Indian Country Today
A former Phoenix Indian Medical Center leader is questioning the hospital’s long-term decision-making that resulted in the abrupt closure of its obstetrics services.
Dr. John Molina, Pascua Yaqui and Yavapai-Apache, was CEO of the Phoenix Indian Medical Center from 2010 to 2013.
The hospital — the largest facility operated by the federal Indian Health Service — closed its inpatient obstetrics services Aug. 26 with no public notice. Molina was made aware of it in October after a concerned former hospital colleague reached out.
Molina has a close connection to the birthing services department. In the 1990s, years before he was CEO, he worked in the unit and delivered hundreds of babies.
“The IHS is severely underfunded, which is a reason why Phoenix Indian Medical Center suffers from a lot of outdated equipment and facilities, but it doesn’t take away the responsibility and accountability of leadership to be proactive and looking at what’s actually going on day by day,” Molina said.
He also cited unexpected financial stress on soon-to-be mothers and the potential harm of not being able to deliver their babies according to their cultural beliefs.
Molina now serves as corporate compliance officer for the nonprofit Native Health in Phoenix and is the founder of Las Fuentes Health Clinic of Guadalupe, a community medical clinic.
Indian Health Service hasn’t shared many details about the closure, except that it’s temporary and related to “facility infrastructure, equipment and challenges with staffing.” It’s unclear when the birthing center will reopen.
The Indian Health Service is among 40 of the country’s largest health systems, according to Becker’s Hospital Review, with 24 hospitals and 22 tribally operated hospitals. It operates on a roughly $6 billion budget and is responsible for providing comprehensive health services to 2.6 million Native American and Alaska Native people in 37 states, according to its website.
Molina said the agency must ensure tribes are consulted on major decisions, which he doesn’t think occurred in this case.
“The Indian Health Service has that responsibility, from the director on down, to make sure the tribes in the Phoenix area are constantly made aware of changes,” Molina said, noting health officials usually meet with tribal leaders quarterly or every six months.
A decision to close a service like obstetrics should be made collaboratively, he said. “Maybe the tribes have a solution; maybe they can work together.”
The Indian Health Service did not respond Tuesday to questions about tribal consultation.
The nearby Salt River Pima-Maricopa Indian Community said it was made aware of the closing, but did not say when.
“Salt River has been able to work with our health partners to continue this important service for our people,” President Martin Harvier said in a statement.
It’s unclear how many babies are delivered at the Phoenix Indian Medical Center annually, but birthing services have been provided for decades. Molina said when he worked at the hospital, the number would fluctuate monthly from 20 to 75.
Molina said pregnant Native women would fly from Utah and Nevada to give birth in Phoenix. Cultural beliefs play a role at Phoenix Indian Medical Center, Molina said, especially when it comes to giving birth.
“That’s the one unique thing that PIMC had that it took away from these women — that opportunity to deliver their baby, in their ways, in their customs, because to them, the baby is sacred,” Molina said.
The closure has left pregnant women scrambling to seek birthing services elsewhere. Some said they were told to travel north to the Navajo Nation to another Indian Health Service facility.
Others say the hospital has provided little to no guidance on what to do next, leaving them frustrated and wondering how they will cover costs.
“The greatest impact that I see for Native women aside from the cultural impact and the cultural harm that's been done to them by the Indian Health Service is that, how are they going to pay for the delivery,” Molina said. “I think Indian Health Service have to at least provide some responsibility and accountability to help the moms connect to another source of care, at least on a financial basis, because they know the impact it could have on the mother's economic status and the family.”
In a statement last week, the agency said the hospital continues to provide prenatal and gynecologist specialty care, and to facilitate care for patients near term. It did not answer questions about how it's advising affected moms.
A bipartisan group of Arizona lawmakers is seeking answers about the closure from current IHS Director Michael Weahkee, Zuni Pueblo. Weahkee was confirmed to head the agency earlier this year. He previously served as acting director and before that was CEO of the Phoenix Indian Medical Center.
A request for an interview with Weahkee went unanswered.
Under Molina’s leadership, the Phoenix Indian Medical Center was designated a “Baby-Friendly” facility as part of former first lady Michelle Obama’s “Let’s Move! In Indian Country” campaign and was co-administered by the World Health Organization and the United Nations International Children's Emergency Fund.
The hospital is one of four IHS-related facilities with that distinction in Arizona and one of two in the Phoenix area. Phoenix Indian Medical Center was redesignated in 2018, according to the Baby-Friendly USA website.
Regarding insurance, Molina said the first step for expectant moms is applying for AHCCCS, Arizona’s Medicaid agency, which would pay for birthing costs. If denied, another option is the Affordable Care Act’s Health Insurance Marketplace, which may have an insurance premium depending on coverage, but is still a low-cost option, Molina said.
Molina encouraged expectant mothers to seek advice. His employer, Native Health, has family health advocates who work directly with Native people on insurance questions and potential payment options at no cost.
Molina said pregnant women should deliver at a hospital of their choice. He said hospitals work with patients and understand how Medicaid works and how coverage requirements could change once a baby comes. For six years, Molina worked with Arizona’s Medicaid program.
“I’m a big believer in patient choice,” he said. “When the mom delivers at the hospital, the staff there will then work with her to get her on the Medicaid program. One of the things that happens in Medicaid is that once a mother has established a liability, or the bills, the hospital will take that into account to relook at her application because they look at the mom’s assets as well as her financial liabilities. And now, perhaps since she has more financial liabilities from the hospital part, she may be able to qualify for the Medicaid program.”
Dalton Walker, Red Lake Anishinaabe, is a national correspondent at Indian Country Today. Follow him on Twitter: @daltonwalker Walker is based in Phoenix and enjoys Arizona winters.
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