Leading Catholic health system has cut a quarter of its labor and delivery departments in past decade
New analysis finds Ascension’s practices disproportionately impact low-income, Black, Latine patients in metro areas
Ascension has cut a quarter of its labor and delivery units in the past decade amidst a nationwide rise in pregnancy- and childbirth-related mortality, according to new analysis released today by National Nurses United, the nation’s largest union of registered nurses.
Ascension’s drastic cuts in obstetrics services are particularly pronounced in metropolitan areas at more than three times the national average. Whereas the nationwide closure rate for metropolitan obstetrics units was six percent from 2012 to 2021, Ascension cut 21 percent of its labor and delivery units in metropolitan areas in the same time period. Furthermore, these closures were more likely to take place in areas with higher rates of low-income, Black, and Latine patients, who are already at greater risk of pregnancy- and childbirth-related complications and death.
“Ascension’s creation of obstetric health care deserts increases the risk of dangerous complications and reduces opportunities for timely, lifesaving care for expecting parents and babies,” said Jean Ross, RN and president of NNU. “The failure to invest in obstetrics services — all in order to prioritize boosting profits and investment portfolios — flies in the face of Ascension’s purported mission of providing ‘spiritually-centered holistic care’.”
A key takeaway from NNU’s report is that Ascension uses its market dominance to shut down and consolidate labor and delivery units. The Catholic nonprofit hospital system is one of the largest in the country with 140 hospitals in 19 states and also one of the wealthiest, with cash reserves, an investment company, and a private equity operation worth billions of dollars.
“Dangerous Descent: How Ascension Betrays its Mission by Gutting Care for Pregnant Patients and Babies” underscores how Ascension’s practice of eliminating obstetrics services –– 26 percent of its labor and delivery units closed within the last decade – stands in stark contrast to the hospital’s stated commitment of “serving all persons with special attention to those who are poor and vulnerable” and the data in the new report bears this out:
- Since 2012, 10 out of 16 hospitals with obstetrics closures were in census tracts with higher poverty rates than the surrounding county;
- Four out of the five obstetrics closures in 2022 and 2023 were at hospitals with a higher Medicaid participation rate than the surrounding county average;
- Eight out of 10 hospitals with obstetrics closures took place in neighborhoods where the number of Black and Latine residents is higher than the surrounding county; and
- Half the counties where Ascension closed labor and delivery units have higher rates of infant mortality than the national average.
ASCENSION EXPLOITS MARKET DOMINANCE TO PRIORITIZE PROFIT OVER QUALITY PATIENT CARE
NNU utilized data from the American Hospital Association (AHA) Annual Survey, spanning from 2012 to 2021, and the U.S. Census Bureau’s American Community Survey to assess the relationship between Ascension’s market power and closures of obstetrics services.
Ascension has closed five obstetrics units since 2022. In all five counties where the hospitals are located, Ascension was among the top two or three hospital systems.
President Ross, RN, continued: “Ascension exploits its position as a dominant health care provider to consolidate obstetrics services at their flagship hospital in the area without compromising their revenue. However, this leaves surrounding communities with few options for nearby, quality OB-GYN care. This is shameful behavior by a supposed mission-driven hospital during a national crisis of pregnancy- and childbirth-related deaths.”
In Indiana, which has some of the highest rates of pregnancy-related mortality in the country, Ascension is one of the largest health care providers in the state.
In 2021, Indiana-based Ascension St. Vincent owned four hospitals in counties without obstetrics services. When questioned by local media that year about the possibility of reinstating full obstetric services in underserved areas, Ascension said its hospitals are “equipped and ready to take care of patients and get them to where they need to be.” In reality, the system has consolidated obstetric services at Ascension St. Vincent Women’s Hospital in Indianapolis, miles away from where many pregnant patients need care.
A year later, Ascension closed St. Vincent Dunn, the only hospital with an obstetrics ward in Lawrence County, creating another reproductive health care desert. Now, pregnant patients must travel across county lines to Paoli or Bloomington, both requiring at least an additional 30 minutes of driving. In Lawrence County, where St. Vincent Dunn is located, Ascension controls 20 percent of the hospital market share.
ASCENSION OBSTETRICS NURSES SPEAK OUT
NNU’s report comes as Ascension finds itself under growing media, regulatory, and staff scrutiny for its practices. In fact, the findings in “Dangerous Descent” align with nurses’ experiences of Ascension’s underinvestment in safe staffing and quality patient care, according to obstetrics nurses at Ascension hospitals.
Bernadette LaWare, RN, worked in obstetrics at Brackenridge Hospital in Austin, Texas, when Ascension closed the entire facility in 2017.
“All of our patients were now expected to go to Seton,” said LaWare, who has worked in obstetrics for over three decades and is now at Ascension Seton Medical Center. “And we had lots of discussions about how that was going to happen when Seton was on a really difficult public transportation line and wasn’t going to be as convenient. Brackenridge was much more accessible. It was something that people knew, [including] people who didn’t have cars, people who didn’t speak English.”
Nurses say that shutting down obstetrics units usually also means forcing patients to change doctors or providers — perhaps even during a pregnancy — which can cause interruptions in the continuity of care and added stress for patients, especially if the new provider hasn’t been with them throughout the current pregnancy or previous pregnancies.
In communities where Ascension still provides obstetrics services to pregnant patients and babies, nurses report that they are severely under-staffed and under-resourced, and specialties within obstetrics (such as antepartum and nursery care) are being discontinued. Ascension is also removing departments, like higher levels of neonatal intensive care services, and consolidating them at regional facilities.
“Our labor and delivery unit is currently so short-staffed that a single nurse is bouncing from one delivery to the next with no time to make sure protocols and assessments are done correctly,” shared Katherine Alvarado, RN, at a Sept. 27, 2023 action at Ascension Seton Medical Center in Austin protesting their facility’s staffing crisis. “These babies are left cold, hungry, and unstable. Without enough nurses on staff, babies face complications that are totally preventable!”
NNU represents nearly 2,500 nurses at Ascension hospitals across the country. Over the last 13 months – driven by concerns over Ascension’s cost-cutting practices in contradiction to its stated mission – there has been an historic surge of organizing by nurses at Ascension-owned hospitals.
NNU demands Ascension fulfill its mission and take the following steps to become an industry leader in combating the meteoric rise in obstetric health care deserts and lowering the pregnancy-related mortality rate:
- Come to the table and listen to nurses, safely staffing every unit to ensure the best care for patients;
- Commit to reopening closed labor and delivery wards; and
- Provide obstetrics services at all new hospitals Ascension opens or acquires.
ASCENSION PRACTICES UNDER GROWING NATIONAL SCRUTINY
The conditions Ascension nurses are reporting track with a broader pattern of Ascension’s greed, which has garnered the scrutiny of local and national news media and regulators, including:
- A February 2023 letter to Ascension CEO Joseph Impicciche by U.S. Sen. Tammy Baldwin, calling into question Ascension’s nonprofit status and mission-driven values.
- Two separate reports in January 2023 from Milwaukee, Wis., discussing “disruptions to patient care, long wait times in the emergency department, delayed surgeries and staff concerns about patient safety” at Ascension facilities.
- A lawsuit filed by Travis County, Texas in January 2023, alleging a breach of contract by Ascension-owned Dell Seton Medical Center, arguing Ascension had not complied with “its commitments to…the low-income Travis County residents who depend on Central Health for healthcare services.”
- A December 2022 Wall Street Journal investigation into Ascension’s deals, finding it has closed hospitals serving low-income neighborhoods and communities that have private insurance coverage below area median levels – instead choosing to open facilities in wealthier neighborhoods.
- A December 2022 New York Times investigation into Ascension’s staffing conditions, reporting that the hospital “spent years reducing its staffing levels in an effort to improve profitability, even though the chain is a nonprofit organization with nearly $18 billion of cash reserves.”
- A November 2021 STAT News investigation, describing Ascension as a hospital system “moonlighting as a private equity firm,” valued at $1 billion.
Ascension is the second-largest and wealthiest nonprofit and Catholic health system in the country. In fiscal year 2021, Ascension reported a net income of more than $5.7 billion, and the system’s CEO took home a compensation package worth more than $13 million. Additionally, according to a 2022 Securities and Exchange Commission filing, Ascension runs an investment company that manages more than $41 billion.
BACKGROUND ON NNU AT ASCENSION
On Dec. 6, 2023, nearly 2,000 Ascension nurses in Austin and Wichita went on strike — for the second time — despite a blatant union-busting scheme by the hospital system.
These strikes followed a wave of historic organizing at Ascension Via Christi St. Francis and Ascension Via Christi St. Joseph hospitals in Wichita, Kan., and at Ascension Seton Medical Center Austin (ASMCA) in Texas, all driven by nurses’ belief that Ascension has failed to invest its resources — including the tens of millions of dollars it does not pay in federal taxes, due to its nonprofit status — back into its communities and workforce. These Ascension nurses are represented by National Nurses Organizing Committee (NNOC), an NNU affiliate.
In November 2023, nurses at Ascension Saint Agnes Hospital in Baltimore, Md., voted to unionize with NNOC, citing as their reasons for organizing many of the same problems that their Texas and Kansas colleagues are facing. And in January 2024, resident and fellow nurses at ASMCA voted to join the existing bargaining unit. That makes five successful union elections at Ascension facilities in the last three years.
Ascension Seton Medical Center in Austin:
- 1,000 nurses represented
- Sept. 21, 2022 - nurses formed the largest private-sector nurse union in Texas by voting to join NNOC/NNU
- Nov. 17, 2022 - nurses held a rally to mark the start of their contract negotiations
- Jan. 4, 2024 - nurses in the resident and fellow programs voted to join the union
Ascension via Christi St. Francis Hospital in Wichita:
- 650 nurses represented
- Nov. 10, 2022 - nurses formed the first private-sector union in Wichita in the city’s largest hospital by voting to join NNOC/NNU
- Feb. 13, 2023 - nurses held a rally to mark the start of their contract negotiations
Ascension via Christi St. Joseph Hospital in Wichita:
- 300 nurses represented
- March 9, 2023 - nurses voted to join NNOC/NNU, making them the second Ascension-owned hospital in Wichita to create a nurses union
- May 22, 2023 - nurses held a rally to mark the start of their contract negotiations
Ascension Saint Agnes Hospital in Baltimore:
- 500 nurses represented
- Nov. 4, 2023 - nurses voted to join NNOC/NNU
National Nurses United is the largest and fastest-growing union and professional association of registered nurses in the United States with nearly 225,000 members nationwide. NNU affiliates include California Nurses Association/National Nurses Organizing Committee, DC Nurses Association, Michigan Nurses Association, Minnesota Nurses Association, and New York State Nurses Association.