Victoria Valdes wants to give birth to her twins in the same hospital she helps care for patients.
But Valdes and other employees at Palmetto General Hospital fear the labor and delivery unit, the only one still open in Hialeah, could be next on the chopping block as new hospital management tries to cut costs.
Dr. Roberto Fojo, chief of the department of obstetrics and gynecology, told the Miami Herald that one of the hospital’s top executives “threatened to close the unit” during a discussion with several physicians, including himself, in late January after the hospital ended its partnership with the company that staffed some of the doctors that provide care to pregnant women at the hospital.
Ob Hospitalist Group, which provided doctors around the clock in Palmetto General’s labor and delivery and obstetrics emergency department to handle maternity-related emergencies, stopped services on Jan. 23. The company told the Herald it “worked to explore multiple solutions to continue providing care” but that Palmetto chose to end the partnership. The company declined to say why the partnership ended.
“I am pregnant with two babies, my pregnancy is high risk because they are twins … if the maternity unit closes, I have no idea where I will give birth,” said Valdes, the Palmetto nurse who is nearly 26 weeks pregnant. Fojo, who is her doctor, doesn’t have privileges at other hospitals to perform deliveries or C-sections.
TeamHealth, a company that provided Palmetto General and its sister Hialeah Hospital with anesthesiologists for pain-free C-sections and other surgical procedures, also will be off the job at the end of February. The company has struggled to get paid on time by the hospital. The problem started when the hospital was owned by Steward Health Care System, and continues with new operators Healthcare Systems of America, known as HSA, which took over four months ago.
Alejandro “Alex” Contreras-Soto, formerly the chief executive officer of Palmetto General and North Shore Medical Center and now the regional CEO for all five HSA-operated hospitals in South Florida, told the Miami Herald that Palmetto General’s labor and delivery unit won’t close like the units at its sisters Hialeah Hospital and North Shore Medical Center in North Miami-Dade. He says Palmetto General “remains fully committed to providing high-quality labor and delivery services to the community without disruption.”
The CEO’s comments are at odds with what the hospital’s longtime chief of obstetrics and gynecology says he and others were told weeks ago when the Ob Hospitalist Group left.
If Palmetto’s labor and delivery unit closes, pregnant patients would be turned away, and the hospital’s NICU, which provides specialized care for sick and premature babies, would also have to shut down, employees say.
For the doctors and nurses at Palmetto General who have grappled with supply issues, delayed paychecks and service cuts under what they describe as Steward’s mismanagement, it’s also a sign that things aren’t improving under the new operators.
Workers are concerned Palmetto General, 2001 W. 68th St. in Hialeah, is heading on the path of North Shore Medical Center, which last year closed its costly labor and delivery, neonatal and behavioral health units to try and slow the financial bleeding.
Keep up with Tampa Bay’s top headlines
Subscribe to our free DayStarter newsletter
We’ll deliver the latest news and information you need to know every morning.
You’re all signed up!
Want more of our free, weekly newsletters in your inbox? Let’s get started.
Explore all your options
Hialeah doctors and nurses ask for help
“The situation at the hospital is critical. Palmetto is the only hospital left with a maternity ward in Hialeah,” said Fojo, who has worked in the unit for 35 years. “If the city of Hialeah or Miami-Dade County doesn’t step in, this could become a serious problem, and there’s a real possibility that the unit could close.”
Several other nurses and doctors took their concerns to Hialeah’s elected city leaders to ask for help in improving the situation at Palmetto General.
“There’s many shortcomings of the hospital. … I’m hoping that you can become more involved and see what we can do to save the hospitals,” Dr. Hugo Ferrara told the Hialeah City Council on Jan. 28. The mayor and council didn’t address the issue directly at their meeting, but several council members later told the Miami Herald that the city has expressed concerns to Contreras-Soto about the possible maternity ward shutdown.
Hialeah Mayor Esteban “Steve” Bovo, who is expected to step down and join a prominent lobbying firm in Washington, D.C., told the Herald on Jan. 31 that Palmetto General is a private entity and “it’s not customary to intervene in private business.” His comments came three days after Palmetto General workers attended the Hialeah City Council meeting on Jan. 28 to raise concerns.
“We do not want the maternity ward at Palmetto to close; we want those essential services to remain in place, and that’s the city’s firm stance,” Bovo said. “However, if concrete steps are taken toward shutting down the unit, we will have no choice but to take stronger action and escalate the matter with the Florida Department of Health.”
A week after the council meeting, hospital leaders tried to reassure workers in a meeting that the labor and delivery unit would not close. Contreras-Soto, in an emailed statement to the Herald, said Palmetto General has a “strong network of OB-GYNs and dedicated healthcare professionals who play a vital role in ensuring comprehensive coverage for our patients.”
“Our priority is maintaining excellent patient care while supporting our medical staff and employees through operational transitions,” he said. “We are actively working to strengthen our partnerships with providers and vendors to support uninterrupted medical services and a stable work environment for our team.”
Palmetto General has recruited four doctors to be on call, at least through March, to handle emergency shifts that were previously assigned to doctors with the Ob Hospitalist Group.
That’s a relief for the rest of the unit’s doctors, who were reluctant to take on the shifts due to the high cost of medical malpractice insurance, which is optional for doctors in the state of Florida and is also not provided by the hospital. Compared to other surgical specialties, specialized doctors who deliver babies have some of the highest risk of being sued during their careers, according to the American Medical Association.
But Fojo, the OB-GYN chief, is worried that the staffing — and the hospital’s commitment to providing maternal care in an underserved community — won’t last. Patient care has also been affected.
On Jan. 27, a 34-week pregnant woman in labor was rushed to the hospital, but there was no doctor available. The on-call doctor did not make it to the hospital on time and “as a result, a nurse, who isn’t trained to handle deliveries, had to step in. This is completely unacceptable,” Fojo said.
“This is the issue we’re facing now, and it’s only going to continue. There are simply not enough doctors to meet the demands,” Fojo said. He said the lack of doctors has caused a severe strain on resources, with medical staff often forced to attend to patients without proper doctor supervision.
Palmetto General employees want better working conditions
Maternity isn’t the only area seeing problems. Last month, registered nurses organized a demonstration outside the hospital calling for the hiring of more nurses, safe staffing on every shift and in every unit, and better equipment, pay and health insurance. The demonstration was one of several in Florida and other states by National Nurses United, a union that represents more than 224,000 registered nurses in the country.
Palmetto General is also trying to pin down a new vendor for anesthesia services as its existing one prepares to depart. TeamHealth, the vendor that provided anesthesiologists to Palmetto General and Hialeah Hospital, told the Herald that HSA, just like Steward, fell “significantly behind in payments” and that “it is apparent that they are unable to meet their financial obligations.”
“Though this is not the outcome TeamHealth ever desires,” HSA’s lack of payment “left us with no other way to maintain our commitment to providing exceptional patient care and ensure that our clinicians are fairly compensated for the care they provide,” the company said in a statement, noting that it will stop providing services at the two Hialeah hospitals at the end of February.
Anesthesia issues are not new. In 2023, while under Steward, Palmetto would sometimes pivot to “emergency-only days meaning no elective cases were to be performed,” according to documents filed in court during the bankruptcy process by a cardiovascular surgeon who said he was owed money by Steward.
“A hospital without anesthesia is not a hospital but a glorified clinic,” Fojo said in a recent letter he sent to Bovo and Miami-Dade County Mayor Daniella Levine Cava about Palmetto’s problems. Levina Cava did not respond to the Herald’s request for comment.
For-profit hospital systems like HSA — which operates Palmetto General, Hialeah Hospital, Coral Gables Hospital, North Shore Medical Center in North Miami-Dade and Florida Medical Center in Lauderdale Lakes — is a private business. State and federal regulators are in charge of monitoring hospitals for patient safety.
Because it’s a private hospital system, Hialeah City Council members say there’s not much they can do.
“It’s terrible to see a hospital that’s been in our city for so many years, with so many phenomenal doctors … and to see that it’s going through this turmoil and then the fear of our residents having a health emergency, feeling safe, and not having somewhere to go,” said council member Mónica Pérez.
Future of Palmetto General’s maternity ward
The possible closing of Palmetto’s labor and delivery unit, which has delivered at least 152 babies so far this year, could increase the risk of complications for moms and babies and make it harder for families to get the care they need in an area that is struggling to access essential health services, according to March of Dimes, a nonprofit that focuses on the health of babies and mothers and monitors the ease of access to maternal care services in the country.
The concerns over Palmetto General’s labor and delivery unit highlights the challenges in a region that, much like the rest of the country, is seeing maternity ward closings mostly in areas affecting underserved predominantly Hispanic and Black communities. Hispanics and Blacks have a higher rate of dying from pregnancy-related complications.
“Transportation is already a major barrier for many families, and longer travel distances for prenatal and delivery care could increase the risk of complications for both mothers and babies, including preterm birth, low birth weight, and other pregnancy-related complications,” said Tenesha Avent, the nonprofit’s director of collective impact and maternal and child health for South Florida, when asked about what the possible closure of Palmetto’s maternity ward could have on the community.
Palmetto General’s labor and delivery unit is the only one in the city of Hialeah and one of nine that remain open in Miami-Dade County. Its sister hospitals — Hialeah Hospital and North Shore Medical Center in North Miami-Dade — closed their units in 2021 and 2024, respectively, while under the ownership of Steward Health Care System. Jackson West in Doral, part of Miami-Dade’s public hospital system, shuttered its ward in June 2023.
For Hialeah, a city of 250,000 people, one of the most populous cities in the state and the second largest in Miami-Dade County, the potential shuttering of Palmetto General’s labor and delivery unit would leave families without an essential service, forcing them to travel farther in South Florida’s traffic congestion for maternity care.
The nearest maternity wards to Palmetto General are slightly more than 11 miles away at Jackson North Medical Center in North Miami-Dade and Memorial Hospital Miramar in Broward County. Farther away is the Women’s Hospital at Jackson Memorial in Miami, HCA Florida’s Kendall Hospital and Mount Sinai Medical Center in Miami Beach. Baptist Health South Florida also has maternity wards across Miami-Dade at Baptist Hospital in Kendall, Homestead Hospital, South Miami Hospital and West Kendall Baptist Hospital.
“We are not seeing the light at the end of the tunnel because it’s more of the same as the previous company,” Ayme Marti Parra, a nurse who has worked at the hospital for a decade, told the Miami Herald in Spanish.
The departure of the anesthesia and OB-GYN vendors at Palmetto are the latest examples of service disruptions at the hospital that was owned by the for-profit Steward Health before HSA took over hospital operations in September. HSA was initially tapped to be the hospital’s interim manager, running the day-to-day operations, but became Palmetto’s permanent operator in October. The change was part of a deal Steward made with its landlord in court to thin debt.
Marti Parra and other employees who attended the City Council meeting in January are hoping political leaders will find a way to intervene or put pressure on the hospital to improve the situation at Palmetto General.
In Massachusetts, Gov. Maura Healey used eminent domain to seize control of a struggling Steward-owned hospital last year while the health system was undergoing bankruptcy to help keep it open and transition it to new owners. Massachusetts legislators, who had a longstanding feud with Steward Health, also crafted a law, later signed by the governor, that is meant to increase regulator’s oversight over for-profit healthcare systems in the state.
“I do not understand how it’s possible that we have so many people here in the community in Hialeah that take care of so many other things — how have they forgotten Palmetto?” Marti Parra said. “How have they let this hospital get to where it is and the things that are happening here?”
