SIERRA VISTA — Huge increases in doctors’ malpractice insurance premiums forced Copper Queen Community Hospital in Bisbee to shut down its Obstetrics Department in January 2002, causing all expectant mothers to be referred to Sierra Vista for prenatal care and births.

Copper Queen’s closure came on the heels of the Douglas hospital’s — Southeast Arizona Medical Center’s — decision to close its obstetrics department in March 2001, also citing physicians’ inability to pay skyrocketing malpractice insurance rates.

“Arizona Family Care Associates contacted us and said that due to the increase in malpractice insurance rates, our doctors who were under AFCA would no longer be doing obstetrical services,” recalled Jim Dickson, chief executive officer at Copper Queen Community Hospital.

The two closures left Sierra Vista Regional Health Center as the only hospital in Cochise County with an obstetrics department, which has translated to long drives for some expectant moms when it’s time to deliver. Women living in the southeastern part of the county must travel between 50 and 100 miles to deliver their babies in Sierra Vista.

“The drives are inconvenient, but women are learning to plan ahead,” said Melinda Sallard, someone who knows a little about child births and the inconveniences of long drives.

Sallard was expecting her third child in 2002 and was halfway through her pregnancy at the time Copper Queen Community Hospital’s obstetrics department closed. A resident of Double Adobe, which is an unincorporated community between Bisbee and Douglas, Sallard’s prenatal care started in Bisbee, but was shifted to Sierra Vista once her hospital no longer provided the care.

It’s about a 50-minute drive from Sallard’s home to Sierra Vista.

Around 1:30 in the morning, Melinda started having contractions. She woke her husband, Francisco Sallard, and the two were on their way to Sierra Vista.

But the Sallard’s baby Susana couldn’t wait.

“There I was, in the front seat of our 1979 Impala at 2 in the morning, in the dark, delivering a baby while my husband kept his foot on the accelerator, racing to the hospital,” Sallard said as she relived the evening’s events.

Sallard wrapped Susana in a sweater to keep her as warm as possible during the drive to the hospital. Once they arrived, medical staff rushed to the Sallards’ car and cut the baby’s umbilical cord.

Mom and baby were fine.

When it came time to deliver her fourth baby, Sallard’s doctor suggested inducing labor, which allowed for a much more predictable delivery.

“It’s especially advised for mothers who have had other babies,” Sallard said. “After my second child, it was obvious my deliveries were fast. Dr. (Kenneth) Kacenga was my obstetrician during my fourth pregnancy and he recommended inducing labor, which really was a good idea in my case.”

Kacenga, who is a board certified obstetrician and gynecologist, has been practicing in Sierra Vista for 24 years.

“Every year, there are women who have babies on their way to the hospital,” the doctor said. “There are those who know the baby is coming fast and they’ll go to the nearest hospital, sometimes in Douglas or Bisbee, and deliver there. And babies have been born in the car as close as Fort Huachuca.”

It’s not unusual for obstetricians to recommend inducing labor.

“We do that frequently, particularly in cases when women have already had one or more babies and a history of fast deliveries,” Kacenga added. “We induce them a little early if their cervix is dilated.”

Once Sierra Vista Regional Health Center became the county’s only hospital delivering babies, the facility expanded its maternal/child unit as part of a much larger remodeling and expansion project. More birthing rooms were added, equipped with specialty beds, comfortable chairs designed for a sleeping guest, color televisions with cable and large windows to create a homey atmosphere for the expectant moms and family members.

 In addition, all rooms are equipped with state-of-the-art fetal monitors that allow observation from the nurses’ station.

About 1,400 babies are born at the hospital every year, a number that is expected to increase as the community continues to grow.

Even with the additional beds, private birthing rooms and all the upgrades, there are times when the maternal/child ward is full and patients overflow to the medical/surgical department.

“It’s unusual, but it does happen at times,” Kacenga said. “You never know what to expect when it comes to deliveries. We have our slow days and we have our extremely busy times.”

Kacenga also spoke about the hospital’s plans for building a new women’s center on the hospital’s east campus off Highway 90. As a member of the project’s planning committee, Kacenga said he’s excited about the new center and what it means for the area.

Dickson said there are no plans for bringing obstetric services back to Bisbee and Douglas.

 “It’s because the cost of malpractice insurance has become prohibitive for physicians in communities that size,” Kacenga said. “As an obstetrician, I’m paying $75,000 a year in malpractice.”

Bisbee and Douglas simply don’t have the patient numbers to support that kind of outlay.

“Tort reform would be a huge advantage for this state,” Kacenga added. “States that have instituted tort reform have experienced a huge influx of physicians. Colorado is one example. Furthermore, it’s becoming more and more difficult to recruit physicians in Arizona.”

Kacenga pointed to the area’s OB/GYN pool, saying new physicians are simply not interested in working in Arizona.

“Our doctors are aging, and we’re not finding young physicians to replace them when they retire,” he said. “Right now our youngest obstetrician is 48. We haven’t had a young obstetrician come into the area in years.”  

Doctors, he added, are not interested in areas where they’re expected to work 50 percent more, while making less money. A recent American Hospital Association survey indicates that a third of physicians practicing in the United States are older than 55 and will likely be retiring in the next 20 years. While health care professionals and policy makers scramble to come up with creative solutions for dealing with the health care system’s physician shortage, it’s a bit disconcerting to discover that most hospitals and medical practices across the country are actively recruiting doctors.

“Recruitment is one of our toughest battles,” Dickson said.

HERALD/REVIEW reporter Dana Cole can be reached at 515-4618 or by e-mail at dana.cole@svherald.com.

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