03/13/2026
A discussion about local maternity care and Nevada Regional Medical Center
The ongoing conversation in our community about the future of Nevada Regional Medical Center has provided an opportunity for some to make suggestions about how to assure the future of the hospital without the current ballot measure for the hospital district and associated property tax. There have been recommendations that outside hospital systems come in and take over operations or for NRMC to become a Rural Emergency Hospital (REH). The problem-solving efforts and concern are admirable and I am happy to read the supportive comments that have been shared by many people. However, this is a complex topic and there are reasons that some measures may not be the solution we would hope they could be. One service line in particular, maternity care, is at risk with many of these solutions.
The Labor and Delivery Department at NRMC has endured while many surrounding maternity care departments have closed. It has saved lives and provided meaningful moments with excellent care of growing families. It would be at increased risk of closing if a larger hospital system absorbed NRMC and it would not be possible to maintain in a Rural Emergency Hospital. By their very nature, REH’s do not allow inpatient care and can only have an emergency department, an outpatient observation unit for stays up to 24 hours and a skilled nursing facility. Maternity care is an inpatient service. Nearby hospitals managed by larger systems have often closed their OB departments. The Mercy facility in Carthage and the Cox hospital in Monett are recent examples. Freeman acquired four properties in NW Arkansas this month. It is too soon to tell what will happen with their OB departments but the Freeman location in Neosho has not had maternity services in decades and the Freeman Ft. Scott hospital offers only an emergency department and a 10 bed inpatient medical unit. The likelihood that a large nearby hospital system is interested in acquiring NRMC is not known but the closures of the Mercy hospitals in Ft. Scott and Independence KS a few years ago demonstrates that rural satellite hospital locations sometimes don’t work out as planned and are expendable to the organizations. OB departments are likely considered a liability to an outside group because of the potential for malpractice claims in addition to the inherent cost of operating the department.
It is not obvious to the public why maternity departments are so vulnerable to closure and why it is difficult to prove if they are actually financial beneficial or result in losses to a hospital. Most people would agree that access to a hospital for birthing care is a necessary resource for the public but they may not be able to articulate exactly why and to what extent it should remain local.
Childbirth is an unpredictable experience each time. I have often said that the fun of it is not knowing what’s going to happen next. It is never boring. But that’s not always fun. It can be rapid or seem to take forever. It can happen without difficulty or be impossible without assistance. Mom and baby can be continuously well or their lives can be in peril with no notice. The life threatening part can occur before, during or after delivery for either one. Maternity care patients present for care hours or moments before delivery and sometimes right after. This happens without regard for clocks, calendars, holidays, clinic schedules or patient volumes. It is a time of great anxiety for laboring mothers and their loved ones and tensions can be quite high. This is the environment that OB nurses and physicians choose for their work. It is not a job for everyone.
There are some temperaments that are more suited than others for maternity care work and it requires specialized training. A nurse orienting to the department needs at least 12 weeks of training to work independently after earning a nurse’s license. We can’t just pull a nurse from a different department when we need the staff. These nurses have knowledge and skills that they have learned specifically for this department, and more importantly, they love the work and are good at it. There is a nurse available in the department at all times, even when we don’t have any patients in it. We never know when someone is going to arrive with an eminent delivery so we have someone ready to receive them and begin their care. A second nurse is on call at all times to come in when a patient is admitted. Sometimes we get lots of business at once and start calling in additional nurses who are not scheduled but might be available to come help. When business is slow these nurses are not getting enough hours to keep their income at a steady predictable level but when it is busy they risk burnout.
A maternity care department cannot exist without surgical services. There are times when a cesarean section is needed without delay, again without regard for calendars, clocks and holidays. When we call for a c-section we are requesting the immediate arrival of a CRNA for anesthesia, a scrub tech, a circulating nurse and a recovery nurse. The NRMC surgical department has had difficulty recruiting staff over the years because of the need to be available for call and live within a distance that allows for a rapid response without notice. These staff members get paid a smaller amount for being available on call and a larger amount when they are called in. We maintain a second physician to be available as a surgical assistant with the understanding that a newborn may need intensive resuscitation while the mother’s surgery is still continuing. That physician is paid to be on standby. The CRNA staff is also available to place epidural anesthesia during labor and so those staff members come in much more frequently than the surgical crew. It is a challenge to recruit and staff the anesthesia department because of the demanding hours and this has been a reason that some of our former staff members have chosen to leave. Loss of anesthesia services is one common reason for loss of obstetric services in nearby hospitals. There is a looming shortage of anesthesia professionals making recruitment even more difficult. I cannot stress enough how fortunate we are to have our surgical services and anesthesia crew. These people have exceptional attitudes and professionalism and that matters so much in these often stressful situations.
It has become more difficult over time to recruit physicians to work in rural areas. There are two patients in a labor so there must be a physician continuously available to care for each. Pediatricians care for newborns, obstetrician/gynecologists care for mothers and family medicine/OB physicians care for both. Drs Russell, Heiner and I are FMOB. Dr. Seals is a gynecologist who retired from OB a few years ago and Dr. Fox is an internal medicine/pediatric physician. We have managed to put together a call schedule with these physicians and many others who have come and gone over the years so that there is always a physician available for a mother and a baby. It’s not easy to look at a calendar and split it up three ways so that someone is always available with no lapses. But we have done it for the 25 years I have been here and for quite a long time before that. The reason many rural OB departments have closed is that there have not been enough physicians. Dr. Russell and I went three years doing all the OB between the two of us many years ago and it just about did us in. Being instantly available to the hospital half of one’s life isn’t sustainable. Many physicians are drawn to larger urban settings because they might only have to take call 1/10 of the time instead of 1/3, or less. Many of the larger hospitals now have “laborists,” physicians who work only in the labor and delivery departments and leave prenatal care in the clinics to other physicians and midwives. Many OB clinics do not offer visits with the same physician throughout prenatal care with the expectation that this physician will very likely also attend the birth. We are fortunate to still provide this more personalized service for our community.
When looking at finances in profit/loss statements and return on investment an obstetric department is expensive. We have staff standing by at home for c-sections, for laboring epidurals and deliveries just in case. We have a nurse available for a department that might not have a patient in it. This department has a share in the allocations for dietary, housekeeping, maintenance, material supplies, information technology, electronic health records, billing, administration, Human Resources and energy usage as none of these departments has any income of their own. This probably makes some wonder why NRMC came to us at Nevada Medical Clinic and arranged an employment/purchase agreement so that we would be able continue obstetric services and thereby help save the hospital from closing back in 2022. The answer lies in a program that I find impossible to fully explain titled 340B. This is a government-funded plan to help hospitals at risk by providing blocks of money based on prescriptions written by employed physicians and providers and filled at participating pharmacies as long as the hospital maintains a minimum amount of services to individuals covered by Medicaid plans. The department that reliably keeps NRMC qualified for the 340B program is labor and delivery. A large portion of our patient population has Medicaid coverage, typically both mother and infant. I don’t know how long this particular program will continue but it brings in big payments regularly and is one of the reasons we have had improving financial numbers this year. The purchase of Nevada Medical Clinic has been questioned in some of the social media posts this year. The details of that would require another lengthy post but the reason this made financial sense for NRMC was the 340B program. Rural Emergency Hospitals are not eligible for 340B payments.
NRMC has remained as an oasis in what is otherwise a maternity care desert. If the labor and delivery department does not remain open in Nevada the closest choices for obstetric care are currently Freeman and Mercy in Joplin, Mercy in Pittsburg, Overland Park Regional, St. Lukes in Lee’s Summit, Golden Valley in Clinton and Citizen’s Memorial in Bolivar. Most people would be able to make the trips required for routine prenatal care and delivery to one of these locations. However, a substantial number would struggle with transportation and childcare arrangements for the visits that are typically every week by late pregnancy and the trip to the hospital during active labor would become much longer than it is now. Even now there are babies delivered on the way in or without adequate warning at home. That number would increase. Family members often drive recklessly in their feeling of urgency and I fear that will worsen with a longer distance. We occasionally have someone arrive in dire condition and we know a life was saved because we intervened. The time to that intervention will meaningfully increase. We have a growing number of people who choose to deliver in the home with a midwife. Occasionally things do not go as planned and a decision is made to come to the hospital for further management. Those trips are already long for a population that is often remote with limited transportation options. Increasing their distance to medical care will certainly be a hardship for them. Of note, there are patients who currently choose to receive prenatal care at clinics in El Dorado Springs and Ft. Scott with the plan to deliver in Bolivar or Pittsburg and when the time comes they come straight to NRMC because it is closer and they sense they don’t have enough time to go the extra distance.
Many would assume that I am speaking about this subject in my own best interest. After all, this is how I make my living, of course I want this department to remain open. But I am nearing the end of the OB portion of my career. I intend to pivot to primary care in a clinic setting and see what it’s like to sleep all night, finish a day in clinic without interruptions from the hospital and not worry about weekends and holidays in the near future. No matter what happens with NRMC I can find a job either near or far away within a short time. My concern about this department comes from my knowledge about how deeply the loss of it will affect the community. It is nearly impossible to re-open an OB Department after it has closed. That’s why Dr. Russell and I managed to hold it together with just two of us for so long. I don’t know that passing the ballot measure will save the OB department and I don’t know that the ballot measure failing would hasten the loss of the hospital. I don’t know that an outside larger system would choose to close the OB department or maintain it if they took over operations. But I do know that it is extremely difficult to keep it fully staffed, that it costs a lot of money, that it is hard to prove financial viability and that it saves lives. I know that driving an hour or more is a lot different than going down the street while in active labor. I know that prenatal care makes a tremendous difference in outcomes for both mothers and newborns and those frequent visits are more difficult to manage with further distances. I believe that keeping control of the hospital in local hands is in the best interest of the OB department in particular and that the health and future of Vernon County will be stronger if NRMC continues to provide maternity care.
These complicated topics have so many details that they cannot be quickly and neatly summarized. Thank you for continuing to engage in the spirited public conversation about the future of NRMC’s governance and the upcoming ballot measure and for the time you spent reading this post.
