Stork Stops Often at Olive View Hospital; Finds Beds in Halls

When Paulette Nakamura was hired last November as nursing supervisor for labor and delivery at Olive View Medical Center in Sylmar, she swore she would never leave expectant mothers on gurneys in the hallways.

But black smudges and scrapes along walls in the delivery wing are silent testimony to the avalanche of patients that has forced Nakamura to break her promise many times.

“I stamped my foot and said, ‘There will be no beds in the halls!’ ” she said. “Now we have numbers for the hallways . . . like room numbers. We’ll say, ‘They’re in hallway 1, 2, 3 or 4.’ ”

Olive View, a Los Angeles County hospital, is the only San Fernando Valley refuge for pregnant women who have neither medical insurance nor sufficient money to pay for their own deliveries. Four weeks after the official Nov. 16 opening, the maternity ward already was the busiest in the Valley.

Shortage’s Causes Noted

Doctors, nurses and administrators there said the growing ranks of northeast Valley poor, combined with a high number of devout Catholics opposed to birth control and with private hospitals’ increased reluctance to take charity cases, have triggered an expanding need for their services.

Asked how the medical staff handles the workload, chief physician Dominic Muzsnai shrugged and said, “I don’t know how we manage.”

Typical of the Olive View client is Elvia Infantado of Van Nuys, a Guatemalan immigrant who gave birth to her fifth child Tuesday.

“I can’t afford to pay for a private hospital, so I came here,” Infantado said. “It’s new and it’s nice.”

One of Infantado’s other children was born at Women’s Hospital in East Los Angeles, a county hospital where most Valley patients were sent before Olive View opened.

Downtown Trip Difficult

Because of the distance, the traffic and the unfamiliar turf, a trip downtown in labor could be a harrowing experience.

“We drove 100 miles per hour, all the way, that time,” said Nora Velarde of Pacoima, comparing the birth of her first baby five years ago at Women’s Hospital to the more tranquil entrance of her second child early Wednesday morning at Olive View.

Original plans were for Olive View to handle 3,200 births during its first year of operation. When county supervisors approved a $5.4-million hospital addition three years ago, they said they hoped it would lessen the practice of sending pregnant women across town to Women’s Hospital or to private Valley hospitals with county contracts.

But even before a full staff of nurses has been hired, Olive View Administrator Douglas Bagley estimates that the maternity ward is running at an annual rate approaching 4,200 patients, or between 11 and 12 deliveries daily. Some days there have been as many as 18 babies born.

“The volume here grew very rapidly,” Bagley said. “It was low for the first couple of weeks, and then it really took off.”

Crowding means patients are spilling over into other wings of the hospital and are being sent home early. Women who arrive in the best health and who are the furthest in time from hard labor still are likely to be referred to private hospitals with county contracts.

Bagley said patients in labor are transferred “where possible, if there’s enough lead time on the delivery.”

“That’s really not all that successful, to be honest,” he said. “Usually by the time they get here, it’s too late to divert them.”

No one ever suggested that Olive View would be a permanent escape valve for the Valley’s soaring birth rate, but even Barbara Fletcher, nursing director for Maternal and Child Health Services, was surprised by how quickly her beds filled up.

“I expected a lot, because I came from Women’s, and I knew,” she said. “But this has been even worse than I expected.”

Staff Shortage Noted

Adding to the ward’s problems is that more than half of the nursing and support staff positions necessary for the projected 3,200-patient load remain vacant, according to Fletcher. The greatest staff vacancy rate is in the wing where mothers rest after giving birth.

Nurses are logging lots of overtime and taking on extra shifts. Fletcher worries about them becoming too tired to do their jobs well. With a chronic nursing shortage existing nationwide, hiring for county hospitals is especially difficult, she said, chiefly because salaries do not match those in the private sector.

Temporary nurses are being used to fill many of the openings, but Fletcher said that is an expensive and flawed alternative.

“Sometimes their loyalties are not all that wonderful, and they are not familiar with our procedures,” she said. “But the biggest disadvantage is to the patient. . . . We lose that continuity of care.”

The congestion at Olive View is no revelation for Dr. Dorris Harris, chief physician for the north Valley’s nine county health centers, whose staff often sees the pregnant patients first during prenatal clinics.

Harris said she didn’t think county officials “believed that we had that many patients when they started the hospital. We kept telling them, but they didn’t really believe us.”

In general, Harris praises Olive View. She said health center staff members appreciate being able to send patients to the nearby hospital instead of trying to track their progress through the referral system.

Patients also like being able to deliver at a hospital closer to their homes and the amenities of Olive View, she said.

Harris’ only criticism is that the intense use of the maternity ward leads medical staff there to favor the mothers who have potential problems, including those who don’t seek medical care until they are ready to deliver. Instead of receiving preferred treatment at Olive View, the reward for mothers who plan ahead and attend county clinics is a ticket into the transfer system, she said.

“I just wish they would be able to deliver more babies” at Olive View, Harris said. “They have reached their peak, and I don’t know how they’re going to cope. I really don’t.”

One step recently taken to ease overcrowding is the renewal of county transfer contracts with two Valley private hospitals--Burbank Community Hospital and Valley Hospital in Van Nuys--as well as with the UCLA hospital. In all, those three hospitals will accept 190 patients a month from around the county this year, lightening Olive View’s load slightly.

So far, no Valley patients have had to be sent downtown to Women’s Hospital, Bagley said. That is reassuring for Women’s Hospital Administrator Martha Aguayo Galaif, who is enjoying the respite.

“We were in an overload situation. We were in an unsafe situation,” Galaif said. “We are in right now what we consider to be a manageable situation.”

With projections setting the Valley’s share of county hospital births above 5,000 next year, Olive View administrators acknowledged that private contracts are little more than a stopgap.

But expansion at Olive View is limited by available space.

Because a maternity ward was an afterthought to the newest county hospital, it had to squeeze into an existing ward. One day last week there were vacancies in only a couple of the 24 beds set aside for mothers.

Charge nurse Latisha Stewart labled it an unusually slow day.

Olive View Medical Center--minus maternity services--began operation in May, 1987, as a replacement for a hospital destroyed 16 years earlier in the Sylmar earthquake. The maternity ward was not part of the original plans because the federal government agreed only to duplicate the former hospital.

County supervisors didn’t want to pick up the tab, either, until predictions of spiraling birth rates were combined with tales that would make any politician cringe: Women in labor were waiting in cars parked outside the Valley’s private hospitals until they were too far along to be denied admission, witnesses at county hearings said, and babies at Women’s Hospital were being born on gurneys because there were not enough beds.

Although Olive View has not suffered such extremes, crowding does lead to some inconveniences.

Mothers sometimes give birth under the hot lights of a traditional operating room instead of in a delivery room with muted lights and comfortable tables. After delivering, mothers may have to recuperate in another wing of the hospital, a floor away from their babies.

Those sent home early, after one day of rest instead of two, risk complications. But so far no problems have been reported, Bagley and Fletcher said.

Also, mothers who go into labor on a busy night occasionally spend time outside one of the nine delivery rooms on a gurney, an inconvenience that didn’t seem to bother either Nora Velarde or Dolores Mirzaie, who both said they spent about an hour in the hallway before delivering their babies last week.

“The nurses were really nice to me. They kept checking on me,” Mirzaie said. “It was OK.”

DELIVERIES AT OLIVE VIEW

Average Month births/day November, 1987 3.3 December 8.6 January, ’88 10.7 February 12.1 March 11.0 April 13.0