On July 1, the last maternity ward in the Bieszczady Mountains will disappear from the map. The hospital is drowning in debts in parabanks

• The Lesko County Council is to consider changes to the county hospital statute that would eliminate the last maternity ward in the Bieszczady Mountains. The hospital is in debt for PLN 110 million
• The maternity ward in Lesko is a victim of the low number of births, but also - as one might assume - the lack of a hospital reform law that would enable financial support for the restructuring of the hospital
• The original version of the reform planned support for maternity wards with a smaller number of deliveries in areas where access to another maternity ward would be difficult. That is, among others, in Lesko
• Ultimately, there is no law, but there will not even be a pilot consolidation of three Bieszczady hospitals, which could allow maintaining the last maternity ward in this region - such an idea appeared earlier during talks with the Ministry of Health
• The situation is not clear-cut. Because now about half of those giving birth choose other hospitals, not the closest one. And according to experts, the number of births that guarantee safety is about 400. Here, half as many are born.
• The question is whether the journey will be safe? If the maternity ward is closed, women giving birth from distant towns in the Bieszczady district will have to travel up to an hour and a half to give birth.

The Social Council of the District Hospital in Lesko (Podkarpackie Province) has passed a resolution giving its opinion on the liquidation of the gynaecology-obstetrics and neonatal wards in this hospital. If this happens, the last maternity ward in the Bieszczady Mountains will disappear from the map. Such wards were previously closed in two other Bieszczady hospitals: in Sanok and Ustrzyki Dolne.

The maternity ward in Lesko is falling victim to the low number of births, but also - as one might think - the lack of a hospital reform act, which was supposed to provide a chance to support the hospital's repair program and debt restructuring. The Ministry of Health considered the concept of a pilot project testing the consolidation model of three hospitals in the Bieszczady Mountains according to the proposed act. It is known, however, that the idea will not be implemented.

The District Hospital in Lesko is indebted by PLN 110 million. This is the result of, among other things, high interest on loans taken out a few years ago in so-called parabanks. This is how even some institutes subordinate to the Ministry of Health saved their finances. The hospital is not repaying the debt because it is in the process of restructuring based on an arrangement with creditors, but despite this, there is a lack of money even for current operations.

- We have reached a wall. The situation is dramatic - said Małgorzata Bryndza, who has been managing the hospital since November 2024, during the recent (30 May) extraordinary session of the Lesko County Council. There is no money for regular purchases of medicines, the facility is late in paying salaries to contract staff. - The hospital needs financial help, here and now - she argues.

In the director's opinion, the only chance for the hospital to survive is to close down the obstetrics and gynecology department. Last year, it brought in a loss of PLN 5.8 million. From January to the end of May 22, 2025, 56 deliveries were made in the obstetrics and gynecology department of the hospital in Lesko, and 197 children were born there in the whole of 2024. Far too few for the department to be able to balance financially.

The hospital's problems became widely known in September 2023, when a demonstration of employees took place in the streets of the city protesting against plans to liquidate departments that were causing the hospital the greatest losses, including gynaecology and obstetrics.

- Patients from the Bieszczady district already have a problem, because they have to travel 30-40 or more kilometers to reach us. Please, let the decision-makers say who will take responsibility for the safety of a woman giving birth, who in winter in mountainous terrain will have to travel, after the liquidation of the ward in Lesko, to distant Brzozów or hospitals located further away - asked Magdalena Dąbrowska, representing the protest committee, chairwoman of the company trade union organization of the All-Poland Trade Union of Nurses and Midwives.

Who will take responsibility for closing down the last maternity ward in the Bieszczady Mountains?

Now the Lesko County Council is facing a difficult decision. Also because, in the public perception, the Lesko county government will be responsible for the consequences of the liquidation of the last maternity ward in the Bieszczady Mountains.

- We cannot allow ourselves to be drowned by taking sole responsibility for the fate of pregnant women because years earlier the local governments in Sanok and Ustrzyki decided to liquidate such units in their counties - emphasizes Małgorzata Bryndza.

As Rynek Zdrowia has verified, the obstetrics and gynecology department of the District Hospital in Lesko accepts women giving birth from neighboring counties. In 2024, out of 206 children born in SP ZOZ Lesko, 82 were parents of residents of the Lesko county, but as many as 69 children were from Sanok, 47 children from Bieszczady, and the remaining 8 were residents of other counties.

We also obtained data showing how often residents of the city and commune of Lesko choose "their" county hospital to give birth to their children. Data held by the Civil Registry Office in Lesko show that in 2024, 62 births of children of residents of the city and commune of Lesko were registered in this office. 34 women decided to give birth in Lesko, 9 in Brzozów, 8 in Rzeszów; the remaining 11 births occurred (max. 2 each) in several other cities.

About half of Lesko's residents give birth in the county hospital in this city . This may be influenced to some extent by the fact that abnormal pregnancies require treatment in another hospital. In Lesko, there is a lack of neonatologists in the neonatal ward; children are cared for by pediatricians. However, the clinic in Lesko is also chosen as the place of birth for a large group of residents of the Sanok and Bieszczady counties (Ustrzyki Dolne).

The District Hospital in Lesko has applied to the Podkarpackie Provincial Branch of the National Health Fund to terminate the contract from July 1, 2025 in the field of obstetrics and gynecology - hospitalization.

We asked the Ministry of Health for comment. - With the strikingly low number of deliveries, maintaining a maternity ward generates hospital debt, but at the same time does not ensure the functioning of this ward at a sufficiently high level, guaranteeing patient safety - the Health Market was informed by the Ministry of Health's Communication Office.

An hour or more to get to the hospital

What if women are not allowed to give birth at the District Hospital in Lesko? The Ministry of Health indicates that obstetrics services for patients from the Sanok and Bieszczady districts are provided by hospitals with higher reference levels: in Jasło, Krosno and Przemyśl. However, the closest, 37 km from Lesko, the agreement on coordinated care for pregnant women at level II perinatal care is implemented by the Specialist Hospital in Brzozów (obstetrics and gynecology department and neonatal department).

Using Google Maps, we checked the distances and travel times from three district towns (Ustrzyki Dolne, Lesko, Sanok) to the nearest maternity ward other than Lesko, i.e. Brzozów. The travel time from Lesko to Brzozów is 37 minutes. It is faster to get from Sanok to Brzozów, because the cities are 23 km apart, which - according to Google - takes 25 minutes to cover. So there is an alternative for those giving birth.

The situation is different, however, when the woman giving birth lives in Ustrzyki Dolne. Then you have to travel 62 km to Brzozów (the closest, if there were no maternity ward in Lesko), which takes 1 hour. You can also choose a hospital in Przemyśl located at a similar distance - 63 km, 1 hour 6 minutes to get there.

These travel times seem quite long. They correspond to those that must be reserved today for travel from Ustrzyki Górne to Lesko. However, assuming that the ambulance transporting the woman giving birth from there would have to pass both Lesko and Sanok without maternity wards, the travel to Brzozów would take 1 hour 37 minutes.

This is what the situation will look like if the last gynecology, obstetrics and neonatal ward in the Bieszczady Mountains disappears from Lesko.

There was an idea for a financial "drip"

The contemplated concept of consolidating Bieszczady hospitals gave some hope for leaving the gynaecology and obstetrics department in the Bieszczady Mountains. Since January 2, directors of hospitals in Sanok, Lesko and Ustrzyki Dolne and starosts from these counties have held several meetings with the Podkarpackie Voivode Teresa Kubas-Hul, during which attempts were made to work out such a concept.

The idea had been around for years, but until now, local governments and hospital directors had not been able to reach an agreement. This time it was supposed to be different.

- As directors of three Bieszczady hospitals, with the approval of local government authorities, we agreed that we need to consolidate departments to secure good quality health care for the residents of Bieszczady and to stop the growing debt of hospitals. We decided that it is necessary to stop duplicating departments. This would also end unnecessary competition between our hospitals for money for services and for staff, which we are currently ripping off, which increases wage rates and deepens the difficult financial situation of our hospitals, and does not improve access to services at all - says Małgorzata Bryndza.

The hope for the consolidation of three Bieszczady hospitals was given by the draft bill reforming hospitals presented by the Ministry of Health in July 2024. Among other things, it provided for support from the National Economy Bank in repaying debt for those hospitals that prepare rational repair programs and stop generating losses.

- I know that after meetings between the Voivode and the starosts at the Ministry of Health, the idea of ​​a pilot program emerged, which would allow for the transfer of financial resources for Bieszczady hospitals under such a program, before the hospital reform act comes into force. These funds were to be a "drip" enabling them to survive until the consolidation process - Małgorzata Bryndza tells us.

The Ministry does not plan to pilot hospital consolidation

As Grzegorz Panek, director of SPZOZ in Sanok, explains, the Ministry of Health spoke rather about the initial concept of launching a pilot program. - Theoretically, a pilot consolidation of SPZOZ in Sanok, Lesko and Ustrzyki Dolne was accepted for consideration. The very fact of organizing a meeting at the Ministry of Health was an expression of the ministry's interest in this concept - he emphasizes.

Its implementation seemed possible. In February, in an interview with "Rzeczpospolita", Deputy Minister of Health Jerzy Szafranowicz indicated that he would not specify a deadline for completing work on the act. However, he announced the launch of a pilot reform for those facilities that decide to restructure and merge branches before the regulations come into force. The funds for this purpose were to come from the Medical Fund - the daily wrote.

- Despite earlier signals about the possibility of implementing the pilot in the Bieszczady region, the Ministry of Health did not present conceptual documents or formal criteria that would allow the project to be considered launched - says Grzegorz Panek.

Deputy Minister of Health Jerzy Szafranowicz, during a meeting on 26 March this year at the Ministry of Health, informed the directors of Bieszczady hospitals that at this stage the ministry does not plan to start a pilot program, focusing on systemic activities with a nationwide scope.

- I asked the minister directly whether there was any chance that our hospitals would receive financial aid while the new hospital reform bill was still being worked on. I received an answer that there was no such chance - says the director of the hospital in Lesko. Some experts, however, point out that the responsibility also lies with the hospital managers, who did not undertake appropriate restructuring actions in time.

The example of Bieszczady hospitals shows how much a plan for maternity wards is needed in Poland. When the Ministry of Health presented the first version of the draft bill on hospital reform in July 2024, which included the possibility of consolidating departments and hospitals, the justification for the bill included a criterion of 400 deliveries as the profitability limit of a gynecology and obstetrics ward. But also one that guarantees the safety of those giving birth - as indicated by gynecology and obstetrics consultants. Local governments protested, interpreting such a provision as releasing the ministry from supporting permanently unprofitable maternity wards and announcing their closure. Arguments were made about the need to maintain some of them in order to ensure the safety of those giving birth. Ultimately, in subsequent versions of the bill (we already have the fourth version - editor's note), the ministry did not mention reforming maternity wards. Therefore, there is no plan, and the problems have remained and will continue to grow due to the growing demographic crisis.