MaineHealth Said It Studied the Alternatives. It Would Not Say Which Ones.

On August 8, MaineHealth confirmed it will close the labor and delivery unit at Miles Hospital in Damariscotta in December, the only such unit in Lincoln County, Maine ^[1][2]. It confirmed that after rebuffing a community coalition that offered to fund an independent study of alternatives, and after appeals to delay one to two years from more than 70 bipartisan legislators, Governor Janet Mills, candidates for governor, medical staff, local businesses and organized community opposition that drew national coverage ^[3][4][5].

MaineHealth's stated rationale is that the closure was not financially driven but reflected staffing concerns and low delivery volume ^[6]. It also said it had examined alternatives, but provided no details, and it did not respond to Forbes contributor Judy Stone's interview request or questions, referring her to its website ^[7][8]. That is the asymmetry operators should notice. An organization asking to be believed on the strength of an internal options review it will not describe, while turning down an externally funded review it would not have had to pay for, is not managing a consultation. It is managing a schedule.

Two people quoted by Stone read it the same way. Dr. Stephanie McCullough, a family practice physician who does deliveries at the unit, said the outcome was predetermined: "It's very clear that this was a strategic plan, and I don't want it to be blamed on a lack of qualified providers. Because again, we have excellent quality indicators for our unit. We have incredible patient satisfaction" ^[9]. Lizzy Anderson, MPA, told Stone the timing was likely deliberate, falling when the legislature was out of session ^[10].

The financial backdrop exists whether or not it drove the decision. Citing the Portland Press Herald and research from the Health Care Cost Institute, Stone reports Maine private insurers pay $14,630 for a vaginal delivery and $23,595 for a cesarean, while MaineCare pays $4,607 and $6,847 ^[11][12]. That is roughly 3.2 times and 3.4 times more for the same births, depending on payer ^[13]. MaineCare also covers nurse-midwives but not midwives without a nursing degree ^[14].

The volume-and-staffing problem has known workarounds, which is what makes the refusal to detail the analysis load-bearing. Some states pay rural birthing hospitals a $1,500 Medicaid add-on per delivery ^[15]. Harold Miller of the Center for Healthcare Quality and Payment Reform has proposed a standby capacity payment from insurers to cover the fixed cost of maintaining staffing regardless of birth counts, telling the New York Times, "we don't fund fire departments based on how many fires there are every year" ^[16]. Affiliating with an HRSA Teaching Health Center graduate medical education program brings supervised residents, and working through a Federally Qualified Health Center puts malpractice coverage under the Federal Tort Claims Act ^[17]. In Shattuck, Oklahoma, a certified nurse midwife handles low-risk births while OB-GYNs rotate in weekly for high-risk cases and surgery ^[18]. Texas plans maternal simulation training for emergency room physicians at 11 rural hospitals, most without obstetrics ^[19].

Miles is the twelfth maternity unit in Maine to close in a decade and the fifth in the past year ^[20], meaning about 42 percent of the decade's closures happened in the last twelve months ^[21].