Originally published by Lilo Stainton, NJSpotlight.com
An embattled New Jersey hospital continues to lead the nation with an extremely high rate of early-elective deliveries in cases where it is not medically necessary — a procedure that can cause long-term health issues for the mother and baby — according to a national report on maternal health released Tuesday.
Meadowlands Hospital and Medical Center induced labor in more than 60 percent of the births it handled in 2016, data from the Leapfrog Group showed, far beyond the target rate of 5 percent and much higher than any other Garden State hospital included in the study. (Hackensack UMC Mountainside, with a 13.8 percent EED rate, was the second highest; Englewood Hospital and Medical Center ranked third in New Jersey with an 11 percent EED rate.)
But the findings also show the level of chemically induced non-emergency births at Meadowlands Hospital is down from the nearly 72 percent it reported to Leapfrog in 2015 and 2014; MHMC also had the nation’s highest confirmed levels of EED in those years. The nonprofit watchdog group collects data not available elsewhere directly from hundreds of hospitals nationwide, including 50 in New Jersey, to assess a host of quality metrics and help patients make good healthcare decisions.
“To have these high numbers is still a problem,” said Linda Schwimmer, president and CEO of the New Jersey Health Care Quality Institute, who has raised concerns about Meadowlands’ performance in the past.
Early-elective deliveries often done to accommodate doctors
Early-elective deliveries — one of several procedures considered in the report — are often done to help accommodate the doctor’s schedule, or for the mother’s convenience, but can lead to respiratory diseases, including pneumonia, and even infant death, according to the Leapfrog report, which also examined rates for non-emergency cesarean sections and episiotomies, a surgical procedure to enlarge the birth canal. Nationwide, Leapfrog found EED rates at an all-time low, but while the numbers for C-sections and episiotomies are also dropping, there remains room for improvement.
The findings for Meadowlands Hospital raise questions about the institution’s “AmeriMama” campaign designed to entice Russian women to travel to New Jersey and give birth at the for-profit facility to ensure their children can obtain American citizenship, as detailed in a series of reports by NJ Spotlight last summer. The process involved visa and travel restrictions that experts suggested could contribute to the need to carefully schedule these births, potentially driving up the hospital’s EED rate.
Meadowlands officials declined to respond to a request for comment on the Leapfrog findings, but an attorney Anthony K. Modafferi III, with the Agresta Firm in Englewood, who said he represented the hospital, said he would file suit against NJ Spotlight and others if it filed a story “that advances untrue statements couched as fact.”
“We are aware of your participation in feeding a narrative critical of my client,” Modafferi wrote, closing with “BE GOVERNED ACCORDINGLY,” in capital letters.
DOH, Meadowlands Hospital officials met to review protocols
While the state Department of Health has said it does not regulate hospital marketing campaigns like AmeriMama — which appears to have had only minimal success — it does monitor quality concerns and issue annual hospital licenses. Questions about the high EED rate and other maternity practices at the hospital prompted health department officials to meet with Meadowlands Hospital leaders last summer to review the facility’s OB/GYN protocols and “urge them to improve maternal and child health outcomes,” DOH communications director Donna Leusner said.
Meadowlands Hospital has paid millions of dollars in government fines for tax violations, hundreds of thousands to state regulators for administrative violations, and has been cited for multiple health and safety violations. In September, an administrative judge found the hospital had violated dozens of federal labor laws and required it to pay former and current hospital employees lost benefits believed to top $2.5 million.
At the same time, a select group of owners appears to have been paid at least $9 million in dividends for their investment in the struggling for-profit venture they purchased in 2010, existing reports show. They have also funneled another $8 million to companies they control in exchange for medical equipment, computer systems, and other goods and services used by MHMC.
Despite these difficulties, in July Yan Moshe, a New York resident who runs a plastic surgery center in Hackensack, submitted an application to purchase the facility for $12.2 million, some $5.4 million less than it sold for in 2010. Leusner said Moshe has since provided additional information in response to questions from the DOH and the department is now reviewing those submissions. Hospital officials have yet to provide annual financial reports for recent years, as required by law.
Leapfrog’s “2017 Maternity Report” revealed that efforts to reduce EED numbers has been a “tremendous success” nationwide, with overall rates dropping from 17 percent in 2010 to 1.9 percent last year. Episiotomies fell nationwide from 13 percent in 2012, when first measured, to 9.6 percent last year; Leapfrog has also set a 5 percent target for this procedure. In New Jersey, Jersey City Medical Center had the highest number of episiotomies (37.1 percent), followed by Cape Regional Medical Center, in Cape May Courthouse, (35.4 percent), Holy Name Medical Center in Teaneck (32.7 percent), and Meadowlands Hospital (30.9 percent).
Rate of C-sections has declined nationwide
However, the data for C-sections — which focused on low-risk, first-time mothers who were not told by a doctor they needed to undergo the surgical procedure for medical reasons — showed that the procedure had declined from 26.4 percent of all births in 2015 to 25.8 percent last year, but still hovers above the Leapfrog target of less than 24 percent. Leapfrog said statewide averages for C-sections were highest in the northeast and southern regions and ranged from 17.1 percent in New Mexico to 32.1 percent in Louisiana.
High C-section rates have been a persistent problem for New Jersey hospitals, although numbers have started to decline in recent years. Data collected by the state health department suggests the rate of all C-sections — both medically required and by choice – has hovered between 36 percent and 37 percent in recent years, down from more than 38 percent in 2009.
Leapfrog reports in recent years, which focus only on low-risk, non-emergency C-sections, suggest 28 percent of these procedures are performed as a result of doctor or patient choice. The “2017 Maternity Report” found that Hackensack University Medical Center (with a 42.8 percent C-section rate) and CentraState Medical Center, in Freehold (with 42.2 percent) led the New Jersey facilities in this category; Meadowlands Hospital, with 41.3 percent C-sections, was third.
“Once you go in that direction it’s hard to reverse course,” NJHCQI’s Schwimmer explained, noting that some 90 percent of women who have C-sections for their first child will be forced to deliver future kids the same way. “You start to create a long-term trend.”
Leusner said this dip reflects an ongoing campaign by the DOH and partners at the New Jersey Hospital Association and the March of Dimes, which is focused on maternal child health. The state has also invested $13.5 million in grants to community health agencies and other partners to help them educate women about the importance of a full-term pregnancy and connect them in prenatal care.
“Babies born just a few weeks early can have more health problems than full-term babies — so every week matters and that is why the Department of Health has taken a leadership role on this critical issue,” Leusner said. This effort has also helped cut the state’s EED rate in half since 2011, she noted.