Tahoe Forest to launch trial-of-labor-after-cesarean this fall; CEO highlights growth, cybersecurity and federal funding risks

Tahoe Forest Hospital District officials told the board during a CEO update that the health system plans to begin offering trial of labor after cesarean (TOLAC, often called VBAC) this fall and that the program will be rolled out only after final logistical checks and staffing confirmations.

The announcement came as Anna Roth, president and CEO of Tahoe Forest Health System, summarized systemwide performance and strategic work. "We're working on these areas and...we're bringing it or calling it the true north initiative," Roth said, describing a multi‑year effort to strengthen care, improve access and optimize operations across the region.

Why it matters: TOLAC availability affects birthing options for people who previously had a cesarean and can reduce the need to travel to other facilities. The CEO update also framed several near‑term policy and financial changes—disproportionate share payments, a rural health transformation fund and other Medicaid adjustments—that could affect partner hospitals and the district's operating environment.

What officials reported: Roth highlighted a marked increase in outpatient visits and operating-room utilization. She said outpatient visits rose from 91,000 in 2018 to 161,000 in 2025, describing that as a 66% increase over that period. The district also reported roughly 70% operating‑room utilization in current months.

On the TOLAC proposal, Dr. Evans (identified in the meeting by title "Dr. Evans") described the clinical rationale and risk framework for offering a trial of labor after cesarean. "The thinking around how to deal with laboring women who have had a cesarean section in the past has evolved somewhat ... it's generally considered safer to do a trial of labor and try to get a vaginal delivery even if a patient has had a cesarean section in the past," Dr. Evans said. He added that with careful patient selection the risk of uterine rupture is "less than 1 percent." He said the hospital had worked with nursing leadership, OBGYNs, pediatricians and anesthesiologists, and that nursing staffing assessments support the launch.

Roth also told the board the system is tracking cybersecurity threats: "Over a million email threats were blocked in June alone," she said, as an example of daily operational work that guards patient data and system availability.

Federal and state policy context: Roth walked the board through policy items with potential financial impact. She summarized that certain program rates for services for people with developmental disabilities are being capped retroactively, and that changes to disproportionate share hospital (DSH) dollars and Medicaid waivers are expected to start affecting larger Medicaid providers in coming months. She also summarized the federal Rural Health Transformation funding opportunity and timing: a competitive $50 billion carve‑out for rural hospitals with a five‑year timebound program and applications due December 31; rules and eligibility were not yet released.

What the board asked and next steps: Board members asked about insurer support for TOLAC; Dr. Evans said the district's insurer, referred to in the discussion as "Beta," was supportive. Roth said the district will complete remaining logistical items and return to the board and public with engagement opportunities as the "true north" initiative proceeds.

Ending: The CEO framed the update as an overview of continuing operational improvements and external risks, and said the district will return with more detailed engagement opportunities and implementation plans for specific items including the TOLAC rollout and federal funding pursuits.