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Alternative birth center fails to demonstrate need

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Editorial: Aug. 11, 2013

ISSUE: State rejects birthing center request
OUR VIEW: Process requires proving need

After examining a business plan, taking testimony from opponents and advocates and analyzing all that data, the state review panel rejected a certificate of need application for the Visitation Birth and Family Wellness Center proposed for Elizabethtown.

Proposed by a certified nurse midwife who offered to forego salary during the facility’s infancy, the birthing center would have provided an alternative to hospital labor and delivery facilities.

Health care does not operate in America’s free-market system. In order to operate in Kentucky, a certificate of need is required. A key element of that process is demonstrating the need.

An expert witness in health planning who drafted utilization projections for the center forecast an increase in home birth rates in Kentucky from 0.9 percent of all births in 2009 to 1.2488 percent by 2014. That’s about the national average. He applied that factor to a service area covering more than 20 counties. No retailer and no health care provider in Hardin County draws from such a broad area.

The figures provided by the applicant, midwife Mary Carol Akers, indicated she expected to draw 90 percent of Jefferson County home births as patients.

As the lone facility of its type in Kentucky, the draw might be far greater than the normal regional commuting patterns but the marketing figures do seem out of touch. The burden of proof does rest with the applicant.

The 34-page report detailing the state’s decision included the suggestion that Elizabethtown might not be the ideal location for her facility — particularly if it is dependent on significant support from Louisville’s population.

While supporters of birthing alternatives are vocal in their support of Akers, elements of her business plan did not meet the need aspect of the certificate.

Another aspect of this certification process is a tendency toward the status quo. That’s natural because it is designed to prevent against a proliferation of medical facilities, health services or major medical equipment which could raise the cost of health care or challenge quality.

Health care is not an element of the free market system. Because consistent high quality and positive outcomes always are anticipated, the whims of economic pressures and business expediency are offset by government regulators. That means what already is in place has a favorable position when even a tiny competitor wants to enter the scene.

Three area hospitals providing traditional birthing services argued against the center. While expressing concern about unexpected emergencies, the main argument was one of unnecessary duplication. The hospitals said the birthing center’s impact on its revenues would be negligible. In a sense that too challenges the need and viability of Akers’ proposed facility.

The Visitation Birth and Family Wellness Center definitely has its advocates and they are highly motivated. A free-standing facility that would serve low-risk expectant mothers in a home-like setting is appealing to some expectant mothers.

Midwives and doctors need to find a way to collaborate to educate parents so they can make a wise healthcare decision, balancing a respect for the parents’ wishes and reasonable precautions for the child.

Across the country, birthing centers are a viable option. Facilities exist in neighboring states and some are said to thrive. Expectant parents in Kentucky deserve that option.

Akers is researching options regarding an appeal of the state decision but it will require more than a second hearing or legal review. It still seems that this matter could be resolved for all concerned with more realistic business projections plus some cooperation between midwives and doctors.

This editorial represents a consensus of The News-Enterprise editorial board.