State to Investigate UCI Medical Center Turn-Away Policy

The state’s Health Services Division announced Monday that it will investigate the UCI Medical Center’s unprecedented “obstetrical diversion” policy in which some women in labor are turned away if the facility is overcrowded.

“I’ve clearly got some concerns with this (new policy),” said Dr. Patricia E. Chase, a consultant to the state’s Licensing and Certification Division, the enforcement arm of the Health Services Division which oversees hospitals.

Dr. Chase said the policy may violate the state’s “anti-patient-dumping law,” which was passed last year to keep hospitals from turning away emergency patients to other facilities.

“The intent of the law is to ensure that a woman in labor can get help. . . . It doesn’t say you can send them away,” said Dr. Chase, who is charged with enforcing the law.

Mary A. Piccione, UCI Medical Center executive director, defended the policy Monday and said she welcomes the state examination. She scoffed at the ironic turn of events.

“Here you have a medical center that handles over 60% of the medically indigent patients in this county and, yet, we only have 6% of the total number of county beds, and we’re the one’s being investigated,” said Piccione from San Francisco, where she is negotiating a new contract with the state’s Medi-Cal commission.

Over the weekend, the medical center instituted the policy in which women in labor are turned away if both the emergency room and obstetrics units are full, saying the health of its patients is threatened by overcrowding. The only exception to the new policy is women who have received prenatal care at UCI Medical Center.

University system and medical center officials defended that decision Monday saying that although many physicians and administrators at the center had “agonized” over the new policy, it does fall within the law.

“Turning away people is not something we do lightly around here. We have very ethical physicians, but this is symptomatic of the desperate straits that this hospital is in,” said Dr. Cornelius Hopper, vice president of health affairs in Oakland with responsibility for policy oversight of hospitals within the UC system.

“This policy of ours was reviewed by our legal counsel, and we are instructed that, in fact, it is not in violation of our legal obligations,” Hopper said.

Piccione said it was “one of the most painful decisions we’ve ever had to make.”

Under the “patient dumping” law, the state can fine physicians $5,000 and hospitals $25,000 that fail to provide necessary emergency care for the poor. The law, which took effect Jan. 1, 1988, bars the transfer of emergency patients before their conditions have stabilized, Chase said.

In addition, Chase said the medical center could risk its Medicare certification, which represents a substantial portion of the medical center’s revenue.

Medical center administrators have said that in the past several months the center’s capacity to safely deliver 250 babies a month has been exceeded to more than 500 babies a month.

Nurses and doctors complain that fetal monitors, which signal if a baby is in distress, are not always available and that patients often go through labor in hallways, where no oxygen units are on hand. In addition, overcrowding has resulted in a higher infection rate among women who undergo Cesarean sections, according to the medical center’s administrators.

While the enforcement division “sympathizes” with the medical center’s dilemma, Chase said its policy of diverting patients in labor is the same as “diverting ambulances” of patients injured in car accidents to other hospitals and potentially a violation of the law.

“The real issue,” Chase said, “is that (the law) does state that any patient needing emergency medical care shall be taken care of and this includes women in labor. So, any hospital with an emergency room unit is obligated to take care of these women.”

At UCI Medical Center, inadequate Medi-Cal compensation from the state may cause a deficit expected to reach $13 million this fiscal year, said medical center officials, who in March threatened to withdraw from the Medi-Cal system.

The medical center’s new policy is symptomatic not only of the hospital’s situation but also of a larger question facing Orange County, say experts in the medical field.

Hospitals like UC Irvine’s have been complaining about inadequate Medi-Cal compensation for years, a problem that has prompted some smaller facilities to shunt patients--with map in hand--to the larger hospitals.

“Our emergency room gets three to four patients every day with another hospital’s prescription pad with a map to our place,” said Paul S. Viviano, St. Jude Hospital and Rehabilitation Center executive director.

“We don’t think it’s fair. We, like UC Irvine Medical Center, take a disproportionate share of the patients,” Viviano said.

Chase said the state would be “very much” interested in receiving copies of any maps as part of the state’s investigation.

“This is not a provider question,” said Dennis Gaschen, a spokesman for St. Joseph Hospital in Orange, “it’s more of a major societal issue and how we deal with health care for the poor. I think that UC Irvine, in their letter to other hospitals (notifying them of the policy) is trying to bring the issue to the forefront.”

Both St. Joseph and St. Jude hospital spokesmen said they will accept any patient in labor or needing emergency health care.

UCI Medical Center’s letter, written by Dr. Thomas J. Garite, acting chair of obstetrics and gynecology, said 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.”