The future of Bryan W. Whitfield Memorial Hospital’s labor and delivery unit dominated discussion at Tuesday’s town hall meeting at Rooster Hall.

All but one resident who spoke up at the hour and 30 minute meeting was in favor of keeping labor and delivery open.

BWWMH announced a week ago that it would close labor and delivery at the end of February due to not having enough employees to staff the unit and satisfy medical malpractice insurers.

Whitfield CEO Mike Marshall has said he hopes the move is temporary and a task force formed to save labor and delivery will keep working on a long-term solution.

Several in Thursday’s crowd said they believe more should be done to keep labor and delivery open.

“I have been patiently sitting here and have been told why we can’t have labor and delivery. That’s basically what the message is,” said Woody Dinning, Demopolis municipal court judge and Marengo County Commission attorney. “I have a real problem with that. Maybe it can’t be done with what the income is [that] doesn’t mean all these people can’t fix the problem.”

Another recurring concern was that the hospital is expanding detox, psychiatric and behavioral health problems while cutting units like labor and delivery.

“Are your plans to turn our community hospital into a detox?” Mary Jo Martin asked Marshall. “I use this hospital. Everyone in here knows I am not against the hospital, but why can you not do this off-premise?”

Marshall responded by saying that it would cost too much to house those departments offsite, and there are security mandates that must be met for psych units.

“It sounds good in theory, but if you keep people overnight there is tremendous amount of cost that goes into that. It would be cost prohibitive,” Marshall said.

As far as detox, Marshall said there has been one incident in four years and that was with a patient who was discharged for not following program rules.

“The emergency room in one weekend has more problems than 3.5 years [of detox],” he said.

The programs are also money makers for BWWMH. Since it opened, the medical detox unit has added more than $5 million to BWWMH’s bottom line, with the geri-psych department adding another $3.1 million in revenue.

“We can’t throw our hands in the air. There are no packs of unicorns that are going to fly in and drop sacks of money off on the lawn of the hospital,” Marshall said. “Had we not done those two things, along with expanding outpatient volume, we wouldn’t be having the discussion about labor and delivery, you wouldn’t be having a hospital (potentially).”

Marshall said constantly changing Medicaid and Medicare payments have made those two units more profitable. It’s the same reason BWWMH plans to take back over its cancer center in April.

“We were this close to shutting the cancer center down,” Marshall said. “Seven years later, payment has shifted. We are going to be taking back over the cancer center April 1 because we can make money doing it. The money never gets bigger — all they do is shift the pieces.”

Since the the detox and psych units make money, several residents said they fear the hospital will turn its focus to those programs.

Marshall said 50 of 99 hospitals in Alabama has some from of psych-treatment and that on any given day the hospital, which is licensed for 99 beds, has 30 or more available.

“Over the last four years, inpatient admissions have declined by 29 percent. It has nothing to do with physicians and quality care,” Marshall said. “The demand for inpatient services is going to continue to decrease. [For Medicaid], the entire focus will be keeping people out of the hospital.”

Former Demopolis Mayor Cecil Williamson asked if an independent audit of the hospital could be done.

Marshall responded that the hospital is independently audited each year and has always clean audits in the past.

“I don’t have a problem with anyone looking at our books,” Marshall said.

The hospital has brought in consultants to look at its operation and billing departments in recent years, Marshall said.

He added the hospital’s administration size is the same today as when he started at BWWMH more than 10 years ago.

Still the overriding sentiment was that everyone wants the labor and delivery task force to find a way to save the unit.

“You saved oncology, which was great. This is one-fifth of what the cancer center was losing,” Lucy Chu said, adding doctors also aren’t paid enough for their time and level of care. “They do it because they care … It’s to serve the community.”

The task force will present its recommendations to the full hospital board by the middle of March. A vote on their suggestions should follow soon.

“We have begun to come up with some good ideas that we are going to continue to flesh out,” said Mayor Mike Grayson. “Everything is an opportunity if you take it the right way.”