Hospital’s Turn-Away Rule Must Be Changed

The decision by UCI Medical Center in Orange to begin turning away women in labor because of overcrowding was medically dubious. It may even violate a state law that requires hospitals to care for patients in emergency situations.

The state’s Health Services Department is looking into the legality of the medical center’s “obstetrical-diversion” policy of turning the women away when both its emergency room and obstetrics unit are full. But even if investigation finds that the diversion falls within the letter of the law, posting security guards outside with maps and lists of area hospitals to give to women in labor is hardly consistent with the intent of state law.

We sympathize with the frustration of UCI officials who face an estimated $13-million operating deficit this fiscal year at the hospital, which treats a disproportionate amount of the county’s indigent patients. Doctors worry about overcrowding, about the fact that fetal monitors are not always available, and about patients who often go through labor in hallways. Overcrowding, doctors say, also results in a high infection rate among women who undergo Cesarean sections.

But turning women in labor away is not the answer. As crowded as the medical center may be, its hallway is a safer place to give birth than the back seat of a car or a sidewalk.

There should be communication among the county’s 31 hospitals to ensure that patients arriving at one overloaded hospital could be sent in safety to one where space and care are available. But the state keeps Medi-Cal payments too low and the county spends too little on the poor for that to happen.

More hospitals and doctors might be willing to accept more Medi-Cal patients if state payment at least covered the cost of treatment. Instead, hospitals are forced to absorb at least one-third or more of their actual costs in treating each Medi-Cal patient. To complicate the problem, few of the clinics--which are themselves so overcrowded that they turn away 1,500 to 2,000 expectant mothers each year--are equipped to deliver babies. It would help if the clinics’ prenatal service included prearranged delivery at some hospital. UCI Medical Center and the other hospitals are victims of an insensitive state policy that provides the Medi-Cal program to ensure medical care for the poor, yet fails to provide the money needed to keep the program financially solvent and workable. But the real victims are the mothers in labor who, when they rush to the medical center, are not sure whether they will get emergency medical care or a map. That is an unconscionable condition that the state and the medical community must resolve.