Sometimes it is helpful to predict the pushback and do research in advance to address these predicted responses that push back.
When a private hospital announces the closure of a critical healthcare service, a county government cannot simply order the hospital to reverse course. However, counties are not powerless. Across the United States, local governments have used public pressure, recruitment incentives, partnerships, transparency requirements, and targeted funding to stabilize essential healthcare services in rural and isolated communities.
In the case of Los Alamos Medical Center, residents are not only asking leaders to oppose the closure of labor and delivery services. They are also proposing specific ways the County and hospital could work together to increase delivery volume, stabilize staffing, and rebuild public trust in local maternal healthcare.
- Workforce Recruitment & Retention Programs
One of the clearest community concerns is provider instability. Residents argue that labor and delivery services cannot grow if families are uncertain whether services, providers, or staffing levels will remain consistent from year to year.
The County could work with LAMC to support:
• recruitment bonuses
• housing incentives
• student-loan repayment
• childcare support
• relocation packages
• partnerships with residency programs
• retention incentives for full-time OB/GYNs, midwives, anesthesiologists, and labor & delivery nurses
Expected pushback to this idea:
“There is a nationwide shortage of OB providers and rural recruitment is extremely difficult.”
Possible response:
Many rural communities successfully recruit providers by combining financial incentives with long-term community stability and quality-of-life advantages. Consistency itself may help rebuild patient demand.
- Stabilizing Services So Families Know What to Expect
Residents repeatedly argue that uncertainty surrounding closures, staffing changes, redirected patients, and inconsistent provider coverage has weakened public confidence in delivering locally.
The County can publicly advocate for:
• maintaining predictable labor and delivery operations
• minimizing abrupt service interruptions
• clear communication regarding available women’s health services
• transparent explanations of prenatal, delivery, and postpartum care availability
• reduced variation in care between providers
Expected pushback to this idea:
“Hospital operations must remain flexible due to staffing realities.”
Possible response:
Predictability and transparency are themselves healthcare access issues. Families are less likely to plan local births if they believe services may disappear unexpectedly.
- Expanding Acceptance of Local Expectant Mothers
Petition organizers argue that hospital delivery numbers may not fully reflect local demand because some expectant mothers report being redirected to outside facilities during periods of provider shortages or staffing instability.
The County could request public clarification regarding:
• patient acceptance policies
• referral practices
• circumstances under which pregnant patients are redirected
• whether more local births could be supported under a stabilized staffing model
Expected pushback to this idea:
“Patient transfers are sometimes medically necessary.”
Possible response:
The community is not opposing medically appropriate transfers for high-risk care. Residents are asking whether more low-risk pregnancies could safely remain local if staffing consistency improved.
- Supporting Providers in a Lower-Resource Rural Setting
Residents argue that rural hospitals require a different operational mindset than large urban medical centers. Providers may need additional support, cross-training, and institutional backing to feel confident practicing in smaller-volume environments.
The County could explore partnerships supporting:
• rural obstetrics training
• emergency obstetric simulation programs
• telemedicine backup systems
• regional specialist partnerships
• continuing education incentives
Expected pushback to this idea:
“A smaller hospital cannot provide the same resources as a major regional center.”
Possible response:
Rural healthcare systems across the country routinely use partnership models and targeted training to safely manage lower-risk maternal care locally while transferring higher-risk cases when necessary.
- Operational Subsidies for Essential Maternal Healthcare
If labor and delivery services are operating at a financial loss, the County could explore whether targeted public support mechanisms are possible.
Potential models include:
• temporary stabilization funding
• maternal-health grants
• recruitment assistance funds
• regional healthcare partnerships
• state or federal rural-health funding opportunities
Expected pushback to this idea:
“Taxpayer dollars should not subsidize a private corporation.”
Possible response:
Counties routinely invest public funds into infrastructure and services considered essential for community safety and economic stability. Residents increasingly view maternal healthcare access in the same category.
- Emergency Obstetric Preparedness Requirements
Even if labor and delivery services are reduced or eliminated, residents are asking whether the Emergency Room will remain fully capable of handling obstetric emergencies, precipitous labor, neonatal distress, and emergency deliveries.
The County can request detailed public clarification regarding:
• emergency obstetric protocols
• neonatal emergency capability
• transport coordination
• staffing levels
• anesthesia availability
• ambulance response planning
• contingency planning during severe weather or road closures
Expected pushback to this idea:
“The ER already has emergency protocols.”
Possible response:
Residents are specifically concerned about maternal and neonatal emergencies occurring in an isolated mountain community with long transport distances and limited cellular coverage in some areas.
- Independent Review of Regional Capacity & Public Safety Impact
Residents have raised concerns about appointment availability, staffing shortages, and continuity of care within the proposed regional model involving Española and Santa Fe facilities.
The County could commission or request:
• a maternal-health impact analysis
• travel-time modeling
• emergency transport analysis
• regional appointment-capacity review
• independent assessment of maternal-care access gaps
Expected pushback to this idea:
“This duplicates existing hospital planning.”
Possible response:
An independent public review ensures that local public-safety priorities are evaluated transparently and not solely through internal financial models.
- Public Hearings & Transparency Requirements
County Councils cannot directly manage private hospitals, but they can create public forums where healthcare leaders explain decisions, answer questions, and respond to community concerns.
The County can hold:
• public hearings
• healthcare roundtables
• maternal-health workshops
• stakeholder meetings with hospital leadership
Expected pushback to this idea:
“The hospital is privately owned.”
Possible response:
Hospitals operate as critical public infrastructure and depend heavily on public trust, emergency systems, Medicare, Medicaid, and community partnerships.
- Preserving Prenatal, Postpartum, & Educational Services Locally
Even if full labor and delivery services become limited, residents are asking that local support services remain available within Los Alamos County.
This could include:
• prenatal appointments
• postpartum care
• lactation support
• childbirth education classes
• maternal mental-health support
• high-risk pregnancy monitoring
• newborn follow-up services
Expected pushback to this idea:
“These services do not replace a labor and delivery department.”
Possible response:
Residents agree. However, maintaining continuity of care locally still improves outcomes and reduces healthcare fragmentation for families.
- Using ACOG Guidance to Shape Local Policy Discussions
Petition organizers point to guidance from the American College of Obstetricians and Gynecologists which cautions that closure of low-volume obstetric units can create unintended maternal-health risks and reduce healthcare access in rural communities.
The petition specifically highlights ACOG language stating:
• “Closing hospitals with low-volume obstetric services could have counterproductive adverse health consequences and potentially increase health care disparities by limiting access to maternity care.”
• “This information should not be interpreted to imply that hospitals with low delivery volumes are not safe for care of women with low-risk pregnancies, or as a call to close hospitals with a lower volume or acuity.”
Residents argue that these recommendations support strengthening partnerships and referral systems while still maintaining local delivery capability for lower-risk pregnancies whenever safely possible.
Expected pushback to this idea:
“ACOG also supports regionalized care and higher-level referral systems.”
Possible response:
Petition organizers agree that regional partnerships are important for high-risk cases. Their concern is that partnership and referral systems should complement local care, not entirely replace it for a geographically isolated community like Los Alamos.