UCI to Reject Women in Labor When Facilities Full

UCI Medical Center, saying the health of its patients is threatened by overcrowding, will turn away women in labor when both its emergency room and obstetrics unit are full.

Although the medical center has the capacity “to safely deliver” 250 babies a month, “for the past several months (it) has been delivering at or above 500” babies a month, according to a letter delineating the policy change that was signed by hospital executive director Mary A. Piccione and Dr. Thomas J. Garite, acting chair of obstetrics and gynecology.

The result, Garite said, has been women laboring on stretchers in hallways, as well as some “bad outcomes” for mothers or babies when Cesarean sections had to be delayed because no delivery room was available. In one case, he said, an urgently needed Cesarean was delayed 90 minutes and the baby ended up in the intensive care unit with respiratory complications.

“People keep coming to UCIMC with no prenatal care and from the (Orange County) health department because they’ve heard this is a good place to have their babies. What we’re telling them is that this is a very unsafe place at this time,” Garite said.

To avert what Garite fears will be “a disaster,” medical center officials will no longer always accept every woman “in active labor” who comes to the hospital.

May Be Unprecedented in UC System

Instead, according to the new policy, which may be unprecedented in the UC system, women in active labor will be directed to other hospitals when the medical center obstetrical unit is full and the hospital emergency room is on “bypass”--full and no longer accepting ambulances.

However, even when the medical center enters “obstetrical diversion,” the hospital will still give priority admissions to women in labor who have received prenatal care at the medical center, the letter said.

Garite said he wanted other hospitals to share the responsibility of caring for these obstetrical patients. Medical center officials have estimated that 90% of the women in labor that the medical center treats are indigent and that most have received no prenatal care.

Garite and Piccione’s letter was mailed or delivered Friday evening to other medical center officials and to county health clinics, hospitals and ambulance companies. A copy of the letter was obtained by The Times.

Reaction to the news was difficult to gauge Saturday, but a leading hospitals representative questioned the new policy’s legality.

“This seems to be really on the edge” of the law, said Jon Gilwee, vice president of the Hospital Council of Southern California. Gilwee said hospitals are required under state law to care for patients in an emergency situation--”and active labor is certainly one.”

Gilwee also questioned how successful the diversion effort would be when “everybody (every Orange County hospital administrator) is dealing with a situation of uncompensated care and indigent patients.”

Latest Reverberation in Crisis

Still, it was clear Saturday that the medical center’s decision to start turning away some patients was the latest reverberation in a continuing crisis over health care in Orange County.

In the last several years, local hospitals have complained that they have been saturated with indigent patients. Some have refused to renew Medi-Cal contracts, saying they are not sufficiently compensated when they care for poor patients.

In recent months, medical center officials have protested the loudest, saying poor patients, shunted to their former county hospital in Orange, have made teaching and research increasingly difficult. The officials have argued that they care for 65% of the county’s poor with only about 6% of the hospital beds.

And citing those problems and a deficit expected to reach $13 million this fiscal year, medical center officials in March threatened to withdraw from the Medi-Cal system.

Hospital officials are expected to announce later this week whether they will continue their contract.

Garite, meanwhile, said the new policy on women in labor had nothing to do with continuing negotiations involving the state commission that sets Medi-Cal reimbursement rates.

“I’m not trying to make a statement,” he said. “I’m trying to safely take care of my patients. If that results in action by other hospitals or a state agency, so be it.”

Still, the main problem cited by Piccione and Garite in Friday’s letter is also a key issue in the Medi-Cal negotiations: overcrowding.

UCI Medical Center, with three delivery rooms, three emergency beds and 11 labor beds, is sometimes filled with more than 25 patients a day, Garite said.

Not only do women labor on stretchers in the hallways, but they labor in the obstetrics unit waiting room because there are no beds available, said B. J. Snell, associate director of nursing.

“There are so many numbers we’re concerned we’re not going to be able to get women in and be evaluated. We’re concerned she’ll be in the waiting room when she has her baby. . . . There have been times that when we finally get them in (from the waiting room), they are so far dilated that they have their babies within 10 minutes,” Snell said.

Snell and Garite both said they worried that women with high-risk deliveries might not be evaluated quickly enough to help them because there are not always the nursing staff or beds to go round.

That congestion not only perils laboring mothers but threatens the safe care of the medical center’s smallest babies, who are cared for in Orange County’s most sophisticated neonatal care unit.

Because the neonatal unit is so often full, some babies sometimes have to be referred to other hospitals, Garite said.

According to Garite and Piccione’s letter, “this overcrowding in the delivery rooms carries over to the nursery and even to the Neonatal Intensive Care Unit. The result is that we cannot guarantee patient safety under such conditions.”

Garite said the letter explaining these conditions puts other hospitals and clinics on notice that the medical center will not tolerate them shunting all patients in labor to the medical center.

“We are requesting health care providers in Orange County to cease and desist from issuing maps to individuals showing only UCIMC as the hospital for obstetrical services,” it said.

Garite said that this statement was not meant to be “vindictive” but that he and Piccione were concerned that some hospitals and Orange County Health Care Agency clinics often give laboring patients a map showing them how to get to the medical center. The county clinics offer prenatal care but do not perform deliveries.

“They say, ‘Go somewhere to have your baby.’ ” Garite said.

But now, he continued, the medical center should not be considered the only place to go.

Garite said he anguished over the new policy. “I have great anxiety about this. . . . I wouldn’t be doing this without being afraid someone may have a complication who’s being turned away” from the medical center, he said.

Getting Wise

“But what if they continue to have bad outcomes in my delivery room? When you have 25 patients in labor and delivery (in one day) in a unit that’s safely capable of taking half that many? You know from experience in obstetrics that you’re waiting for a disaster to happen.”

Garite said he hoped laboring women would get the word from clinics and other hospitals that they can “turn around and go to a hospital that will more safely take care of them.”

“I hope other people will get wise to the system,” he said, because “their health-care system is breaking down.”

Starting at 5 p.m. Friday night, the medical center broadcast to other hospitals that it was on its first “obstetrical diversion,” Garite said. At that time, however, the only laboring patients who came to the hospital center were women who had received their prenatal care at the medical center, so they were all admitted. He said the hospital went off the obstetrical “deflection” about 11 p.m. Friday.