Golden Valley decision to cut obstetric services at Modesto hospital sparks an uproar
Golden Valley Health Centers has created an uproar by changing policy to end labor and delivery services for its low-income patients at Doctors Medical Center and by reassigning three obstetricians to work primarily in clinics.
The safety-net provider, with 47 clinics in Stanislaus, Merced and San Joaquin counties, sent termination letters effective April 30 to doctors Christopher Grover, Lloyd Lee and Kevin Rine, who care for pregnant women in Golden Valley clinics, deliver patients’ babies at the hospital and also perform gynecologic surgeries.
Golden Valley has proposed new agreements with the trio that would require them to work 40 hours weekly in its clinics.
Critics of the decision said obstetrics is a continuum of care and high-risk patients should have access to their obstetricians through labor and delivery, not be handed off to doctors unfamiliar with their complex medical issues.
Health professionals said the decision will eliminate Golden Valley’s hospital-based service, which has worked well for years. They’re concerned the cuts will harshly impact low-income women, who have higher rates of pregnancy complications and more challenges in getting access to health care.
Golden Valley, serving nearly 200,000 patients per year, has become a leading source of care for Medi-Cal patients in the region. Its obstetric patients often struggle with “high-risk” pregnancies, meaning they may have a history of miscarriage or need care for preeclampsia, untreated diabetes, preterm labor or other complications.
Golden Valley has been talking with administrators at DMC about making arrangements for laborists and on-call obstetricians to handle the labor and delivery duties in the hospital after April 30. The changes at the hospital only affect obstetric patients of Golden Valley Health Centers.
“On so many levels, this is wrong,” said Dr. Susan Podolsky, a laborist at DMC who assists the obstetricians. “I have to raise the question — is this patient abandonment? It makes no sense and it’s frankly abusive to women of color and folks on Medi-Cal.”
Podolsky added: “There is a simple fix to this, and that is not to do this.”
A Golden Valley official said Monday the Merced-based organization is placing a priority on clinic services, as patient demand has grown for obstetric services since the COVID-19 pandemic.
“We believe it makes sense for the hospital to be responsible for labor and delivery services,” said Dr. Eduardo Villarama, chief medical officer for Golden Valley. “That is their expertise. Our expertise is in the clinics.”
Villarama said the three obstetricians are needed in the clinics and, under the new agreement, would see clinic patients from 8 a.m. to 5 p.m. five days a week, or 10 hours in four days. After those hours, they could deliver babies or perform nonurgent OB-GYN surgeries at the hospital.
In addition to a surge in patient demand that started after the pandemic ended in 2023, Villarama said, the volume increased after Golden Valley took over obstetrical services from the county last year at two clinic sites: McHenry Medical Office and Paradise Medical Office.
“It’s hard to recruit new obstetrical providers to join the workforce,” Villarama said. The medical officer said in an interview he didn’t have data on maternity care visits, but said most obstetric patients coming through Golden Valley are considered high risk.
Doctors Medical Center released a statement: “Golden Valley Health Centers have been a long-standing partner in providing access to obstetric care and we will continue to collaborate with them in serving our communities. It is important to note that Doctors Medical Center will continue to provide high-quality obstetrics and neonatal care without disruption.”
The three obstetricians did not comment or could not be reached. The Modesto Bee learned that several physicians airing concerns about Golden Valley’s decision will send a letter to the hospital board of directors.
Is the hospital program in the red?
Nurse Practitioner Maria Obispo, who assists the Golden Valley obstetricians at DMC, said the doctors handle as many as nine to 12 births a day. Some of the patients are healthy mothers with normal pregnancies, while others are “high risk” due to complicated pregnancies. Some require C-sections and some are homeless.
Obispo said that two weeks ago, Golden Valley eliminated her hospital position and offered her a new job requiring her to work only in the clinic. She said the head of Golden Valley’s obstetrics department explained the decision by saying Golden Valley’s program at DMC loses money.
“Golden Valley is nonprofit,” Obispo said. “So what does that matter? As long as the bills are paid and patients are taken care of, that’s all that matters. ... These patients are the ones who are going to suffer.”
Obispo said she won’t accept the new position working only in the clinic. “I have worked too hard to get where I am and then to go backwards,” she said.
Dr. Silvia Diego, a Modesto physician and former chief medical director for Golden Valley from 1997 to 2014, said the decision is a serious misstep and called it a travesty for underserved patients. Diego said she worked with Grover to develop the hospital program when she was with Golden Valley.
“Now they propose to destroy it? For what purpose?” Diego asked. “Have they not stopped to think of the consequences for the babies, for the moms and for the community at large?”
Golden Valley receives federally qualified health center funding that’s far greater than historically meager Medi-Cal reimbursements, which often are cited as the reason private doctors don’t accept Medi-Cal patients. Proposition 35, touted as an historic investment in Medi-Cal, is expected to increase funding for those services since it was approved by California voters in November.
Golden Valley’s obstetrical program at DMC has handled 2,000 deliveries and up to 1,000 gynecological surgeries per year. Diego, who operates Family First Medical Care, suggested that reassigning the hospital-based obstetricians will give Golden Valley more outpatient visits and more revenue from that source.
But that’s assuming the three obstetricians stay with Golden Valley and don’t follow other opportunities.
Local OB-GYN groups are stretched thin
Diego said her primary care practice will likely see more pregnant patients because of Golden Valley’s reorganization. She said she refers women with pregnancy complications to an OB-GYN group, which is already stretched thin.
“The problem is the community has been strapped for obstetricians for awhile,” Diego said. “Who is going to pick up the slack in the hospital? I have no idea what they intend to do.”
If Golden Valley is determined to stand by the decision, Podolsky said, it should accommodate currently pregnant women who will need hospital care. “It needs to be phased in, and no one has come to the table trying to work out a plan,” Podolsky said. “They just want to do it.”
Villarama said Golden Valley has been talking with hospital administration about the transition for six months. Golden Valley is not able to continue support for billing and malpractice insurance for the hospital services, he said.
“It’s more about staff resources to sustain our model for outpatient services,” Villarama said.
Villarama agreed a continuum of obstetrics care from early pregnancy to labor and delivery is the ideal model. But it’s not always a realistic expectation in the Central Valley with its finite resources, he said.
“We are fully committed to women’s health,” Villarama said. “We are furthering our partnership with the hospital and Health Plan of San Joaquin to come up with a good transition plan for our patients.”
