National Nurses United

units. More than 180 hospitals have closed since 2005. By 2014 more than half of all rural counties had no hospital that offered care for pregnant people even as 28 million women of reproduc- tive age live in rural counties. More than three-quarters of rural counties in Florida, and more than two-thirds of rural counties in Nevada and South Dakota had no in-county hospital obstetric services at all. California, where Redwood Memorial is located, recorded a net reduction of 14 labor and delivery units between 2010 and 2019, representing an 11 percent decline. In April 2020, San Jose Regional Medical Center, which is owned by the country's largest private hospital chain HCA Health- care and serves largely low-income patients in east San Jose, closed its labor and delivery ward despite nurses' vocal and public protests. Maureen Zeman began her 29-year tenure at the San Jose Regional Medical Center when it was owned by a nonprofit hospital chain and said there have been profound and devastating changes at the hospital since HCA took over in 1996. When HCA announced they intended to close the obstetrics unit, Zeman was devastated. "I was just angry and sad, just very, very sad. Sad for the patients, sad for the nurses that worked there. It was our heart and soul." "We did accept Medi-Cal for many, many, many years and then probably about eight years ago they got rid of their medical con- tract and our deliveries went from 300 to 30," said Zeman. When the hospital stopped accepting Medi-Cal, the ob-gyn doctors left. Eventually the hospital began taking Medi-Cal again, but the damage was done. With the doctors gone, the patients didn't return. "HCA is all about money. They wanted a service line that brought in a lot of money. They didn't care about helping the com- munity and doing what was best for the mothers that live near the hospital." The nurses fought back. They brought their pleas to the public and to local elected officials, but in the end, HCA refused to recon- sider. HCA, the multi-billion dollar for-profit hospital system based more than 2,200 miles away in Tennessee, closed the unit. Hovie said when the Redwood Memorial nurses joined commu- nity members to oppose their L&D closure, they felt like their voices were ignored by hospital management and by those making the decisions at the headquarters in Washington state. "We just felt there was no buy-in from anyone, and that the hospital had abso- lutely made up its mind." "You have too many people with perverse incentives making decisions," said Monica McLemore, an associate professor in the nursing department at University of California, San Francisco. "If your only accountability is to your shareholders because you're part of the national conglomerate of groups that own hospitals around the country that does not get the people we serve, the care that we need." Nurses at Regional and Redwood Memorial, owned by Prov- idence, say another way their health systems justified closures was by orchestrating low birth rates. Besides doing things like no longer accepting Medi-Cal, the hospitals achieve this by failing to recruit, retain, and support family physicians or ob-gyn providers. Without providers to provide prenatal care and attend births at those hospitals, patients stop delivering their babies there. Then A P R I L | M AY | J U N E 2 0 2 2 W W W . N A T I O N A L N U R S E S U N I T E D . O R G N A T I O N A L N U R S E 25

• Cover