Birth center founder would forgo salary to keep facility solvent

Mary Carol Akers said she will refuse a salary to avoid jeopardizing the financial health of a proposed birth center in Elizabethtown. She also testified Wednesday that she has sought partnership agreements with doctors outside Hardin County after being denied locally.

Marty Finley

Attorney J. Guthrie True questions his client, Mary Carol Akers, during Wednesday's certificate of need testimony in Frankfort for the Visitation Birth & Family Wellness Center. Akers, a certified nurse midwife, has proposed building the center on Ring Road in Elizabethtown.

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Akers, a certified nurse midwife who practices in Elizabethtown, took the stand as testimony stretched into day three of a certificate of need hearing in downtown Frankfort for the Visitation Birth & Family Wellness Center, proposed for 2813 Ring Road.

Akers said she pursued the center after practicing midwifery services in several hospitals and feeling restrained by stringent rules and regulations she says prohibit the practice of true nurse midwifery and evidence-based medicine.

Akers left her job at Ireland Army Community Hospital on Fort Knox a few years ago to enter private practice and takes part in home births to stay active.

The proposed center will accept only “extremely” low-risk mothers who do not pose medical, surgical or psychological risks. Akers said she also considers social risks.

“Most birth centers don’t take smokers,” she said.

While birth centers provide medications for hemorrhage and antibiotics and allow IVs, they stray from the inducement of labor and use of epidurals, she said.

Hardin Memorial Health opposes the certificate of need request, citing safety concerns and excess capacity. HMH has been joined in the challenge by Flaget Memorial Hospital in Bardstown and Twin Lakes Regional Medical Center in Leitchfield.

Attorneys for all three hospitals worked Wednesday to discredit Akers’ choices for an obstetric consultant and medical director of the center. Neither holds medical privileges at HMH, which is less than three miles from the birth center site.

Akers said she selected Dr. Mark DeMuth, a family practice physician in Elizabethtown, as her medical director and Lexington obstetrician Dr. James O’Neill as her obstetric consultant.

Attorney Ellen Houston said DeMuth does not have credentials to oversee the center or ensure its standard of care is sufficient because he is not specialized in obstetrics and has not participated in a delivery since his medical residency.

Akers said DeMuth’s background could familiarize him with standards of care for low-risk mothers, which would be paired with her expertise in midwifery. Obstetrics training opportunities could assist him if needed.

Akers estimated the medical director would be paid an annual salary of around $50,000 and would have an office at the facility, a portion of which will be designed as clinical space for prenatal care apart from the actual birth center.

O’Neill also received scrutiny from the opposition, who said because he lives in Lexington he’s prohibited from applying for privileges at the hospital. HMH policy requires doctors to live within a 30-mile radius.

Akers was unaware of the requirement but said O’Neill indicated he wants to close his Lexington practice and make a change.

Akers said she approached every obstetrician in Hardin County who would speak to her about the birth center; none of whom agreed to partner.

Ira Dyer, deputy director of Hardin County EMS, wrote a letter to Akers saying he would work with her to provide service for the center if built, but attorneys said Dyer’s letter should not be construed as support.

Houston said Akers could have pursued a sponsoring physician to gain practicing privileges at HMH. If done, she said, Akers could have performed midwifery services at HMH so local physicians could evaluate her level of care.

Akers said she is finished with hospital-based practice and saw no need to take this approach.

“It’s an unnecessary step in the process,” she said.

The center, if approved, will not accept Medicaid patients and is unlikely to offer charity care in its formative years because it is financially impractical, Akers said. Patients without health insurance will be expected to pay upfront, she said.

The center’s business model states Akers’ $80,000 first-year salary would double to $160,000 by year two, but she told the certificate of need panel she does not intend to accept the money during those two years, living instead on her U.S. Army retirement. Akers plans to pay for the center’s construction primarily through private money and business loans.

Roger Cochran, a Florida-based consultant with Morgan Healthcare Consulting, developed the center’s utilization projections. He said Akers will have a built-in cushion by denying the salary, dropping the break-even number of needed births annually from around 150 to 93.

Cochran’s projections indicate 100 births could be expected in year one and 200 the following year, which he defended as reasonable based on his research.

Cochran outlined a 24-county service area broken into primary and secondary regions based on distance. Disputing testimony from consultant Richard Baehr, who argued labor and delivery is inherently local, Cochran believes birth centers are a regional service with a wider service area than a typical obstetrician’s office because fewer birth centers are active in the United States

Cochran said his research indicates women are willing to drive an hour or two to find these services.

“It’s a different service,” he said. “It’s not a hospital-based service.”

He projects half of the births will come from Jefferson County and about 7 percent from Hardin County, which has been framed by opponents as unreasonable because it is unlikely women will drive from Louisville when the home birth rate there is minuscule.

Cochran said roughly 5,000 normal, uncomplicated vaginal deliveries occur annually in Jefferson County, so it is not unreasonable the center could attract a fraction of those patients.

He also disputed Baehr’s assertion a surge in Kentucky’s home birth rate was caused by the economic downturn. He said a large portion of women who pursue home births have higher levels of education and larger personal incomes.

In making his projections, Cochran said he looked to convert home births in the service area rather than hospital births because women who use a hospital are less likely to frequent a birth center. Those who choose home birth already have shown they want an alternative to a hospital, he said.

Marty Finley can be reached at (270) 505-1762 or mfinley@thenewsenterprise.com.