Sustaining us is made possible by Fireheart Entertainment and viewers like you.

Thank you.

Maternity wards are shutting down all over California and throughout the U.S.

this is having a drastic impact on many women, forcing them to travel further and wait longer for care.

For example, recently in California, the maternity units were shut down at USC Verdugo Hills Hospital in Los Angeles.

Beverly Hospital in Montebello shuttered its labor and delivery department, and Ridgecrest Regional Hospital in Kern County now has limited service.

These hospitals serve tens of thousands of California patients.

The shutdowns nationwide have had the most dramatic impact on patients with Medicaid insurance.

Medicaid is a taxpayer funded, government provided plan for people who cannot afford their own health insurance.

In fact, Medicaid pays for more than 40% of baby deliveries in the United States, and Medi-Cal, which is California's state version of Medicaid, pays more than 50% of deliveries in the state.

And while there is an argument to be made over exactly who should be eligible for Medicaid and Medicare, and what's fair, given the fact American taxpayers fund these government plans despite the politics of this argument, the maternity ward shutdowns are taking a toll on patients.

To find out more about this crisis, we traveled here to Pomona Valley Hospital Medical Center, located in Greater Los Angeles.

Greater L.A.

is the most populated area in California with millions of residents.

This hospital has one of the busiest maternity departments in the state, and the medical center borders massive LA and San Bernardino County, serving thousands of patients.

And this high risk maternal fetal program.

This program that helps care for all women.

Thousands of women include low income women and families, and it's now been forced to take in patients from all over California due to the shutdowns all over the state, California has experienced a higher rate than other states, with some 60% occurring within the last three years, and they're not limited to sparsely populated rural areas of California.

Nearly 20 closures were within very busy and densely populated LA County.

If I was in the race, I wouldn't be here for seven days, not just to be taken care of when the doors can wait, you know, when our medicine her and me being her companion, not being safe.

This is Luis Andrade and Regina Alejandro.

Regina has been a patient here at Pomona Valley Hospital Medical Center for over a week.

Regina is very ill due to her high risk pregnancy.

She's being treated for a potentially life threatening thyroid infection, which has now given her chronic hypertension, all brought on due to the pregnancy.

It took Louise and Regina a few hours to get here on the freeway.

The couple lives in Ridgecrest, California, which is about 150 miles away from the Los Angeles area.

Maternity wards closer to where they live have been shut down, so that's been a problem.

Also, Regina needs Pomona Valley Hospital's highly specialized maternal fetal department due to her serious health condition, which has taken a toll both physically and mentally.

It's been frustrating as well.

They said that being a controlling thing or being around what I need, it's tough.

It's just harder for us to go everywhere else.

Lewis says a maternity ward shutdown crisis here in California has been tough on the family.

A family just struggling to survive.

Lewis admittedly says they basically have no money.

He's trying to find a new job, and the couple is surviving on his unemployment.

And now they have no car.

We had three hours away.

Our, transmission blew, and, that's hard to, said that we deny transportation and we blew our transmission five minutes from here.

So we're going to have a ride back.

And yes, it's very stressful, especially knowing that, we don't have a ride anymore or our car is broken down and got towed away.

It's gone.

We don't have money for another car.

We're just being far away from home in general.

Yeah, that has to come out after the hospital is not more than a few blocks away.

And, it's not a problem.

But now that she has the thyroid infection, they want her to come in every two weeks.

We don't have a vehicle anymore, you know?

And, I can't afford to be running all the time.

For now, Lewis says the car is the least of his worries, given the serious health condition of Regina and knowing how much worse things could have been for her had they not gotten to this hospital for treatment due to all the maternity ward shut statewide, overwhelmed me to the point that I cried, I cried, I didn't know how bad it could have been.

You know, they call it the silent death.

And, it just comes out of nowhere.

It's a high blood pressure being caused by a thyroid infection.

Pomona Valley Hospital has a state of the art neonatal intensive care unit, also known as an ICU.

And this is for infants who require special care.

The hospital here treat sick babies born in its women's center, or babies who need to be transferred here from the surrounding areas.

The center has a dedicated neonatal transport department, and the medical team here includes pediatric specialists who are physicians practicing everything from cardiology to neurology.

There are also registered nurses, respiratory care therapists, developmental therapists, medical social workers, the list goes on.

And this nCCU also has what's known as a neck view webcam system.

This advanced technology allows parents and families of all newborns to be with their infant virtually when they're unable to physically be at the hospital.

A specialized care team with a high tech solution for patients like Regina.

I'm getting help here.

I feel a lot better.

So she's good to have to know what's going on now.

Doctor Richard Berwick is a maternal fetal medicine physician here at Pomona Valley Hospital Medical Center, where he serves patients from all over the state, including greater L.A., San Gabriel Valley and Inland Empire.

For more than 20 years, Doctor Berwick has specialized in providing care for women experiencing high risk pregnancies.

Doctor Berwick says the maternity ward shutdown crisis throughout California and the U.S.

has been devastating.

It's a major problem that we're seeing in terms of maternity care, like you said, throughout the United States.

And there's, because of hospital closures, closures of labor and delivery units throughout the country.

We're seeing basically local maternity deserts where patients don't have access to obstetric care within, within their vicinity, within their town, within their county.

They may have to travel long distances for care.

And this happens even within California.

California is not spared by this phenomenon.

We also have maternity deserts in terms of hospital closures, obstetric coaches are happening just as much in California, southern California as it is in other parts of the country.

And I'm a high risk specialist.

And there may not be enough high risk specialists in, in certain areas where there's maybe lower volume hospitals closing, they may not have the high risk maternal fetal medicine expertise.

So we see patients come to our office for consultation, sometimes driving hours for, say, an ultrasound consultation to check on baby, to provide some genetic counseling, to provide, diagnostic tests and make a plan for that pregnancy.

So, we have to think about any medical condition that could impact the pregnancy, how many things that we see in our community diabetes, hypertension, obesity.

Now we're seeing more heart disease in younger women.

Twin pregnancy.

And then we see, maybe, birth defects that babies have.

And so we have to make up, sort of high risk, I think of it.

We make a plan for the primary care ObGyn better when we counsel the patient and give them the information, tell them what to expect, and then make a care plan.

Going forward, for example, in some cases of a complex heart abnormality, we have to decide where is the safest place to deliver what's needed immediately after delivery.

Is that child going to require cardiac intervention?

Heart surgery.

So these are really complex issues that, that we have to coordinate.

Doctor Berwick explains that hospital maternity departments all over the U.S.

deal with tens of thousands of patients like this each year with these serious health complications.

And tragically, he says, as these medical cases increase nationwide, the number of obstetrics departments are decreasing.

Why is this happening?

Why is it so bad throughout the nation and particularly here in California?

Yeah, it seems to be a big part of it.

Is, insurance, and particularly those hospitals that care for patients with Medicare or Medicaid.

These plans, the reimbursements are, poor.

And so this affects the hospital, and it also affects the physicians caring for those patients.

And California has, relatively speaking, one of the lower rates for obstetric care reimbursement through Medicare, which is that state version of Medicaid.

It's sometimes seems like there's no reason for it.

Like if we want to see a patient, we should be able to see a patient.

And, you know, a lot of them, the Medicaid plans are now managed care Medicaid plans, which means that we need prior authorization.

And that causes large delays.

So we say we want to see the patient, but they can't get in.

There's no, they they're not authorized.

They're not authorized to get, the diabetes counseling.

We have this great nutrition program and insurances.

Sorry, we're not going to cover that nutrition program, which we know how well that program works and how much patients improve when they're on that program, and then just seeing patients later than they should.

So.

And we see them more like, why weren't you here a month ago?

And they said, well, I switched channels, my insurance change.

I was waiting for authorization.

I couldn't afford it.

For more context about the financials of this maternal care crisis, Medi-Cal has disastrous reimbursement rates for obstetric care.

California's reimbursement rates are the fifth lowest, fifth lowest in the nation.

That's insane.

And that low rate is also part of the reason so many maternity departments throughout the state are shuttering.

And in this state, even the most busy departments with low income Medicaid patients, well, they don't even break even.

In other words, many of them are operating in the red.

They basically have no money.

The doctor reimbursement that Medi-Cal pays is below the market costs for providing maternal care, and this deficit is helping seal all the California closures.

However, it's not just California.

Women all throughout the US are also dealing with this health care crisis, adding to the increase in the United States maternal death rate from about 2011 to 2021.

That decade, a quarter of all rural hospitals with maternity wards shut their doors to pregnant women and many of those nationwide hospitals.

Well, they had to absorb all the absorbing costs and were doctor shortages.

They were concerned about all that.

They were some of the reasons all the shutdowns were taking place in hospitals, say, this situation.

Well, it's just getting worse.

So in 2023, the number of medical students applying to obstetrics residency programs while they drastically declined, according to the AMA, the American Medical Association.

So places like, let's say, Texas, Alabama, Tennessee, they're all now taking a mega hit.

And more than a third of US counties, mostly in rural areas, particularly in the South and Midwest.

Well, they don't even have an obstetrician or a maternity ward.

And it's two things.

One, yes, Medicaid reimbursement could be better.

Also, private insurances are too expensive.

One reason we see so much patients on, Medicaid these plans is that the private insurance commercial insurance options are too expensive.

So we yeah, we take care of, lower income population.

And, and the cost of those private plans are just too much.

So it is of a two for the fact that we see the cost of the insurance is the premiums are becoming a larger percentage of someone's paycheck, basically how they have to spend their, their monthly, allotment that they have from their income.

They're working individuals in, in many cases.

But the premiums of their insurance plans, the the deductibles, co-pays, it's just adding up to be too much.

And and so that's, you know, what's really adding and contributing to the problem.

What does it say about our health care system today when a woman has to get in her car and get on the freeway for 4 or 5, six hours, you have a patient from Mammoth Lakes.

That's insane that that's six hours away from the greater LA area.

What does that say about this crisis?

And it tells you really emphasizes the the scope of it, that a patient will have to drive 5 to 6 hours, to get care from a specialist.

And, and that's a disruption to their everyday life, of course, with their work, with their family, just just that alone, the logistics of doing that.

But the fact that they have to do that, that they don't have the access point.

Why why is that?

And and like I said, it does kind of go back to, if people are closing because the reimbursements are poor.

So we're losing doctors where there's in labor and delivery force and, and that, that the distance that they travel is kind of showing you how big the problem is to find out why Medi-Cal reimbursement rates are so low in California and why there's not more money in the state budget for health care.

I contacted the office of Governor Gavin Newsom for some context.

During Covid, California received billions of dollars in federal funding from the Biden administration.

A massive state budget deficit was instantly erased, and Governor Newsom now had some money.

So it seemed to reason there should be more funds for health care in the coffers.

However, as always is the case in California, the funds were gone soon thereafter.

Today, the state again has billions of dollars in deficit.

The question is where did all the Covid bailout money go?

There's some critics of which there are many say the governor wasted some of the newfound Covid cash on things like climate change initiatives, pork projects and bridges to nowhere, and critics of the way Medicaid and Medi-Cal are distributed also say that Newsom, as well as Democrat governors of other blue states, made the wrong decision to include illegal immigrants as recipients of the taxpayer funded government health insurance because that decision has taken a toll on state budget, finances.

Even more so, the insult to many Californians is that the Golden State is the highest tax state in the nation, depending upon who you talk to.

And yet California is broke.

Many voters simply say they're worn out.

With all the financial mismanagement on the part of Governor Gavin Newsom and the state of California, Governor Newsom and his office declined our request for an interview.

Adding to this challenge, Doctor Berwick says, is a simple fact there are now far fewer people going into medicine these days, and that's also fueling the maternity ward shutdowns.

Doctor Berwick says that pay is the worst it's ever been for physicians, and with the lower take-home paycheck, the hundreds of thousands of dollars, if not more in student and medical loans, and the blood, sweat and tears hours many young people who initially opted for a career in medicine and specifically obstetrics, are now going into other fields.

Yeah, it's it definitely changed because also that, students say undergraduate students, medical students that are looking at that, they're hearing about all of these concerns, looking forward and deciding what they want to do with their life.

And and that may take them out of medicine, which would be unfortunate if they go away from that or even those that are in medical school, they're just hearing, oh, I need to be a specialist because primary care doesn't reimburse.

And so now you have a drain on primary care field.

But we work with a lot of we work with local medical schools.

We have one Western university close by that we work with, we work with a lot of, trainees, residents that want to come through our hospital.

So we're always trying to sort of train the next generation of physicians.

Doctor Claribel Solorio is one of those next gen physicians.

Doctor Solorio is a second year maternal fetal medicine fellow.

She recently completed her residency and most of her medical training.

And now she's collaborating with doctor Brook, possibly to eventually work with a hospital in the obstetrics department or the community clinics and the Medi-Cal patients.

Pomona Valley Hospital serves doctors Solorio knows more than most about the health care crisis.

She remembers how her own family often had to travel many hours just to visit the doctor.

It's definitely very challenging and very long to be, become a physician.

But I think my story starts with my parents who immigrated here from Mexico.

To give us better opportunities and more opportunities than what they had.

And so that's one of the main reasons why I became a doctor is just because I wanted to bridge gaps, particularly with underserved patients and under-insured patients and patients who were Spanish speaking and didn't really know how to navigate the system or didn't really understand all of the options that were being presented to them.

I was raised in Mammoth Lakes, California, born in Bishop.

Because it's a little bit of a bigger hospital.

But both of these, small towns are very far away from the nearest big, big center where they can receive care.

So a lot of my family members just had to travel 4 or 5 hours in order to get basic care when they were pregnant or when they just needed any sort of, even slightly higher type of care than than what they could get with the family medicine doctor.

And, you know, twins run in my family.

So like, all of my family members who were pregnant with twins just had to travel 4 or 5 hours to be seen by a high risk specialist.

And that was a huge burden with just finances and other children.

Certainly, are a lot of challenges just with the, you know, reimbursement rate for doctors.

And I think that has become one of the reasons why some doctors are choosing to no longer work in areas where, they do take Medi-Cal patients.

But I, I think that there's still an opportunity to partner with certain types of groups that, see both a combination of private and, public insurance, patients so that they can still continue treating the patients, who do have Medi-Cal, Medicaid, but can still continue to make some money from the private insurance patients, so that, you know, we can still find a lot of fulfillment in our job and we can make sure that all patients are receiving really wonderful care.

One of the things with pregnancy is that you can turn, you can turn from being a completely normal pregnancy to being in a very emergency situation very quickly.

Doctor Maria Elena Rodriguez is part of the specialized physician team at Pomona Valley Hospital Medical Center.

Doctor Rodriguez has dedicated her entire life to this hospital, working here nearly 40 years.

Doctor Rodriguez is the medical director of maternal fetal Medicine Services.

We cater to patients with and with all different types of pregnancies, the very low risk, including to the very high risk patients.

So if the mother has some kind of medical complication either secondary to her pregnancy or because she had it at a medical condition before becoming pregnant, that makes them high risk not only for themselves, but also for their babies.

So we especially take care of them also.

And we not only, cater to our immediate community, but we also do a lot of outreach.

So we go to communities that are as far away as mammoth or, Ridgecrest that are 200, 250 miles away.

We get patients from those areas that come to see us because we welcome really any patient.

It doesn't matter what their ability to pay is or isn't we ready to try to take care of everyone?

Some of the high risk things that we see, the most common high risk things are things like preterm labor, about 9% of patients going to pre-term labor.

So there are ways that you can either prepare the baby for early delivery or try to stop the preterm labor that we are able to deal with.

Another fairly common thing is preeclampsia.

Preeclampsia is something that is, very common in patients that may be pregnant for the first time or patients that are, pregnant when they become a little bit older, which we're seeing more of now.

So, high blood pressure problems is something that is dealt with.

We also deal with patients that have maybe have had, cancer before their pregnancy, or maybe they're, it's been diagnosed during the pregnancy and it cavi a condition.

Now we have babies that were born with cardiac abnormalities that had some kind of heart surgery, and now they're pregnant and becoming mom.

So they are high risk.

Also, in addition to the poor insurance reimbursement rates, fewer people going into the field of medicine and financial mismanagement on the part of the state.

Doctor Rodriguez adds another possible reason for the maternity ward shutdowns.

We do have a decreasing fertility rate, and with the decreasing fertility rate, there are less deliveries when you have very few deliveries, it's impossible to keep your hospitals open because you don't have enough patients delivering not only financially, but also in terms of maintaining your expertise.

So if you are only doing a delivery every, you know, three days, then you nurses that are not able to get the experience that they need and they don't want to work someplace where there's no experience, even if you were able to hire them.

So it's hard to get personnel to come to a place that is not delivering very many babies.

I think that's part of it.

I think part of it is you know, deliveries or OB affects women, and women have always been the lowest priority when it comes to our system.

So I think we need to change that.

We need to really focus more on women.

Because really without women you have no choice.

And the society really is the women.

And you need to make sure that they're well taken care of.

So I think that and, making sure that we all really just take care of each other, but money and then decrease fertility, decrease expertise in our, providers.

What is a possible solution so that these maternity wards don't have to keep shutting down so that women don't have to drive hours on the freeway to get here?

Or is there a solution?

Yeah, definitely.

We need more access to care, but how are we going to get more access to care?

In some cases, some new hospitals will, build a new obstetric unit, but actually some new hospitals being built don't include an obstetric unit.

So there has to be definitely intense focus on maternal health that can come from multiple levels at the state level, like you said, in terms of funding, prior For, you know, Medicaid, because a lot of pregnant women are on a large portion of deliveries, are on these Medicaid plans.

So we either need to make that process better, improve reimbursements to make it feasible, for physicians and hospitals to be able to maintain that, that practice.

Yeah, they're continue to work on private insurance and not allowing them to keep escalating costs because our patients do want commercial insurance in many cases.

So that's another angle that, you know, we can kind of improve that.

So insurance is is a big piece of by investment from the hospital's local resources.

And people are kind of advocating for women's health in general, you know.

And it's really heartbreaking when when we know that we could have prevented some of these complications.

Well, as a person, as a mom, a sister, a daughter, it's really heartbreaking to see that many women do not have the support that they really should have, that everybody deserves.

And I think it's all of our jobs to try to see how we can lend a helping hand, not necessarily as a doctor or nurse, but really as, as a fellow human being.

I think that we should do whatever we can in our communities to make sure that women do have access to the care that they need.

Thank you so much to all the great folks here at Pomona Valley Hospital for their help.

Was so greatly appreciated for this special report.

Now for more information about our program, just click on KLCS.org and then click on Contact Us.

Send us your questions or comments or even your story ideas so we can hear from you or you know, you can contact me directly at DavidNazarNews on X or on YouTube or just go to DavidNazarNews and contact me there and be sure to catch our program here on PBS, or catch us on the PBS app.

Thank you so much for being here.

Hi, I'm David Nazar host of Sustaining Us.

Thank you so much for watching KLCS.

If you enjoy our program as well as all the other programs here on calcs, please consider supporting this station.

Your support helps keep all your favorite programs available.

You can support calcs by calling 888998 KLCS or simply visit KLCS.org.

Again, thank you so much for watching KLCS PBS.

In the next minute, I'll show you how ethical, well-regulated hunting fuels conservation.

Dallas Safari Club is about the hunting lifestyle and so much more.

Ethical big game hunters consume the animals they hunt, and what can't be consumed immediately gets distributed to the local community.

From food banks here in the U.S.

to feeding entire villages in places where food is scarce.

DSC programs educate and advocate for the sustainable use of wild resources.

And our dollars helps safeguard the future of wildlife, their habitats, and even people from Texas to Tanzania.

Ethical, well-regulated hunting fuels conservation Dallas Safari Club.

Hunt big.

Think bigger.

Learn more at Big game.org.

We understand on a mission together we bring hope and healing.

When you see the changes in people's lives, these are the things that makes your life really worthwhile.

Shared our laughter, held our tears.

Build the bond I found last year.

Even though I know we are here for work, sometimes it doesn't feel like it because it's just people you love.

This experience is definitely same with me for as long as I have memory.

The bonds we formed forever, they last.

Me to see how you can change lives.

Visit Mercy ships.org today.