9 Clinics Overwhelmed : Baby Boom Gives Birth to Prenatal Care Crisis

By LYNN O’SHAUGHNESSY

May 21, 1989 12 AM PT

<i> Times Staff Writer </i>

It was close to quitting time, but the waiting room at the Van Nuys public health center was filled with pregnant women. Many, in their last stages of pregnancy, had waited hours to see a doctor.

As Dr. Norman Kaplan, the clinic’s obstetrician-gynecologist, rushed along the threadbare carpet from one examining room to another, he had one thing to say: “We need more doctors!”

Kaplan is trying to cope in what Los Angeles County health officials call the “Fertile Fifth.” The term was coined by 5th District Supervisor Mike Antonovich to describe the unprecedented baby boom in his area.

Outpacing the rest of the county, the 5th District’s nine public health clinics in the San Fernando, Santa Clarita and Antelope valleys have been flooded with pregnant women, most too poor to pay for private care. The situation has prompted the clinics’ medical staffs to worry that care will be jeopardized if relief does not come soon.

The number of pregnant women pouring into the centers--many of which are cramped and decrepit--jumped 76% from January to April. But the need for prenatal care has been snowballing for years in the north part of the county, in part because of a huge influx of Latino immigrants, health officials said.

In the 1984-85 fiscal year, the clinics handled 17,590 prenatal visits. If the trend continues to June 30, the end of this fiscal year, the clinics will have treated 35,320 women--a 101% jump over five years.

“The entire north county is in a crisis in prenatal care,” said Karen Menacker, the public health nursing supervisor at the Van Nuys clinic.

That would come as no surprise to the hundreds of expectant mothers who earlier this year waited an average of almost two months for their first appointments. Average waits were longer at facilities in Canoga Park, Pacoima and Valencia--ranging from 78 days to 107 days.

Because of a four-month backlog at the Valencia clinic, women would have had to make an appointment before they conceived to ensure receiving a critical blood test that detects abnormalities early in pregnancy. And three months ago, a woman who had waited weeks for her first appointment was in labor when she arrived at the Van Nuys clinic and was whisked away to a hospital.

Pregnant women who never see a physician or who must wait until the last trimester risk medical complications for themselves and their babies, said Dr. Paul Toot, chief of obstetrics at the county’s Olive View Medical Center in Sylmar, where many of the clinic patients have their babies. Such infants are more likely to be born underweight or to start their lives in intensive-care units, he said.

At other county clinics, a pregnant woman who called in February had to wait less than three weeks on the average before her first visit. In the San Gabriel Valley, the wait was slightly more than a week, and in the coastal communities, it was two weeks. Only in South-Central Los Angeles was the wait as long as four weeks.

The situation was compounded for those on the prenatal front lines in the northern part of the county when tentative budget cuts were announced by the county earlier this month. The cuts will become effective later this year if the state does not provide more money for local health care, county officials said.

Slated for extinction is the Burbank clinic, where the clients are primarily pregnant women and those seeking birth control. During an average month, 1,594 people use this center, and county physicians predict that a ripple effect will result in even longer waiting lines elsewhere if the clinic closes.

When it became obvious that the north county clinics were overbooked, the county in February ordered emergency measures taken.

To free the staff for prenatal duty, clinic physicians and nurses began spending less time treating those who might have diabetes, hypertension, chronic backaches or other health problems. Sessions for the detection and treatment of venereal disease and tuberculosis were combined for the same reason. Meanwhile, extra nurses hired to spend more time with pregnant women with gestational diabetes and other complications instead have been helping with the overflow.

As a result, the average wait for women seeking first appointments dropped to three weeks by mid-April. But there was no celebrating since everything done to ease the congestion had only encouraged more pregnant women to appear.

After the county measures were instituted, women began hearing that waiting periods had lessened, and appointments were scheduled by those who might have waited until they were in labor to seek help, officials said. Consequently, by mid-April, there were 1,061 women signed up for first appointments--compared to 924 in February.

“It’s like putting a finger in a dike, and it just isn’t stopping it,” lamented Dr. Dorris Harris, medical director of the north county clinics. “Even though we are seeing more patients, more patients are showing up.”

The clinic medical staffs are dreading August and September, when the clinics will be bombarded by children who need immunizations to enter school. At some facilities, nurses typically set up card tables on lawns to handle the crush.

Larry Roberts, the county’s depty director for health center operations, is hoping extra money comes from the state to prevent the closing of the Burbank clinic and to provide relief for overburdened facilities. But he is not sure whether the health department will receive any of the $2.5 billion in additional revenue that the state discovered last week. He expressed frustration at his limited options.

“We cannot stop the women from getting pregnant,” Roberts said. “What do we do? We don’t have any more money.”

The reasons for the baby boom are easier to grasp than solutions to the clinics’ prenatal crunch.

With fewer obstetricians welcoming Medi-Cal patients, the public clinics have become a last resort for more people, clinic officials said. Meanwhile, the population of the county’s northern tier continues to grow, and many of the newcomers are from Latin America, county officials said. Some of these immigrants are seeing a physician for the first time, and many are not practicing birth control for religious reasons, officials said.

But even the middle-class communities in the Santa Clarita Valley are contributing to the prenatal push. The Valencia staffers were surprised when they began seeing suburban housewives in examining rooms. Some were between insurance policies when they conceived or did not have the money for insurance after paying their mortgages or other bills, clinic officials said.

Phyllis Rothwell, holding her stomach as her fetus fidgeted inside, said she lost her insurance coverage last year when she quit her job as a nurse to study for her real-estate license. By the time she and her husband, a masonry contractor, looked for a new policy, she said, she was pregnant, and no insurance company would accept her.

Rothwell had been receiving her prenatal care at Holy Cross Medical Center’s maternity clinic. But the hospital wanted $1,600 in advance for the delivery, which was not possible after the couple was hit with a tax bill for thousands of dollars, she said.

“We have good credit. We have good credit cards. No one would let us make payments; I couldn’t believe it,” complained Rothwell, who said she is happy with the care that she is receiving.

Anyone qualifies for the clinics’ services. The medical care is cheap compared to that of private physicians. The first seven prenatal visits are $25 apiece, and subsequent visits are free.

Most of the clinics’ patients will deliver their babies at Olive View Medical Center, which operates the busiest obstetrics department in the San Fernando Valley. Olive View is designed to handle 300 deliveries a month, but because of the prenatal explosion at the clinics, it is handling 400 a month.

In addition, the hospital’s clinic for women with prenatal complications is bulging. In July, 1,461 women visited the clinic, but eight months later, 2,269 were treated.

And Olive View Administrator Douglas Bagley said he expects the fertility tidal wave to intensify.

At the Van Nuys clinic, Kaplan, the obstetrician/gynecologist, said he has been forced to shorten the amount of time that he spends with patients.

“I don’t know how much good you’re doing going through the motions,” he added. “Maybe the county feels going through the motions is better than receiving no health care at all.”

But Kaplan’s patients do not seem to notice being whisked through their appointments. And though they might have to wait hours to be seen once they arrive at the center, they are mostly appreciative.

“They treat me well. It’s a good service,” Matilda Reyes, 34, said through an interpreter. She considers the small windowless waiting room at the Van Nuys clinic a “social club.”

The faster pace, however, has taken a toll on clinic staffs, officials said. Keeping morale up at the centers--which have worn linoleum, faulty air conditioners, mix-and-match furniture, faded health posters and institutional paint jobs--is a necessity to stave off nursing defections, Harris said.

The staffs give each other Danish rolls and juice breaks and throw impromptu office parties.

“Every once in a while you need a pep talk,” explained Sondra Tilson, Pacoima’s nursing supervisor. “Little things help.”

THE DEMAND FOR PRENATAL CARE

Prenatal visits in North County public health clinics

VISITS

1984-85: 17,590

1985-86: 23,197

1986-87: 25,860

1987-88: 29,874

1988-89*: 35,320

* Projected. July 1988 to April 1989 29,434 (Two months shy of the complete fiscal year).

Number of Weeks Waiting for Prenatal Appointment: For new county patients during a two-week period ending Feb. 10, 1989.