Eastern Oregon is a great place to raise children, but when it comes down to having them, well, you might have to take a small road trip.

While Umatilla County has about five doctors who have the certification to deliver babies, and La Grande has two, if you go too much further east, you’re heading into no-OB land.

Moms-to-be in small towns like Joseph, Imnaha, Halfway and Wallowa must travel nearly 70 miles – sometimes more – to be under the care of an actual obstetrician.

Otherwise, they have the option of seeing a family practitioner who is trained or certified in obstetrics at Wallowa Memorial Hospital in Enterprise, St. Elizabeth’s Hospital in Baker City or Blue Mountain Hospital in John Day.

“It’s a concern for some moms because they have to travel to larger cities, often more than a hundred miles away,” said Deana Cheslak, director of surgery and obstetrics at St. Elizabeth’s Hospital, which delivers around 120 babies annually.

Larry Davy, administrator for Wallowa Memorial Hospital, which has about 40-50 deliveries each year, said many rural areas don’t have the capacity for an OB/Gyn facility. As such, most of the doctors who have the ability to deliver babies are family practice physicians with OB training, not obstetricians.

April Brock, a registered nurse at Grande Ronde Hospital in La Grande, which delivers around 300-350 babies each year, said some physicians will schedule to induce an expectant mother who lives far from the hospital about one week before her projected delivery date in order to reduce the risk of her going into labor and delivering before reaching the hospital.

It’s not that OB doctors dislike Eastern Oregon; instead, other reasons weigh heavy on obstetricians for not practicing. Davy said one of the main reasons for having so few obstetricians in smaller communities is the rising cost of malpractice insurance for doctors.

“Malpractice insurance for each delivery for our hospital is more than $1,000,” Davy said. “We don’t really break even to cover those costs. The only reason our doctors with OB training keep doing (deliveries) is because we’re the closest hospital in 70 miles.”

It’s difficult enough to recruit doctors to Eastern Oregon, not to mention keep them here delivering babies, Davy added.

“St. Anthony Hospital works really hard to recruit quality physicians to the area,” said Staci Buchanan, the Pendleton hospital’s Communication Director. “Having smaller numbers from which to draw will only add to this challenge.”

Davy said many doctors are deterred from obstetrics due to the high cost of extensive training, the cost of malpractice insurance, as well as the logistics involved with delivering.

“Everyone expects you to deliver a perfectly healthy baby,” Davy said. “A doctor can only do so much. Plus, no one likes to be called out to a delivery in the middle of the night consistently.”

While two obstetricians in Hermiston at Good Shepherd Medical Center and three contracted through St. Anthony Hospital in Pendleton may not seem like a lot, hospital administrators say this number is sufficient for an area the size of Umatilla County.

“The number of OB/Gyn’s in the area seems to be adequate, in my opinion,” said Kelly Sanders, vice president of ancillary services at Good Shepherd. “The number of doctors we have here really enjoy delivering babies, and they do a great job of doing so.”

Good Shepherd also has two private obstetricians who have admitting privileges at the hospital. In 2002, Good Shepherd’s obstetricians delivered 578 babies, and this year have delivered about 555, with about 25 still due before the remaining 10 days are up for the year.

“I, myself, am not worried about there not being enough obstetricians because there are three OBs here in Pendleton who are pretty rooted with their families, so I don’t think they’re going anywhere,” said Jenny Samp, a pregnant nurse at St. Anthony who is due in February with her second child.

However, malpractice insurance costs, not to mention lawsuits, are still a concern for the larger hospitals. In June, St. Anthony Hospital was found negligent by a jury in an $11 million child birth malpractice case, but the obstetrician, Cheryl Marier, was exonerated.

In November, a patient filed a $2.5 million lawsuit against Good Shepherd and one of its obstetricians, Nancy Rudd-McCoy. That case is still pending.

According to the Oregon Medical Association, Oregon has been moving toward the crisis of increased medical insurance costs since 1999 when a cap on noneconomic damages, commonly known as pain and suffering, was removed in the court system. Since then, jury awards have dramatically escalated and are driving premium increases. Insurance rates have skyrocketed to a minimum of 150 percent in two years for some, and average jury awards have doubled since 1999.

Blue Mountain Hospital in John Day is feeling the effects of these increased insurance costs, as well. Obstetrics Director Barb Northington said the hospital is losing one of its family practice physicians with obstetrics training due to the high insurance costs.

According to a survey by Oregon Health & Science University earlier this year, of Oregon’s qualified professionals who deliver babies, 125 providers stopped delivering babies during the last four years – that’s 22 percent of all those delivering babies in Oregon. That same survey showed that one in three delivery doctors now plan to quit delivering in the next five years.

St. Anthony President Jeffrey Drop said if obstetricians can’t afford malpractice insurance, there eventually won’t be anyone to deliver babies.

“We aren’t in that situation right now, but that’s not to say that tomorrow we can’t be,” Drop said. As a result of increased litigation, Drop said “the whole community is damaged. Everyone can be affected, not just the individual or organizations involved in the suit.”

The Oregon Medical Association has created a Web site dedicated to ending frivolous lawsuits in the medical field, aptly called www.endfrivolouslawsuits.com. The site mentions that many doctors are being forced to withdraw from programs like the Oregon Health Plan because its reimbursement rates don’t come close to covering the cost of their liability insurance.

St. Elizabeth’s obstetrics department does not even perform OB surgeries anymore, Cheslak said, because doctors can’t afford the insurance to protect themselves.

Brock mentioned that larger cities, like Portland and Seattle, have less to worry about when it comes to the rising costs of malpractice insurance. Doctors at hospitals in those cities tend to have a larger patient load, so they are more easily able to cover the costs of insurance.

“Unfortunately, malpractice insurers really don’t care where your hospital is located,” Brock said. “Even if you’re a doctor without a history of malpractice lawsuits, your insurance is still very high.”

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Contact Casey White at (800) 522-0255 (ext. 1-227 after hours) or by e-mail at cwhite@eastoregonian.com.

St. Anthony Hospital, Pendleton

–Contracts with three obstetricians in Pendleton

–Average 345 babies delivered at hospital annually

Good Shepherd Medical Center, Hermiston

–Employs two obstetricians, considering hiring a third

–Has two private obstetricians with admitting privileges to hospital

–Average 575 babies delivered annually

Grande Ronde Hospital, La Grande

–Employs two obstetricians, in process of recruiting a third

–Average 300-350 babies delivered annually

Wallowa Memorial Hospital, Enterprise

–Employs four family practice physicians with obstetrics certification

–Average 40-50 babies delivered annually

St. Elizabeth’s Health Services, Baker City

–Employs three family practice physicians with obstetrics certification

–Average 120 babies delivered annually

Blue Mountain Hospital, John Day

–Employs two family practice physicians with obstetrics certification, one departing soon

–Average 45 babies delivered annually