of the second option, “I think there is the capacity. If you do more births, you need more staff. We could manage somewhat more births with the staff we’re at, and that would be a savings for the hospital. I think that’s possible.”
“In terms of room for expansion, yes the Oliver Wyman Report says in the short term [the hospital] should do nothing different, in the longer term, three to four years down the road, they recommend either the expansion of births or the closing of the center.”
Neither the board nor Woodin have given employees a timeline of the potential closing. Ultimately, there was a total lack of transparency from the start, says Chouinard. Commenting on when this process and discussions began, “only Joe Woodin and the board members know that,” she said.
Years of delays and denials for improvements has left her suspicious of the timeline. Chouinard says the center has had no advertising, upgrades or money put into trying to increase numbers in 13 years. “It’s been a couple years where we were put in for new items and denied, or the plan was there but then all of a sudden it just never happened. It’s because they knew this for a couple years, that the focus was not growing us or improving us, rather, just closing us so they kind of have been really tight with everything finance wise.”
Chouinard said much of this controversy mimics the Springfield birthing center closing. Springfield Hospital, located in Chester, closed their birthing center doors as a cost saving effort in 2019. “They gave their nurses a timeline of June, I don’t know when they started their conversations, but they were planning on closing their doors in June, and I believe they ended up closing their doors a month early. We have a contract, the union and the hospital. The hospital only has to give us five days’ notice before closing the unit,” Chouinard said. The status of their contract leads Chouinard to speculate the decision could come sooner, with little to no warning for employees.
Kopas says,“This is something that other hospitals have done, because of the cost savings. It’s a shame, because it’s necessary care. One would argue that care related to female bodies is not expendable.”
Chouinard believes the birthing center is also the scapegoat for Copley’s real estate problems. “There’s another aspect of this again. It’s kind of transpired, you go to some of Joe’s all-staff meetings and you see he’s got big plans for the campus. Copley has a real estate issue. There’s not enough space, and they’re always trying to acquire more real estate. I believe in my heart of hearts that it’s not even the money that they’re losing, cause you know Copley is projected to make $10 million next year even with the birthing center in the budget. So it’s real estate, they want our space.”
Kopas agreed, “What makes money here is Mansfield Orthopedics. It’s an excellent service, it has a great reputation, people come from outside the area to come and do joint replacements here. They’re building a new operating room and they have opened a new clinic in Waterbury.”
Kopas also revealed that Copley is a critical access hospital, meaning they cannot exceed 25 inpatient beds. She elaborated, “a critical access hospital, it’s a federal incentive program to keep small rural communities from losing their hospitals. Because they exist on such a small margin and they have a hard time making ends meet, for years there’s been this critical access hospital designation which is that your hospital has emergency services and there is no other hospital in that area that’s a reasonable distance.”
A critical access hospital does not need to provide birthing services, except in the emergency room. Kopas, and other women disagree that birth is not a critical service. “I think it’s just inherent sexism, because one, birth isn’t reimbursed at the cost of care, and two, it’s not considered essential care.”
Both Chouinard and Kopas agree that projections of an aging population aren’t justification enough in closing the center. Chouinard said the Northern New England Perinatal Quality Improvement network, a Dartmouth Public Health program, issued the center a letter of support, asserting the low volume of birth will in no way affect the quality or consistency of care. “They said, there is no magic number. We have so many years of experience, a little bit of low volume every once in a while is not going to affect our quality of care, or competency, for that matter.”
“They put out a number of 200 or less, saying that’s a concern. We’re hovering just below 200, so it’s easy for them to kind of use it against us,” she said.
Kopas agreed, “The volume of births at Copley is not huge, but it’s running in the 150 to 200 range. In the last several years, the birth rate has been steady. There’s been no drop in births in the last seven years. There’s been a drop in births probably in the last 20 years.”
Kopas said the hospital has been putting out the word that volume is dropping, alleging it’s not safe if the volume is low. “All of that is just not true. It’s a financial decision,” she said.
Kopas said, while the population of Vermont is aging, Lamoille county has been growing in recent years. Statistics from the state department of health affirm Kopas statement. She also pointed out that one thing young families and people look for are places to give birth. “It’s shortsighted, because yeah we need services for elderly people because the population is aging, but who’s going to care for the older people if we’re not making it a livable place for young families.”
The birthing center uses the midwifery model of care, setting them apart from other providers in the state. This unique model is what first drew Kopas to the area. “Not only is this an important service, it’s really high quality. I moved across the country, and was looking all over New England and chose this place to come and work because of the model of care here, and the outcomes. The nursing staff, the midwifery staff, the OB’s, it’s a good team.”
Both Chouinard and Kopas have major concerns for patients in the area.
“It’s not a good idea to have people travel an hour, half an hour, two hours, for birth. You can travel that far to get a knee replacement, but in labor that’s difficult. For prenatal care when you’re having weekly visits at the end of pregnancy, that’s a hardship for people,” said Kopas.
She continued, “We know that there are people who won’t make it or won’t be able to get to another hospital and they’ll just come into the emergency room at Copley and deliver there. It’ll just be worse care for low income people, which is a shitty way to run a healthcare service.”
“There’s definitely evidence that when a rural area loses its birth services at the hospital, women and babies have worse outcomes. Fewer women get sufficient prenatal care, there’s more complications, there’s more ICU admissions,” she concluded.
Kopas elaborated further on the state of womens healthcare, “Nationally, the United States is under performing in maternal and newborn outcomes compared to the rest of the developing world, we do a horrible job. And we’re not in any hurry to get better. There’s also a huge disparity between people of color and white people in maternal and newborn outcomes. You are more likely to die giving birth in the United States than you are anywhere in Europe. National public health experts who looked at maternity care and are trying to address this problem, what they recommend is avoiding unnecessary interventions, lowering the C-section rate, and the midwifery model of care. Those are all things that are recommended for improving maternal and newborn outcomes, and that’s what we have at Copley.”
“We actually have this amazing thing going on in this shabby little unit that hasn’t been renovated in years, but the quality of care is extremely good. Vermont is unique, the March of Dimes has given Vermont an A in ratings on maternal outcomes. There’s one or two states that have that. Again, we’re looking at shutting down a program that is really successful, providing the kind of care that women need and sadly women don’t get around the country, and outcomes will be worse,” said Kopas.
Employees, patients, and community members will continue to show their support at the upcoming Mother’s day rally, Sunday, May 11. The rally will be held on the corner of Main and Congress, in Morrisville, from 1 to 3 p.m., with face painting, a plant swap, a bake sale, and more.
Raymonda Parchment is a Hardwick Gazette reporter. She recently graduated from Vermont State University - Castleton with a Bachelor’s Degree in English. She is a strong supporter of freedom of speech, and the right to publish information, opinions, and ideas without censorship or restraint. She is a lifelong lover of the written word, and is excited to join the team as a staff member.
