Play Live Radio
Next Up:
0:00
0:00
0:00 0:00
Available On Air Stations

Fired-up Fosston pushes back on Essentia Health's planned OB closure

Holding her infant Saige, Hillary Paulson participates in a public hearing on the closure of labor and delivery services in Fosston on Jan. 30, 2024, in Fosston City Hall.
Chelsey Perkins
/
KAXE
Holding her infant Saige, Hillary Paulson participates in a public hearing on the closure of labor and delivery services in Fosston on Jan. 30, 2024, in Fosston City Hall.

Several area residents gathered in City Hall on Jan. 30 to share passionate testimony on the loss of labor and delivery services at Essentia Health’s Fosston hospital.

FOSSTON — When Hillary Paulson thought her water broke, her husband Ryan drove 80 miles from tiny Trail, Minnesota, to Essentia Health St. Mary’s Hospital in Detroit Lakes.

The 29-year-old first-time mother said the hospital ran tests and told her she wasn’t ready for labor. The Paulsons drove an hour-and-a-half home and made the trip again the next day for Hillary’s scheduled induction — only to learn that her amniotic sac was already ruptured.

With 4-month-old Saige in her arms, Paulson was one of several Fosston area residents who gathered in City Hall on Jan. 30 to share passionate testimony on the loss of labor and delivery services at Essentia Health’s Fosston hospital. A virtual public hearing on the health care provider’s decision drew dozens to watch in person and nearly 150 more online.

“It’s not as smooth as you guys probably would think it would be,” Paulson told four Essentia Health leaders.

“ ... I know they’re all doctors. They know what they’re doing. But I don’t want just some kind of random person that I’ve never met being with me in such an intimate time as delivering a baby.”

The lit sign outside the Essentia Health-Fosston hospital contrasts with pink clouds on Jan. 30, 2024, in Fosston.
Chelsey Perkins
/
KAXE
The lit sign outside the Essentia Health-Fosston hospital contrasts with pink clouds on Jan. 30, 2024, in Fosston.

Like many expectant mothers in the city and surrounding area, Paulson received prenatal care in nearby Fosston — a service Essentia Health vows to continue there, along with postpartum care. But in discontinuing labor and delivery and moving to a “shared care model,” leaders said they’re prioritizing the safety of mothers and babies while acknowledging workforce challenges and a declining population in the rural northwestern Minnesota city.

“Things have changed and evolved, even in recent years, in both birthing and population demographics. And at the same time, the industry has changed from a health care delivery standpoint,” said Callen Weispfennig, administrator of Essentia Health-Fosston.

Read more
Feb. 24, 2024: Man in custody for DWI dies in Crow Wing County Jail
Plus: a bill to expand the taconite assistance area garners strong reaction, and the federal government moves to track how much energy cryptocurrency mining operations use.
Minnesota's senators announce grant for Bemidji airport
The Bemidji Regional Airport will receive funding to improve its passenger terminal.
Man in custody for DWI dies in Crow Wing County Jail
The Crow Wing County Sheriff’s Office reported jail staff discovered the man unresponsive in a jail cell about 9 p.m. Thursday, Feb. 22, 2024.
Feb. 23, 2024: Legislators reach compromise on school resource officer law
Plus: Group behind '2,000 Mules' unable to produce evidence of voter fraud in court; and Hibbing asks residents for experiences with walkability.
Hibbing, Essentia Health seek feedback on city's walkability
The survey will be used to inform future decisions, and responses may help secure grant funding for current walkability issues.
Grand Rapids Legionnaires' outbreak updates to be shared at meeting
Grand Rapids Public Utilities and the Minnesota Department of Health will share updates on the city's Legionnaires' disease outbreak at a Yanmar Arena meeting.
Bemidji's lakeside DQ serves February launch under new ownership
Typically, the lakeside DQ in Bemidji opens in late spring, but this year's warm winter provided a chance to get a frozen treat earlier than usual.
Feb. 22, 2024: Legislature considers stiffer penalties for influencing elections with deepfakes
Plus: Bemidji airport gains federal funding; the DNR lists new prohibited invasive species, including jumping worms; and a community meeting is planned on the Legionnaire's disease outbreak in Grand Rapids.
Beavers on ice? Science Museum visits BSU game to talk ice age rodents
Paleontologists from the Science Museum of Minnesota visited with Bemidji State Beaver hockey fans, lobbying for the giant beaver's induction as a state fossil.
Ojibwe language and culture now in Walker-Hackensack-Akeley curriculum
A round dance in Onigum on Saturday, Feb. 17, is one example of the collaborative work between Walker-Hackensack-Akeley Schools and the Leech Lake Band of Ojibwe.

“Operations, recruitment and resource management are all more complex than they have ever been. And the reality is also that liability risks have changed. ... So not only has the bar been raised, but the stakes have been elevated as well.”

Dr. Mark Thompson, president of Essentia Health West Market, said when it comes down to it, it’s about the mothers and babies.

"They’re our first consideration as we have this conversation around creating safer systems,” Thompson said. “We really want to put our best thinking and resources together in pursuit of safe, reliable mom and infant care.”

Dr. Mark Thompson is the president of Essentia Health's West Market.
Contributed
/
Essentia Health
Dr. Mark Thompson is the president of Essentia Health's West Market.

Fosston city officials see things quite differently. An affiliation agreement between the city and Essentia Health to operate the nonprofit hospital requires it to continue providing core services, including obstetrics. But it’s been more than 600 days since a baby was born in Fosston, starting with Essentia’s “temporary redirect” in June 2022 — originally expected to last through September of that year, according to the original news release.

The contract dispute is headed to arbitration this spring. With Essentia expected to maintain its closure plans, however, city leaders have already made clear their intent to end the agreement and return control to the nonprofit First Care Medical Services as an independent hospital.

"Essentia was not brought into the picture to rescue a failing hospital. Just the opposite,” said Mayor Jim Offerdahl to those in City Hall after the hearing. “ ... What did Fosston get? Fosston got some promises. Those promises have now all been broken.”

Beyond the contract, city officials and residents are skeptical of the conclusions drawn by Essentia Health from data on maternal outcomes and population.

One anonymous online hearing participant said despite the challenges, the provider must uphold its obligation to the Fosston community by continuing to provide labor and delivery services there.

Fosston Mayor Jim Offerdahl speaks during a Minnesota Department of Public Health public hearing Jan. 30, 2024, on Essentia Health's plans to permanently close its labor and delivery unit at the Fosston hospital.
Chelsey Perkins
/
KAXE
Fosston Mayor Jim Offerdahl speaks during a Minnesota Department of Public Health public hearing Jan. 30, 2024, on Essentia Health's plans to permanently close its labor and delivery unit at the Fosston hospital.

“It is Essentia’s responsibility to meet the challenge of making this happen with high-quality services and to continue its contractual commitment, rather than to shirk its responsibility by saying it’s too hard to do,” the comment stated.

“That is, frankly, not an option. ... Fosston is an excellent geographic center between larger cities. It is the ideal place among the various surrounding small towns to be the one place in the area that delivers babies.”

Behind the numbers

Essentia Health leaders pointed to a study showing the risk of serious complications almost doubles in otherwise low-risk pregnancies, when mothers deliver their babies in rural, low-volume hospitals. Fosston averaged 72 births each year between 2017-21 — placing it squarely in the low-volume category.

Complications arise in 8% of all pregnancies and can include conditions such as gestational diabetes or preeclampsia and childbirth complications including eclampsia and sepsis — or more seriously, failure to thrive and death of newborn or mother. Because complications can’t always be predicted, having the necessary resources available during labor can mitigate those risks, leaders said.

"Not only has the bar been raised, but the stakes have been elevated as well."
Callen Weispfennig, Fosston hospital administrator

“Time is of the essence,” Thompson said. “When I go back to kind of opening that hood on these small centers [with] low volumes, for physicians working extremely hard, covering all needs of the health care community and stretched, on call ... They do their absolute best.

“ ... It’s resource issues. No one person can be in multiple places and meet needs at all times. We have to have redundant systems to decrease harm.”

Still, the incidence of severe maternal morbidity — a measure indicating serious or potentially life-threatening maternal health problems — is overall a low number in both rural and urban settings. The same study published in the Journal of American Medical Association’s Health Forum showed less than 0.75% of the 11.5 million births analyzed resulted in severe outcomes in any setting.

People sit and listen in Fosston City Hall during a Minnesota Department of Health public hearing on Jan. 30, 2024, concerning Essentia Health's plans to permanently close its labor and delivery unit in the city.
Chelsey Perkins
/
KAXE
People sit and listen in Fosston City Hall during a Minnesota Department of Health public hearing on Jan. 30, 2024, concerning Essentia Health's plans to permanently close its labor and delivery unit in the city.

In bolstering its point, Essentia Health’s team also listed a survey of hospital leaders published by the JAMA Health Forum. Of those surveyed, 34% lead critical access hospitals like Fosston’s in rural areas, and 65% are in rural counties. When asked to cite the number of deliveries a facility should oversee in a year to maintain a safe level of care, respondents gave a variety of answers, but the median was 200.

Difficulty in attracting doctors of all kinds to rural areas like Fosston means the resource shortage isn’t likely to improve, Essentia leaders said. Dr. Stefanie Gefroh, an obstetrician-gynecologist who serves as associate chief medical officer for Essentia Health West Market, said some open OBGYN positions across the system haven’t been filled for years.

“As you can imagine, life balance — ‘work-life integration,’ people sometimes call it — it is becoming increasingly important, particularly to new grads,” Gefroh said. “So they want to be in a facility where they can share on-call [duties] and not be on call 24/7.”

Even if a new graduate were willing to work in Fosston, the birth volume there is too low for physicians to meet the requirements to become board-certified, according to Gefroh.

“That’s a huge factor that you have to consider when you’re trying to recruit new talent,” she said.

Looking into the future, Essentia Health said the data shows Fosston’s birth volume isn’t likely to increase. The city’s population declined by 9% between 2000 and 2020 to 1,434 residents, according to the U.S. Census. Health care market analysis data prepared by Syntellis shows the number of women of childbearing age in the Fosston area is expected to decline by almost 5% by 2028, while the state as a whole would see a slight increase.

City Administrator Cassie Heide fires a series of questions off to Essentia Health officials during a Jan. 30, 2024, public hearing hosted virtually by the Minnesota Department of Public Health. Fosston city officials opened City Hall to allow residents to watch and participate in the hearing, which covered Essentia Health's decision to permanently halt labor and delivery at the Fosston hospital.
Chelsey Perkins
/
KAXE
City Administrator Cassie Heide fires a series of questions off to Essentia Health officials during a Jan. 30, 2024, public hearing hosted virtually by the Minnesota Department of Public Health. Fosston city officials opened City Hall to allow residents to watch and participate in the hearing, which covered Essentia Health's decision to permanently halt labor and delivery at the Fosston hospital.

“I wish there were more people moving to Fosston. I wish more people came when we were providing OB services,” said Thompson, Essentia West president. “I wish we heard more about jobs and growth from Fosston, to tell a different picture than what we’re seeing in the data and the projections.”

Essentia isn’t alone in making these calculations. Between 2011 and 2021, 267 rural hospitals ceased providing OB services, according to an analysis by health care advisory firm Chartis. Nearly a quarter of those hospitals made the change during the height of the COVID-19 pandemic, marking a dramatic escalation in closures.

Minnesota experienced the greatest loss of rural OB units of all states during that decade, with 22 closures. That includes the hospital in nearby Bagley, which, under Sanford Health ownership, moved its labor and delivery services to Bemidji.

'Big decisions need to be made’

For the Fosston area residents who spoke during the public hearing, the risks associated with the labor and delivery unit’s loss were more tangible. Long drives in the snow and wind. A lack of trust or familiarity in the person delivering their baby. Even the city’s economic future itself.

Aside from Paulson, two other mothers who recently gave birth in the Detroit Lakes hospital shared their stories. One woman described waiting for her husband to come home from work a half-hour away so he could drive her there. But with a history of fast labors, she said the trip put her in a very frightening position.

“I did not feel like my safety was really being prioritized when the doctors basically said, ‘Oh, we hope you don’t have your baby in the car,’” the woman said.

Another recent mom, Kate Moore learned while hospitalized for her C-section that her desire to be sterilized at the same time wouldn’t be possible in Detroit Lakes. The facility’s origins as a Catholic hospital mean that procedure isn’t performed on moral grounds, leaving the woman to undergo a second invasive surgery back home in Fosston.

The main entrance of the Essentia Health Fosston facility as seen Jan. 30, 2024, in Fosston.
Chelsey Perkins
/
KAXE
The main entrance of the Essentia Health Fosston facility as seen Jan. 30, 2024, in Fosston.

City officials and others involved in the task force formed to work on bringing OB care back to Fosston see Essentia Health’s decision as a disinvestment in the region. Hospitals in Bemidji and East Grand Forks operated by other health care systems are located along interstate routes and are closer than Detroit Lakes, meaning women might leave Essentia Health in favor of convenience.

They also see the decision as an about-face by the provider. A May 15, 2023, memo from the Essentia Health West Market executive team to Mayor Jim Offerdahl and City Administrator Cassie Heide said it was “fully committed to resuming OB services in Fosston in accordance with the terms of the affiliation agreement.”

After the hearing, Heide said the trust in Essentia is broken.

“That was a very strong legal agreement, but to the mayor’s point, they don’t care. It’s an agreement they’ve broken,” Heide said. “What other parts of that agreement are they going to break? ... This is why big decisions need to be made.”

Evan Fonder, chairman of the First Care Medical Services Foundation and a task force member, pointed to statistics showing 38 other hospitals with similar patient volumes in the state continue to offer labor and delivery. Fonder said if there were one more doctor in Fosston, the volume would increase. City officials said another doctor had already agreed to come to Fosston, before Essentia Health leaders discouraged them from doing so.

Evan Fonder, business owner and task force member, listens at the Essentia Health-Fosston public hearing on Jan. 30, 2024.
Larissa Donovan
/
KAXE
Evan Fonder, business owner and task force member, listens at the Essentia Health-Fosston public hearing on Jan. 30, 2024.

“Prior to their pause [in 2022], that would have solved the issue,” Fonder said. “ ... This is not a ‘your volume is too low as a region’ [and] this is not an ‘ability to deliver safe care’ question.”

“It’s leadership,” Heide continued. “It’s Essentia leadership in the west.”

With the City Council and mayor already committed to ending their contract with Essentia Health if OB care doesn’t return, planning is underway for what happens next. Leaders said an independent nonprofit hospital, profitable before Essentia’s involvement, would be viable. It would also provide the opportunity for more jobs in the community, as centralized services like human resources would come back to Fosston.

Michelle Landsverk, director of the city’s economic development, said she supports terminating the agreement.

“I think if we do not see these services resumed, to me, it is the beginning of a decline of our community,” Landsverk said. “ ... This is a quality-of-life issue. And if we want people to live here, if we want people to work here, they need health services.”

Chelsey Perkins spent the first 15 years of her journalism career as a print journalist, primarily as a newspaper reporter and editor. In February 2023, she accepted a role as News Director of KAXE in Grand Rapids, Minnesota, where she's building a new local newsroom at the station.
Larissa Donovan has been in the Bemidji area's local news scene since 2016, joining the KAXE newsroom in 2023 after several years as the News Director for the stations of Paul Bunyan Broadcasting.