MINNESOTA, USA — On Friday, the small city of New Prague, south of the Twin Cities, closed its only labor ward.
The closure will force people to drive 25 miles or more to another hospital to have a baby. The announcement from Mayo Clinic came less than a month ago, which critics say violates state law; but a Mayo Clinic spokesperson told KARE 11 it was granted an exemption due to low staffing levels, which is allowed under the law.
Mayo Clinic owns the hospital and says it simply didn't have enough staff to keep going.
This is part of a larger pattern. The number of labor and delivery units closing across Minnesota is one of the highest in the country with 22 closing between 2011-2021, mostly in rural areas.
In response, several lawmakers plan to introduce a bill when the legislative session starts again on Monday. One of the authors, Rep. Andy Smith, says while it doesn't fix the whole problem, it's a start to making rural health care, and maternal health, more of a priority.
"The important thing is that rural Minnesotans deserve that health care and we need to protect them and their ability to access that care," said Rep. Smith, who calls the system "fractured".
The data from the Chartis Center for Rural Health and the Minnesota Department of Health shows labor wards closed in several cities including Ely, Hastings, Fosston, Albert Lea and Cambridge.
"We don't want to be leading in that category," said Rep. Smith. "We're proud in some areas that Minnesota is leading, this is not one of them."
His new bill would change the current 2021 law that requires facilities, like hospitals, to notify the state in cases like this within 120 days and hold a public hearing within 45. Mayo Clinic was subject to a $1,000 fine in this latest case but claims its short staffing is part of an exemption.
"What this will do is make it much harder for both non-profit and for-profit hospitals to be able to close their doors or their wards without a public hearing, a public testimony, so that those in the local area will know about it," said Rep. Smith.
If the bill passes, it would require a 300-day notice and a public hearing sooner, within 30 days, that also has to be held no more than 10 miles from the facility in question. Rep. Smith says if any of those rules are broken, the state has to impose a $20,000 fine.
"First and foremost, it (public hearings) gives us more data, more voices to know about this closure," said Rep. Smith. "Secondly, we have potential examples where hospitals, maybe back down or change their plans, based on the outcry. And also the communities will have more chance to prepare for this closure."
Experts who study rural health say this kind of care has been steadily declining for 20 years. University of Minnesota Health Policy & Management Professor Katy Kozhimannil, Ph.D., says staffing shortages, high operating costs and unsafe working environments contribute to closures.
"We know this is something greater Minnesota communities are dealing with, and frankly unless the concerns that underlie these reasons for closures are addressed, I do expect we will continue to see this," said Kozhimannil. "Those risks are no longer born by the hospital, they remain in the community."
Fewer incentives to invest in maternal care continue to put rural mothers, and their babies at a higher risk of disease and death, according to Kozhimannil.
"The fact that it's not profitable is not a good enough reason to withhold health care access for rural Minnesotans," said Rep. Smith, who says reimbursement rates for these services continue to be low.
For example, Medicaid pays for about 40% of all the state's births, but in return reimburses hospitals far less than the cost of providing that care and the hospital continues to lose money.
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