The Brief

Detranay Blankenship was 16 weeks pregnant when she found out she was expecting. The days passed quickly, and soon she was 7 centimeters dilated at Martin Luther King Jr. Community Hospital.

The 26-year-old first-time mom wasn’t sure what to expect during labor, but the team at MLK’s maternity ward soon felt like family. Every hour midwife Angela Sojobi bustled in to check on her progress and offer cheerful words of encouragement. When it was time to push, a nurse lowered the lights and flipped on the soothing sound of rain.

After 14 hours of labor, baby Myla made her appearance in the world. “That’s my grandbaby!” Latrina Jackson, Blankenship’s mother, shouted. The family’s cheers rang down the hall.

Blankenship lives just blocks away from MLK, where her labor was cozy and personalized. It was the kind of birth that many parents-to-be hope for, but a decade of widespread cutbacks to maternity care in California has made it almost a luxury. It’s available only because MLK’s leaders are fighting to keep maternity services despite steep financial losses.

Over the last decade, nearly 50 maternity wards have closed across California, with more than half shutting down in just the last four years. Seventeen of them were in Los Angeles County, where maternity ward closures have far outpaced the region’s declining birth rate.

Driving the trend in L.A. are for-profit hospitals owned by multi-state corporations. For-profit companies owned 13 of the 17 hospitals that stopped delivering babies. State data shows more than half closed at a time when the hospital was making millions of dollars for investors. Those who lost the most access were the state’s poorest patients. One hospital that serves predominantly low-income patients was earning 13 times more than the median hospital operating margin in California when it shuttered its labor and delivery ward.

In contrast, government-run and nonprofit hospitals tend to maintain labor and delivery units even if they are losing money overall, according to state data on hospital finances. State law requires nonprofit hospitals such as MLK to address community needs as part of maintaining their tax-exempt status.

Hospitals raking in profits often do so despite losing money on maternity care — the service has long been deemed a money-loser. That’s in part because Medi-Cal, California’s public insurance program which covers half of all births statewide, has had the fifth lowest reimbursement rate for obstetrics in the country, according to the Kaiser Family Foundation. Private insurance pays roughly five times more for an uncomplicated vaginal delivery. Simply put, when for-profit hospitals look at the bottom line and choose to make cuts, one of the first services to disappear is usually maternity care. No law prevents them from doing so.

In the L.A. area, these decisions disproportionately affect low-income Black and Latino communities, a CalMatters analysis found. The closures in L.A. overwhelmingly took place in hospitals where up to 80% of patients had Medi-Cal. These populations have some of the worst pregnancy-related complications and mortality outcomes in the state.

First: Angela Sojobi, the lead midwife at Martin Luther King Community Hospital in Los Angeles, checks on the dilation progress of Detranay Blankenship, who will soon give birth for the first time on March 22, 2024. Last: Latrina Jackson, the mother of Detranay Blankenship, holds her hand as she is about to give birth for the first time at Martin Luther King Community Hospital in Los Angeles, on March 22, 2024.

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Jules Hotz

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CalMatters

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The morning after giving birth, Detranay Blakenship holds her child, Myla, at Martin Luther King Community Hospital in Los Angeles, on March 23, 2024.

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Jules Hotz

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CalMatters

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“Marginalized patients, women particularly … have really observed the decline in their care even in a place like California,” said Dr. Laila Al-Marayati, division chief for obstetrics and gynecology at Keck Medicine of USC and Los Angeles General Medical Center.

This is because the state has failed to prioritize women’s health for decades, increasing Medi-Cal obstetrics rates only recently, Al-Marayati said. Hospitals with high numbers of Medi-Cal patients frequently can’t break even on labor and delivery. As a result, maternity care takes a backseat to more lucrative hospital services, leading to the wave of recent closures.

Residents in southern L.A. have been among the hardest hit. In the last few years they’ve lost two maternity wards: Centinela Hospital Medical Center and Memorial Hospital of Gardena Medical Center. Both hospitals are owned by for-profit corporations and happen to serve the highest proportion of Black Californians in the state.

Their closures mean that MLK now operates one of the last maternity wards in the area. The hospital gives patients access to a midwife-led program celebrated statewide for its healthy outcomes for both mom and baby.

It, too, is at risk.

Last year the hospital ran a $42 million deficit. A recent $20 million grant from Los Angeles County will keep it open until next summer, MLK’s chief executive Dr. Elaine Batchlor said, but it won’t fix the hospital’s primary funding problem: Medi-Cal doesn’t pay hospitals and doctors enough to keep up, she said.

Medi-Cal reimburses MLK about 71% of the cost of delivery, hospital spokesperson Gwendolyn Driscoll said. The hospital loses more than $2 million annually on its maternity ward. Despite the losses, Batchlor said the maternity ward is integral to the hospital’s mission.

“We serve a vulnerable community that has few other options,” Batchlor said. “The financial distress of our hospital threatens that mission, but we will continue to provide the care that we can as long as we’re able.”

California maternity wards closures outpace U.S. trend

Across the country, communities are scrambling to save maternity care. About 3% of U.S. hospitals, mostly in rural areas, have stopped delivering babies since 2011, according to a report by health consulting firm Chartis. California has lost an even greater share: More than 14% of the state’s 337 hospitals ended maternity services during the same period.

Baby Eren, the daughter of parents Stephanie Herrera and Guillermo Saravia, at Martin Luther King Community Hospital in Los Angeles on March 22, 2024.

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Jules Hotz

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CalMatters

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Parents Stephanie Herrera and Guillermo Saravia with Baby Eren at Martin Luther King Community Hospital in Los Angeles, on March 22, 2024.

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Jules Hotz

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CalMatters

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Some state lawmakers are trying to slow the loss of services. They’ve characterized what is happening in L.A. as “modern-day redlining” in recent legislative hearings.

“If you start looking at where these are being eliminated, I do think the local counties who are familiar with the communities are going to question why the decisions seem to be made around hospitals that are overrepresented of…people of color,” Sen. Dave Cortese, a Democrat from Campbell, told CalMatters.

Hospitals administrators say the state could make a difference by significantly increasing how much Medi-Cal pays for births to incentivize hospitals to keep these services open.

Last year lawmakers approved a rate increase that went into effect in January, bringing up pay for some obstetric services, but the state’s multibillion-dollar deficit makes further raises unlikely. Gov. Gavin Newsom has proposed canceling additional increases to address the budget gap, something that lawmakers have rejected in a counter proposal.

“I’m not sure how many more conversations we need to have about some of the crises that we have within our health care space,” Assemblymember Akilah Weber, a Democrat and an obstetrician from La Mesa said during a recent budget hearing on Medi-Cal rates. Weber said Medi-Cal rates are “embarrassingly low in the state of California.”

The California Department of Public Health in an emailed statement said it is aware of hospitals that have chosen to reduce or eliminate labor and delivery beds, but that in the last three years the total number of beds across the state has slightly increased. “CDPH is exploring any potential avenues within its authority to promote retention or further increases of these beds, in the interest of making sure maternal care across California remains protected.”

Some experts say it will take federal intervention to slow closures. On top of increasing reimbursement rates, they’ve also suggested putting policies in place that would make it harder for hospitals to close maternity services in already underserved communities.

For now, Cortese is carrying a bill to improve transparency and public notification when a hospital decides to close a maternity ward. Private hospitals aren’t currently required to disclose the reasons for eliminating services, he said. Another bill by Weber would require hospitals to notify the state a year in advance if a maternity ward is at risk of closure due to staffing or financial limitations.

Cortese and Weber say their measures would give the state and local governments information needed to intervene if there are potentially unnecessary closures.

They won’t, however, bring back services that have already been lost in communities like Blankenship’s.

Next to her delivery room, a young couple also covered by Medi-Cal rests while their newborn son sleeps in a bassinet. The mother didn’t think she would be able to deliver vaginally after a previous cesarean section, but MLK gave her the chance that other hospitals wouldn’t. At the end of the hall, a homeless woman living in a nearby shelter labors with a midwife by her side.

“If this community lost the services, I don’t know where these women would go,” midwife Sojobi said minutes after catching Blankenship’s daughter.

The insurance divide

More than 90% of the patients who go to MLK are covered by public insurance programs like Medi-Cal or Medicare. In contrast, most hospitals that still operate maternity wards rely heavily on private insurance. Patients with private insurance represent only 3% of MLK’s patient population.

Thirteen of the 17 maternity ward closures in L.A. County happened at hospitals that serve what the state calls a disproportionate share of low-income patients. Six of those closures happened in areas where shortages of medical providers make it difficult to get any type of health care, a CalMatters analysis of state and federal data shows.

Batchlor and other hospital administrators who serve mainly low-income patients say this creates a problem because public insurance reimburses far below the cost of care. The added expense of 24-hour staffing in a maternity ward makes it a loss leader for most hospitals.

Although more than 40 hospitals still deliver babies in the county, doctors say the swath of recent closures has caused care delays. The remaining maternity wards have to absorb new patients, sometimes overwhelming them, said Dr. Lisa Moore, a family medicine doctor with Venice Family Clinic, a community health center with clinics throughout the region. Since 2020, the number of babies born at L.A.’s three county-run hospitals has increased by several hundred each year, state data shows.

Medi-Cal patients often bear the brunt of delays. Appointments for pregnant Medi-Cal patients who need scheduled inductions have been increasingly postponed, and some hospitals have stopped taking all but the highest-risk Medi-Cal patients, multiple doctors interviewed for this story said.

“People are angry, and they’re scared often because we’re telling them ‘We need to induce you. It’s not safe for you to continue being pregnant.’ But then they’re also hearing ‘Not yet. There’s no appointment,’” Moore said.

Delays worsen existing maternal and infant health disparities and increase the likelihood of a pregnant patient needing a cesarean section, Moore said.

The role of for-profit hospitals

The high costs of keeping specialized staff available 24/7 combined with relatively low payment and high malpractice risk make labor and delivery particularly difficult for hospitals to maintain, but experts say hospitals can usually recoup losses on other services.

Two hospitals neighboring MLK that recently eliminated labor and delivery were high-earning for-profit facilities.

Centinela Medical Center, which is owned by national chain Prime Healthcare, averaged a 10% five-year operating margin when it stopped delivering babies in 2023. In contrast, the median five-year average operating margin for all California hospitals was 2%, according to a CalMatters analysis of hospital financial records. Prime Healthcare and its foundation have closed five maternity wards statewide since 2013, the most of any health system in California.

Elizabeth Nikels, a spokesperson for Prime Healthcare, denied that profitability or staffing shortages had anything to do with maternity ward closures at Centinela or its other four hospitals. She instead pointed to declining demand and low birth rates.

Like Centinela, many hospitals cite decreasing birth rates as a reason for eliminating labor and delivery. California’s birth rate has reached record lows and L.A. County is not immune to the trend, but maternity wards are closing faster than birth rate declines.

In 2023, 7,700 fewer babies were born in L.A. County compared to 2020. Maternity wards closed at a faster pace than that decline, forcing remaining hospitals to absorb about 3,800 additional births over three years, according to a CalMatters analysis of hospital utilization records.

“Prime Healthcare’s priority is always community need and patient care. Service line decisions are based on greatest benefit to patients with financial sustainability not a determining factor,” Nikels said in an email.

Centinela consolidated services with St. Francis Medical Center, also a Prime hospital located 10 miles away that delivers almost four times as many babies. In 2022, 732 babies were born at Centinela, state records show, roughly two per day. Another 2,762 were born at St. Francis that same year. Centinela’s consolidation with St. Francis gives patients access to “high quality care with expansive services,” Nikels said.

The other hospital near MLK that stopped delivering babies is Memorial Hospital of Gardena. Owner Pipeline Health System, another national chain, closed Memorial’s maternity ward in 2020. The hospital posted an average annual profit margin of 16% over the five years preceding its closing of labor and delivery services, state records show.

Pipeline owns four hospitals in L.A. County. Only one offers labor and delivery services. Jane Brust, a spokesperson for Pipeline Health System, said it would be “cost prohibitive” for Pipeline to implement obstetrics at its other three hospitals.

Meanwhile, nonprofit hospitals can also be part of large, well-funded systems, such as Kaiser Permanente and Sutter Health, but by law are required to assess the needs of their community and invest in those needs in exchange for their tax-exempt status. The attorney general holds additional regulatory power over nonprofit hospital acquisitions. This is not the case for transactions between for-profit systems.

“These aren’t public entities. They make the decisions in their boardroom, and nobody really knows what the basis was,” said Sen. Cortese.

That means for-profit systems tend to have more leeway in prioritizing the bottom line.

“In order to make money, you have to increase your revenue or decrease your expenses,” said Ge Bai, professor of health policy and management at Johns Hopkins University. “To decrease expenses is to cut off those unprofitable services.”

What do L.A. parents-to-be want?

Other experts say policymakers need to look beyond money.

“The bigger public policy question is, should hospital-based (obstetrics) be part of a set of services we feel everyone in California needs access to and should be a certain geographic distance from,” said Kristof Stremikis, director of markets and insights at the California Health Care Foundation.

For communities in the neighborhoods surrounding MLK, Centinela and Gardena, that’s an easy answer, said Gabrielle Brown, maternal and infant health program coordinator with Black Women for Wellness.

After Centinela ended its maternity program, Black Women for Wellness canvassed households within 10 miles of the hospital and held a community town hall to assess the impact. The verdict: Residents of Inglewood, a majority Black and Latino city, felt abandoned, Brown said.

The community was also reeling from the death of April Valentine, a young Black woman who died during childbirth at Centinela nine months before the hospital stopped labor and delivery care. Last year, state regulators fined Centinela $75,000 for lapses in care that led to the death. The hospital has previously denied allegations of improper care and racial bias.

“Instead of improving the services that they offer, they decided to remove them,” Brown said.

Prime spokesperson Nikels said Valentine’s death was not a factor in Centinela’s maternity ward closure.

If MLK were to close, patients including Blankenship and her daughter Myla would have to travel farther for delivery and postpartum services—barriers that often affect whether a pregnant patient sees a provider at all. In urban areas, the next hospital could be a few miles down the highway, but L.A.’s notorious traffic easily makes travel time untenable. They’d also lose the rare access to a midwife.

Patients and providers at MLK are acutely aware of how dangerous those barriers can be. A whiteboard in Blankenship’s room listedher birthing goals, the words “Safe Delivery” handwritten in bold. Frequently, laboring Black mothers arrive at the hospital terrified of what might happen having heard horror stories, midwife Sojobi said. Many never saw a doctor during their pregnancy.

“They look at me and go, ‘Please don’t let me die,’” Sojobi said.

Angela Sojobi, lead midwife at Martin Luther King Community Hospital in Los Angeles, on March 22, 2024.

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Jules Hotz

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CalMatters

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Next year, MLK is adding another midwife to its maternity team. A quarter of its financial loss comes from midwife salaries because Medi-Cal will not reimburse a midwife and an obstetrician working simultaneously, which is how MLK’s team works. The hospital will absorb the additional loss because midwives improve outcomes for communities of color, MLK executive Batchlor said.

For her, the decision to keep labor and delivery open no matter the cost comes down to believing patients deserve it.

“I think it’s leadership, and I think it’s values. I do,” Batchlor said.

An East Hollywood nursing home that nearly lost its license this year because of repeated state citations for deaths of residents at the facility was cited again last month after another person died.

The California Department of Public Health cited Brier Oak on Sunset after a 92-year-old resident bled to death on Sept. 27. Staff members had continued injecting her with blood thinners over a 40-hour period in violation of clinical guidelines.

It’s an AA citation, the most severe the department issues when violations of care standards are determined to be a substantial factor in someone’s death. The facility faces a $120,000 fine.

These kinds of citations are rare. The department has recently issued, on average, fewer than 20 AA citations yearly across more than 1,200 skilled nursing facilities in California.

Brier Oak has received three AA citations for patient deaths since late 2022.

State regulations require authorities to suspend or revoke the licenses of any facilities that get two AA citations within a period of 24 months.

The state Public Health Department began that process with Brier Oak in May based on resident deaths in 2022 and 2024. But officials dropped that effort later because they say they determined the two patient deaths had occurred 26 months apart — just outside of the two-year window.

A spokesperson for the company that owns Brier Oak told LAist it has appealed the first two citations and is considering whether to appeal the third.

Advocates for nursing home residents say the recent death could have been avoided if the state had taken action.

“There were red flags, and a lot of these red flags existed prior to the death of this poor resident,” said Tony Chicotel, senior staff attorney with  California Advocates for Nursing Home Reform.

The state said Brier Oak has until Dec. 19 to notify the department if it intends to appeal.

What led to the patient deaths?

In the recent death at Brier Oak cited by the state, multiple communication and technical failures by nursing staff led to the patient bleeding out over a period of 40 hours, according to the citation.

The 92-year-old patient was immobile and had been prescribed a blood thinner called heparin to help prevent blood clots from forming. But once a patient is bleeding, those injections make bleeding worse, and potentially fatal.

When nursing staff found bright red blood in the resident’s diaper the day before she died, Brier Oak failed to follow established processes for documenting the bleeding or communicating it to a nurse practitioner or medical doctor, according to the citation.

Nurses told state authorities they delayed informing physicians because they “get mad” when contacted in the middle of the night.

The facility’s staff also failed to fully assess the patient to determine the possible causes of the bleeding and or to properly monitor the issue during crucial periods, according to the citation.

She suffered four internal bleeding episodes over 40 hours and continued to receive blood thinner injections.

The citation says a nurse practitioner at Brier Oak told state licensing authorities later that if she’d been informed about the patient’s ongoing bleeding, she would have stopped the blood thinner and sent her to a hospital.

In 2022, Brier Oak received a AA citation after a 62-year-old woman died from respiratory failure in part because nurses hadn’t been trained to operate her breathing machine.

In 2024, the nursing home got another AA citation. This time, a 63-year-old woman with paraplegia and severe obesity fell from her bed and died while a nursing assistant was changing her. The assistant was alone, even though the woman’s care plan required two staff members.

Who owns Brier Oak?

Brier Oak on Sunset is primarily owned by Genesis Healthcare, a publicly-traded nursing home operator that filed for Chapter 11 bankruptcy in July.

Once the largest nursing home operator in the U.S., Genesis was facing billions in debt when it declared bankruptcy, according to court filings. That includes millions in potential damages from lawsuits related to patient care failures.

In a brief statement to LAist, a company spokesperson said it's still considering whether or not to appeal the recent citation at Brier Oak.

The citation should trigger a suspension or revocation of the facility's license, according to state regulations. The latter means it would have to close its doors. The two most recent deaths and citations at the facility occurred within the two-year window.

The California Department of Public Health confirmed it cited Brier Oak on Nov. 26.

The department said the facility submitted a required written response before a Dec. 6 deadline, showing how it will fix the problems and prevent them from happening again..

The department determined Brier Oak was back in compliance during an onsite visit last week, a representative told LAist.

Brier Oak on Sunset currently houses about 150 patients, according to state records.

A bankruptcy judge has stalled the proposed sale of Genesis Healthcare to an affiliate of one of its investors.

Experts say it’s unclear whether the state would revoke the license of an owner who is actively trying to sell and turn over operations to someone else.

It’s been a rough start to ski and snowboard season for California mountain towns. Snowfall is well below average, but Christmas could come with some of the white stuff. Here's where things stand:

Hmmm. Didn’t we just have a record storm?

Yes. That big atmospheric river that hit Southern California last month made it one of the wettest Novembers on records. But since then, it’s been unusually warm and dry, which is not good for mountain towns that depend on snow, and the outdoor enthusiasts that flock to them.

How bad is it?

California’s snowpack is about 20% of normal for this time of the year, according to the state’s snow-tracking website. Southern California isn’t quite as bad off — we’ve gotten about half our normal snowfall so far.

As for the resorts, only about 20% of the terrain at Bear Mountain in Big Bear is open. About 35% of Mammoth Mountain is open.

Can’t they just make snow?

They are, but the unusually warm temperatures have curbed resorts’ ability to make enough snow to open more terrain. “If you're blowing water into 40-degrees, it's going to stay water,” said Justin Kanton, a spokesperson for Big Bear Mountain Resort. “ So as much as people probably would want us to just crank the snow guns all day, every day up here and just get things moving, that's not really possible.”

But there’s a silver lining!

The dry weather has allowed Caltrans to make good progress toward opening Highway 38, said Evan Engle, who chairs the board of the Big Bear Chamber of Commerce. The road typically handles up to 40% of traffic up to the mountain town, Engle said. But it’s been closed since September when it got washed out by Tropical Storm Mario.

Getting it open as soon as possible is key to keeping visitor traffic manageable, and getting supplies to Big Bear.

What’s the snow outlook?

SoCal mountains are likely to see some precipitation around Christmas, said Kyle Wheeler, a meteorologist with the National Weather Service. But with temperatures not expected to drop much, it’s uncertain how much of it will be white, Wheeler said.

If you go to Big Bear: 

• If you plan to hit the slopes, get on it early, when the snow is at its best given the warm conditions. 
• No snow? There’s more to do than ski and snowboard. Check this list of winter fun events.  
• Worried about traffic? Consider going up earlier in the week. If you can’t do that, consider taking Highway 18 through Lucerne Valley. It’s a longer route if you’re coming from L.A., but less traveled, and less likely to make you car sick (fewer tight curves). 

The Los Angeles Police Department used more than 2,400 crowd control munitions in response to protests from June 6 to 14, according to a new report.

Officers used a total of 2,431 less-lethal projectile rounds and 35 canisters of tear gas over the nine days, according to LAPD reports. The department recorded 12 injuries officers caused with those weapons.

The LAPD released the missing report last week after LAist identified the use of crowd control weapons on four different days in June that had not been reported according to state law. Assembly Bill 48, which went into effect in 2022, limits when and how crowd control weapons can be used, and requires law enforcement agencies to publicly release reports on their use within 60 days.

A 30-day extension for these reports can be granted in some cases, but the LAPD released this report about three months late even if an extension was justified.

Officials acknowledged they were out of compliance on Dec. 10 before releasing the report, saying the delay “stems from the extraordinary volume and complexity of incidents” over that time.

This report is different from others

It is unusual for a crowd control report to include more than one day, and the report for June 9 through 14 covered six days and “45 sepearte [sic] non categorical use of force incidents.”

It does not describe any of those use of force incidents specifically, and the LAPD has not yet responded to LAist’s request for more detailed descriptions of those incidents.

The report also considered the entire six days to have been one continuous protest, though it included several anti-ICE protests over the week and the national “No Kings” protest on June 14.

Two reports released earlier this year for June 6 and 8 covered single days and provided more detailed descriptions of incidents where the LAPD used less-lethal munitions against protesters.