UCI Chief, Aide Defend Turn-Away Decision

Calling it “a regrettable necessity,” UC Irvine Chancellor Jack W. Peltason on Thursday defended the decision of the UCI Medical Center to turn away women in labor when the hospital is overcrowded.

Peltason and Walter Henry, vice chancellor of health sciences--in the first public statements by top university officials on the controversial policy since it was adopted last Friday--said they expected the hospital to continue the “obstetrical-diversion” policy even though several Orange County legislators have sharply criticized it as inhumane and possibly illegal.

Peltason also said the policy--announced just four days before medical center administrators sought a rate increase from the state Medi-Cal contracting commission--was “not a negotiating ploy.” Rather, he said, “this was a decision for medical reasons to help divert the load.”

Henry, a cardiologist as well as an administrator, agreed: “This policy is a policy that is being implemented without regard to the individuals coming in. The issue is one of patient safety.”

Citing crowded and “unsafe” conditions on the obstetrics ward, medical center officials last Friday announced that security guards would turn away women in labor, handing them a map to other hospitals, whenever the obstetrics ward and emergency room are full.

Reportedly, the hospital has been treating up to 500 women a month, most of them indigent Latinas who have had no prenatal care, in a ward designed for 250 patients. So far, only one woman in early labor has been turned away under the new policy.

Also, Henry has said, UCIMC will lose $13 million by June 30 and may go bankrupt because most of the county’s indigent patients are routed to the former county hospital in Orange instead of other local hospitals.

In an interview late Thursday, Peltason said he was sorry that the hospital has had to turn away women in labor, adding: “Well, it’s a regrettable necessity.

“I mean, we didn’t want to do that and the decision . . . came because of the doctors’ and nurses’ professional judgment” that services for obstetrical patients were strained. “We then consulted our attorneys and tried to develop a plan to provide the best possible care.”

Asked if turning away a woman in labor might create an unsafe situation for her and her baby, Henry replied that he “wouldn’t speculate on that kind of ‘what ifs.’ ” Medical center officials reportedly have been exploring a solution to ease overcrowding by diverting low-risk obstetrical patients to as many as 15 other Orange County hospitals, according to Jon Gilwee, vice president of the Hospital Assn. of Southern California.

One of those hospitals, neighboring AMI Medical Center of Garden Grove, was willing to take up to 120 of UCI Medical Center’s patients a month and chief executive officer Mark Meyers said he was looking forward to a “closer relationship” with the university hospital. Henry and other sources said, however, they believed that Medi-Cal officials had vetoed the proposal several weeks ago.

According to hospital council officials, Medi-Cal negotiators so far have refused to let UCI Medical Center contract out such care.

“The problem is that the California Medi-Cal Assistance Commission in Sacramento (which negotiates Medi-Cal rates) will not give them obstetrics-only Medi-Cal contracts. They want them to take the full-boat Medi-Cal,” said David Langness, another hospital council vice president.

Commission general counsel Byron Chell declined to discuss the medical center’s negotiations but said the commission dislikes “obstetrics-only” contracts because it believes that hospitals should provide full services to Medi-Cal beneficiaries. Chell added: “We wouldn’t want a hospital selling Medi-Cal patients, in effect, making a profit by subcontracting out” their Medi-Cal patients. Still, he said, “we explore every possibility.”

Meanwhile, hospital council officials Thursday released a statement noting that the medical center’s “obstetrical-diversion policy is a manifestation of a condition that plagues all hospitals in California.”

“In 1988, Orange County hospitals, including UCIMC, provided an excess of $229 million” in patient care that was not fully reimbursed by Medi-Cal or other agencies, the council statement said.

The council also criticized the Medi-Cal commission’s negotiating posture for having “served to further aggravate” difficulties faced by hospitals such as UCIMC.

As for the practice of diverting obstetrical patients when the medical center is full, a spokeswoman for the state’s Division of Health Services said Thursday that the agency will continue to review the policy. The agency opened an investigation on the medical center’s obstetrical-diversion practice this week.

“We don’t really want a knee-jerk kind of response,” said Dr. Patricia Chase, a consultant with the state’s Licensing and Certification Division, which monitors hospitals.

“We don’t see any solutions immediately available. And one thing is certain; we don’t want to close UCI, as someone from the media suggested. That would really be a dumb thing to do and end up hurting a lot of pregnant women,” Chase declared.

Chase said she had received information that on Wednesday, the medical center had reportedly turned away a woman in labor after the center initiated its diversion policy about 5:45 p.m.

The woman was directed to AMI Medical Center, about one mile away, by a UCIMC security guard. As it turned out, the woman, who eventually was examined by a doctor, was suffering pains associated with false labor.

By law, AMI Medical Center, which has an emergency room, must provide care to indigent patients. But its director hesitated at suggesting that the hospital would accept all referrals if UCIMC were again forced to initiate its diversion policy.

“We do not have a Medi-Cal contract and Medi-Cal won’t pay us,” said Meyers, the Garden Grove hospital’s chief executive officer. “There are other hospitals who have Medi-Cal contracts nearby, so we’re not the most logical place to refer a patient to.

“If they show up here in active labor, there’s no choice, we have to see them . . . and we take our lumps.”

The state’s investigation was initiated because state regulatory officials such as Chase were concerned that the medical center’s new policy was in violation of the state’s anti-patient dumping law.

“We are interested, but we also need more information about UC Irvine, its policy and what other hospitals are doing to share the burden in Orange County,” Chase said.

More Information Sought

Despite the apparent diversion of the one pregnant woman on Wednesday, no complaints have been filed against UCIMC, according to Jacqueline A. Lincer, district administrator with the state agency’s Licensing and Certification division in Santa Ana.

AN IDEA REVIVED--UCI’s Faculty Senate has revived the idea of an on-campus hospital. Page 3