For the second time in less than a year, natural birth centers around the state are facing closure by the S.C. Department of Health and Environmental Control due to a difference of opinion about how to interpret birth center regulations.
In a March 6 letter to the Charleston Birth Place, Gwen Thompson, chief of DHEC's Bureau of Health Facilities Licensing, writes that the birth center has until mid-June to demonstrate its compliance with S.C. Code Section 44-89-60(3) and Regulation 61-102 Sec. D.6(a)(1), which states that "a physician must be on call and available to provide medical assistance at the birthing center at all times that it is serving the public." After the mid-June facility visits, SCDHEC "may take enforcement action immediately after the Report of Visit is generated" if a facility in question "has repeated noncompliance for previous citations or there is an imminent concern for patient safety," according to an SCDHEC spokesman.
A little history: Up until September 2013, SCDHEC allowed the Charleston Birth Place and other natural birth centers around the state to operate without a doctor physically setting foot on birth center grounds. At CBP, for instance, two doctors are on call at all times and can be reached via cell phone to meet laboring mothers at nearby Trident Medical Center (which is about 400 yards from CBP's front door) if complications arise during childbirth.
That all changed after tragedy struck at a Piedmont birth center on Aug. 30, 2013. According to court documents obtained by the Charlotte Observer, two midwives at the Carolina Community Maternity Center in Fort Mill sat with a pregnant woman as she labored through the night and day, eventually transporting the woman to the hospital in their own vehicle without consulting a physician after the infant's heart rate dropped in utero. Hospital employees performed a Caesarian section, but the infant was born without a heartbeat and could not be revived.
On Sept. 6, 2013, birth centers around the state received letters notifying them that they were in violation of Regulation 61-102, which SCDHEC interpreted to mean that "there is an on-call physician who, if called, would be able to come to the birthing center to provide medical assistance." The wording of the regulation hadn't changed, but the interpretation and enforcement of it had.
When word got out about the potential threat of closure at the Charleston Birth Place, parents and activists around Lowcountry rallied to the birth center's cause, writing letters to state regulators, signing petitions, and staging a rally in downtown Charleston with hundreds in attendance. Finally, at the end of November, a spokesperson for SCDHEC said that birth centers were not in danger of closing. "If they are out of compliance, they have six months to get into compliance or ask the General Assembly to change the law," she said.
That six-month deadline is fast approaching, and the Charleston Birth Place has not changed its practices. Instead, CBP Director Lesley Rathbun has been meeting with DHEC officials, Gov. Nikki Haley's office, and state lawmakers in an attempt to update the law, which was written in 1976. A bill currently being considered by a state House committee, H.5002, would delete the on-call physician requirement, require that birth centers set up transfer guidelines for moving high-risk deliveries to a hospital, and also require that all birth centers be accredited based on standards from the American Association of Birth Centers. (Rathbun is the current president of the AABC.)
The bill currently has only one sponsor, Rep. Jenny Horne (R-Dorchester), and it was introduced late in the legislative session on March 27. In a letter seeking support, Rathbun asks South Carolinians to contact Gov. Haley, SCDHEC Director Catherine Templeton, and state legislators to express their support for H.5002.
"We plan to use any legal means necessary to fight DHEC's mid-June deadline to avoid facility closure of all of South Carolina's birth centers," Rathbun writes. "We will take this issue to the nation's highest courts if necessary to ensure that birth centers remain open and are able to grow with consumer demand."
Here's a full statement on the upcoming birth center visits from SCDHEC spokesman Jim Beasley:
On or around mid to late June, the Department will conduct routine follow-up visits to licensed birthing centers to determine compliance with existing law.
When the Department conducts a follow-up visit to a facility, it generates a Report of Visit, placing the facility on notice of any items found not to be in compliance with applicable statutes and regulations. At the same time, the Department asks the facility to provide information as to how and when the items will be corrected. Facilities generally have 15 days from the date of the Report of Visit to submit the information to the Department as to how they will correct any items noted in the report.
In cases where the facility has repeated noncompliance for previous citations or there is an imminent concern for patient safety, the Department may take enforcement action immediately after the Report of Visit is generated.
The Department will review a facility's response to a Report of Visit, including its plan to correct any items of noncompliance, prior to deciding whether or not to take enforcement action against a facility. The Department may deny, suspend, or revoke a license, or issue a monetary penalty, for a violation of law.
If the Department takes enforcement action against a facility, the facility may appeal that action by requesting a final review with the Board of Health and Environmental Control. If a facility wishes to contest the result of a request for final review by the Board, it may then file a contested case with the Administrative Law Court.
Except for emergency orders, Department decisions taking enforcement action against a facility are automatically stayed upon the filing of a contested case with the Administrative Law Court.