EQUAL ACCESS TO HOSPITAL DOORS IN South Carolina

Midwives are demanding EQUAL ACCESS TO HOSPITAL DOORS and a SC statute to protect the profession. Since November, 2017, the Midwifery Advisory Council and other midwife organizations have been urging South Carolina's Department of Health and Environmental Control (DHEC) to repair dangerous errors in a hospital regulation. Over the past three years, midwives have worked diligently to resolve the issues of being denied Equal Access to Perinatal Levels of Care. In addition to streamlining and expediting care in the event of an emergency, adding the midwives to the Levels of Care would automatically give midwives and birth centers access to consultative, outreach, support services and professional continuing education.

DHEC continues to delay making changes to a regulation that does not give midwife patients equal access the levels of perinatal care and forbids level II hospitals from accepting ‘outborn’ babies. In short, DHEC updated hospital regulation 61-16 and listed every maternity care provider in South Carolina EXCEPT midwives and birth centers (including prison infirmaries). ALL other maternity providers get streamlined care when an emergency occurs, but hospitals are only required to give midwife patients minimal EMTALA emergency room access (Emergency Medical Treatment & Labor Act).

Additionally, the negligent regulation is in direct conflict with SC 2020 Appropriations Act Part 1B SECTION 34 - J040 - 34.46 which requires that ALL hospitals act in good faith to coordinate transfer agreements with EVERY midwife attended Birth Center within a 50 mile radius. Freedom of information requests made to DHEC, revealed that EVERY SC Licensed birth center was advised of their requirements regarding the Act each year since 2015, but that DHEC had never contacted any of the hospitals regarding the same compliance. Such delays in care could mean the difference between life and death, but DHEC continues to make excuses for failure to update their regulation. It has been three years since the Midwifery Advisory Council (MAC) first officially notified DHEC of their oversight.

Lori Gibson, Licensed Midwife and MAC Chairperson, poignantly expressed her concerns regarding DHEC’s lack of action,

“When you’re providing care to women and babies and if we’re getting turned away at hospital doors because they don’t see us as a provider; that’s an issue. Some children that have been turned away at the door are now two or three years old… since we’ve been working on this.”

In June 2018, after being informed of the issue, Governor McMaster’s office through Cindy Ledbetter, Office of Ombudsman, created an Intranet Quorum to resolve the error (Casework #: 809918). Initially DHEC responded favorably. Bently White Esq., Counsel for DHEC Health Regulations addressed the error in an email; “We want to ensure a holistic solution for addressing perinatal levels of care that involves the relevant parties. Our goal is to bring together you and all of the other stakeholders for productive dialogue on how best to affect changes based on best practices… The concerns you raised will require extensive discussions to determine the best path forward to support the whole perinatal system of care. We will conduct legwork to bring the parties together, and keep you informed regarding next steps.” Despite repeated request for updates and the resolution, no further communication has occurred on the quorum.

DHEC has proposed that instead of having direct access to the receiving providers at the hospital, the midwives must surrender the women and children in their care to an EMT who will relay necessary reports to the hospital instead of allowing direct access for provider-to-provider information. This additional step in the transfer process hinders proper communication during times of critical care. To our knowledge, no hospitals or emergency management services were invited as stakeholders and none appeared at the DHEC hearings.

The regulations proposal also required Licensed Midwives to call "911" if a woman declines any recommendation by a Physician or other Authorized Healthcare Provider during a Medical Consultation. A regulation requiring a midwife to call authorities and deny patient choice and autonomy could be considered a human righ