The report was written by senior nursing staff who interviewed a total of 30 witnesses, including staff who work or have worked in the obstetrics triage department.

“Some women need a trusted endocrinologist or a trusted obstetrics and gynaecology specialist for that next level of management.”

Its cardiology and obstetrics and gynecology departments are the only ones in the city, he said; now patients must leave the city to find those services.

Without those add-ons, attracting and keeping staff and providing certain types of care — such as obstetrics — became far more difficult, Stark said.

“At every point, it’s kind of shocking,” said Dr. Daniel Grossman, a professor of obstetrics and gynecology at the University of California, San Francisco who reviewed Porsha’s case.