Chico’s first nurse-midwife jumps ship

Lisa Catterall has delivered more than 3,000 babies at Enloe Medical Center since 1984, when she established the first nurse-midwifery service in Chico. Now, after 25 years, her run of delivering babies in Chico is about to end—and not because she wants it to.

Catterall is a certified nurse-midwife who runs OB/GYN Associates of Chico Nurse Midwifery Services Inc. Starting May 1, she is ending her longstanding association with Enloe Hospital after it declined her proposal that it take on her nurse-midwifery service to become, in effect, part of Enloe’s staff, following a “hospital-based” model of health-care operations similar to those of Kaiser Permanente and Sutter Medical Center in Sacramento.

From May 1 onward, Catterall will deliver babies at Feather River Hospital in Paradise, sharing on-call duties with the three nurse-midwives at Paradise Midwifery Service. She will continue to provide prenatal and gynecological services for her patients at a scaled-down version of her Chico practice on The Esplanade.

Catterall cites the increasingly prohibitive costs of running a mid-level-practitioner private practice—including the recent 10 percent decrease in Medi-Cal reimbursement—as being a main reason she went to Enloe officials to ask that they absorb her practice under Enloe’s management.

“Small private practices are not sustainable in this economy,” said Catterall, whose overhead includes paying a billing person, a receptionist and a health worker who provides nutritional and social counseling for her maternity patients. Add to that the salaries of the other midwives employed by Catterall to share duties, plus rent, malpractice insurance and paying the two backup physicians required by law to be available in case of birth complications, and it’s no wonder that Catterall is deeply in debt—her house is on its third mortgage.

“I did what I could [to make it easy] for Enloe [to take over the management of the practice],” Catterall explained. “I basically told them, ‘I’ll hand you my practice on a platter—my office, my staff, plus my back-up doctors.’ It’s up and running; there would be no down time.”

But, she said, Enloe declined after a vote taken by the eight local obstetricians who deliver babies at the hospital resulted in a majority being against having her practice under Enloe’s umbrella. “I really think they thought I would just close,” said Catterall of the obstetricians who voted no, “and they would get all of my business.”

As a result, she said, “I had two choices: Close [the Chico practice] and move elsewhere—I could have gone to Woodland, Yuba City, or Kaiser—or continue practicing [in Chico], in association with Paradise Nurse Midwives, to share call [at Feather River] with the three nurse-midwives up there. I approached them and their back-up physicians, and they were totally welcoming.”

Laura Hennum, vice president of strategy, communications and marketing for Enloe Medical Center, emphasized that the hospital is “exploring a clinical-foundation model” similar to Sutter’s and Kaiser’s to be implemented down the road. Such a model would have physicians and mid-level practitioners contracted to the hospital in a “more direct relationship” than is currently the case.

“We are working as fast as we can to develop a hospital-based and community-based program,” said Hennum. “It will be a major investment of 15 to 20 million dollars over the course of five years.”

Basically, Hennum said, Catterall came to them too soon for Enloe to be able to accommodate her.

“We are absolutely looking for a way to provide this kind of support—[to] the broadest level of mid-level practitioners and physicians,” said Hennum. “OB is only one component of what we’re trying to do. We have a committee of 14 different physicians meeting on a regular basis to work on this. We’re going to Sutter next month to see how they set it up.

“Lisa unfortunately isn’t the first [private practitioner] and she won’t be the last [to be affected by the increasingly difficult economic environment],” added Hennum. “I think California is becoming a very challenging place to practice medicine.”

Catterall said the situation “really is unfortunate, and I wish it could be different, because Chico’s my hometown, and this community should provide all the options [for childbirth]….

“I love to deliver babies. Delivering babies is my ‘true north.’ It’s magic.”