Lawmakers get update on Wyoming's 'maternity deserts'

Carbon, Platte, Goshen, Johnson, Washakie, Uinta and Lincoln counties are considered “low access to maternity care” places, he said.

“Why do we care about maternity deserts?” Fuchs asked. “Really, there are two major issues. One is health.”

Increased distance from delivery centers can increase severe maternal morbidity, or unintended outcomes from labor and delivery resulting in short- and long-term consequences to a woman’s overall health, Fuchs said.

The second issue, he said, is related to economic viability.

“Like electricity, water, sewer, you have to have basic infrastructure to attract workers and build businesses,” Fuchs said. “Health care, and specifically, availability of a hospital or ability to have kids locally, could be considered in that sort of basic infrastructure category.”

‘Disparities across counties,’ cross-training needed

Hospital labor and delivery units have closed in Rawlins, Kemmerer and Riverton since 2018. While Wyoming has 47 OB providers and midwives per 1,000 residents — above the national average of 46 — geographical distribution of those providers is a major issue.

“The main problem here is that there are huge disparities both across counties, and within certain counties,” Fuchs said.

“Teton County probably no real issues. … It is counties like Big Horn that are really suffering when it comes to physicians per capita.”

The Labor Committee was directed by legislative leaders on the Management Council to make maternity health care and child care issues its top priority during the interim, and was tasked with studying ways to increase the number of labor and delivery and maternity health care professionals in Wyoming.

Regg Hagge, a family medicine practitioner who also practices within obstetrics, and who has worked in Wyoming for over 25 years in Douglas, Kemmerer and Newcastle, told the committee via Zoom that cross-training physicians is key.

“What is the solution to the problem of decreasing OB services in our small communities?” Hagge said. “I believe like Nebraska and South Dakota, Wyoming needs to encourage more family physicians to provide obstetrical services in rural areas. Not only can a well-trained family physician provide OB services, but (they) can see clinic patients, nursing home patients, hospital inpatients and cover the ER.”

The two existing family medicine residency programs in Wyoming should be able to produce enough well-trained family doctors to meet the need in Wyoming, Hagge said.

“In the same way, Wyoming needs to focus on training more generalist nurses who are cross-trained to work in different areas,” he said.

Micah Richardson, associate director of policy at the Wyoming Women’s Foundation, offered the committee several potential solutions, including mobile health care units that could travel to women in rural areas, midwifery training at local community colleges and workforce training, and doula coverage offered under Medicaid.

“Most of (these suggestions) create opportunities for partnerships and provide interesting options for addressing the maternal health desert, and maternal health generally,” Richardson said.

Sheila Bush, executive director of the Wyoming Medical Society, said strong recruitment and retention efforts are key. She said her organization would support identifying and removing barriers to family practice physicians who also wish to practice OB care, but added that medical malpractice costs can be prohibitive.

Other states provide a subsidy to OBs and family medicine physicians who provide OB care, as normal family physician medical malpractice premiums are in the $20,000-$30,000 range. When doctors add a rider for OB care, “those jump to $90,000 and $100,000,” she said.

Rep. Jeanette Ward, R-Casper, suggested that the committee look at ways to “increase freedom, not create more government,” suggesting tort reform that would limit a plaintiff’s ability to recover compensation in a personal injury lawsuit.

“How can we do tort reform so that we reduce liability on certified professional midwives and on certified nurse midwives?” Ward said, also suggesting a legislative mandate to require OBs who accept government funding like Medicaid to partner with midwives.

Sen. Eric Barlow, R-Gillette, called tort reform an “uphill battle,” and instead suggested the committee look into what neighboring states have done, including training opportunities and partnerships between OBs, midwives and family practitioners. Rep. Tamara Trujillo, R-Cheyenne, agreed.

“It sounds like the OB doctors have problems working with midwives and family doctors, and sharing their spaces,” Trujillo said. “I’d like to know more on that.”

Rep. Mike Yin, D-Jackson, said he would like the committee to explore the idea of community college curriculum related to midwifery training.

Sen. Anthony Bouchard, R-Cheyenne, said he was concerned the committee may not be able to do much to combat maternal health care deserts, as the projected health care provider shortage expands across the nation.

“I am wondering if we are trying to Band-Aid something we are not going to be able to fix. I want numbers here on how many doctors plan to leave,” Bouchard said. “Maybe this is something we can’t fix, and we are spending time and money on things that are not going to help.”