More Facts About Manistee Hospital’s OB Closure


Manistee Hospital’s leadership knows you have concerns. Closing the OB unit was not an easy decision, and it was made only after a thorough and thoughtful review. Unfortunately, the service is simply not sustainable in Manistee. 

We expected that the community would be emotional about the news. Unfortunately, some are taking their frustrations out on our staff and family members of people associated with Manistee Hospital. Please be considerate of the people trying to care for our community. This was not their decision. Remember that our employees are dealing with this news personally, too. 

We have seen some misleading and erroneous statements posted online. The following list aims to correct some of the misinformation. 

Munson Healthcare closed Manistee Hospital’s OB unit.
The decision to close maternity services in Manistee was made locally. Munson Healthcare did provide support and facilitated our collaboration with Cadillac Hospital. 

Munson Healthcare is making decisions to benefit shareholders.
Munson Healthcare is a non-profit health care system and does not have shareholders.

Munson Healthcare and/or Manistee Hospital are only looking at the bottom line.
Finances must be considered whenever operational decisions are made, but they are not the only factor. Decreasing volumes, increasing operational losses, the departure of a physician, and the availability of services elsewhere all factored into the decision.

Manistee Hospital has been eliminating jobs/services since it was purchased by Munson Healthcare.
No services have closed because of our integration with Munson Healthcare. In fact, we have strengthened services, bringing in more visiting providers, creating a better continuum of care, and improving efficiencies. As in any organization, we regularly evaluate needs and change staffing accordingly, which sometimes means positions are changed or eliminated. Such decisions are made locally.

Plenty of babies are born at Manistee Hospital.
Deliveries at Manistee Hospital have decreased from around 200 to an expected 150 this year. In March we had only six deliveries. We know many patients of Dr. Fuller’s patients will want to continue care with her, so we expect that number to decrease by as much as a third next year. 

Manistee County’s population is aging. Fewer young families are moving to the area, and many young adults leave to pursue educational or career opportunities. According to the US Census Bureau, 25% of Manistee County residents are age 65 or older (for comparison, nationally 16% of the population is in that age range). Women are also having fewer children overall. The birth rate in Manistee County is 8.2 per 1,000 population (the national rate is 11.8, down from 14.7 in 2000).

Dr. Fuller is leaving because the OB unit is closing.
Dr. Fuller announced her intention to leave Manistee Hospital months ago, before the decision to close OB in Manistee was made. Losing one of our three ob/gyns did factor into the decision. Covering call for OB services 24 hours a day, 7 days a week, 365 days a year is not feasible with the remaining two physicians. Plus, we expect to lose as much as a third of our current patient volume as women choose to continue care with Dr. Fuller at Spectrum Ludington.

OB doesn’t really lose that much money.
Hospitals are not well reimbursed for deliveries, and most do not make money on the service. To break even, Manistee Hospital would need to have about 350 births a year, a figure we’ve never seen. We’ll lose over $750,000 on OB in fiscal year 2019. Given the decrease in births we expect next year, plus the need to cover physician call with temporary providers if we were to continue coverage, we estimate we’d lose over $1.2 million.  

The hospital could downsize for the current number of births and keep OB.
Babies don’t arrive on a schedule, and we cannot reduce staffing and continue to provide care. At a minimum, we need to maintain a physician on call around the clock every day, as well as two labor and delivery nurses on the unit, even when we do not have laboring moms in-house. Covering the department that frequently would put a huge burden on two physicians and a reduced nursing staff. Using temporary staffing to cover the gap comes at a tremendous cost. 

Manistee Hospital just spent millions on a new building; now they’re closing OB to pay for it.
The Manistee Community Health Center was a long-planned – and much-needed – capital project. Closing OB was based on volume and operational performance, not capital expenditures. The additional office space and rehabilitation facilities were needed to meet growing patient volume in these areas.

The hospital should provide OB no matter what it costs.
Some hospital services do not make money, and we rely on those that do to keep the organization in a good financial position. However, we cannot continue to suffer a loss of that magnitude each year when the demand for the service continues to decline. To remain sustainable as an organization and provide needed services, we need to be good stewards of our resources.

As a small hospital in a rural community, we simply cannot offer every possible service. We provide the services that are feasible and partner with other institutions to help area residents get the care they need. This is one way our relationship with Munson Healthcare helps our patients. According to a report by the US Government Accountability Office, 64 rural hospitals closed between 2013-2017. That was more than twice the rate of the previous 5-year period. We want Manistee Hospital to remain sustainable for years to come. 

The hospital should close a different service.
All the services we provide are vital to members of our community. We understand labor and delivery is very personal for many, but all the work we do saves or improves lives every day. 

Making women travel to another hospital is unsafe.
Pregnant women will receive guidance on what to do when they believe they are in labor. This may include heading to the hospital earlier in labor if their delivering hospital is farther from home. While some labors are very short, most moms will have plenty of time to reach another hospital. Even with an OB unit, we have the occasional surprise parking lot, emergency room, or nurse-attended delivery. The emergency room should not be considered a birth location. Our staff are prepared to handle emergencies and assess pregnant women, but they lack the amenities and specially trained staff of a birthing unit.