My name is Andrew Castrodale and I’ve been a practicing physician in Grand Coulee Washington for 24 years.

Coulee Medical Center (CMC) is a 25 bed Critical Access Hospital in North Central Washington next to the 1.4 million-acre Colville Indian Reservation. Higher level of care is approximately 100 miles away making Family Medicine truly “full spectrum”. I grew up on the reservation and came home to practice 24 years ago after undergraduate and medical school training at the University of Washington followed by a Family medicine residency and a final year in an Obstetrical fellowship in Spokane.

As pointed out by the Washington State Department of Health, the rate of death in pregnancy is the highest in our Native American population. There are several theories put forward, however after delivering babies in our rural site for the last 2 decades, I find that the most significant hurdle to equitable care is the physical infrastructure to provide the service and even more difficult is attracting, developing and retaining the skilled human infrastructure to provide ongoing obstetrical care in rural settings. 90% of this is obstetrical and surgical nursing available 24 hrs/day.

SB5751: has no obvious remedy for this catastrophic problem we face in rural obstetrics. The number of nurses required by this bill for “call” and care in the obstetrical arena will result in the inability to provide care to our patients. We will not be able to provide Obstetrical care for our patients: Tribal and non-tribal. Additionally, the nurses that do Obstetrics with us are some of our all-around super stars. They will move to larger hospital settings to practice the nursing they love.

It is my opinion, informed from nearly 25 years of direct patient care that this bill as written will lead to the further collapse of rural health systems and really the end to rural Obstetrics. As a result, the equity gap will increase for rural communities-Tribal and non-tribal. The Native American mortality rate in pregnancy will increase and predictably so from my viewpoint.

I don’t think this is the outcome that the authors of the bill anticipated or would want.

Respectfully,

Andy Castrodale MD