Indigent Maternity Patients : State Health Director Offers Care Crisis Aid : INDIGENT

Saying he has “deep concern” about maternity care for Orange County’s poor, state Health Services Director Kenneth W. Kizer offered Monday to help resolve the problems, including overcrowding at UCI Medical Center, by meeting with public and private medical leaders.

The issue of providing maternity care to Medi-Cal and indigent patients “involves both state and county responsibilities, physician and clinic participation,” Kizer said.

“The department cannot provide a single, simple solution, but we are willing to do our part in looking for a better way to protect the health and safety of these patients,” he said.

Kizer’s unusual offer of help came in a letter to Mary Piccione, director of the university’s medical center in Orange, that summarized a two-week investigation of the medical center’s controversial new “obstetrical diversion” policy.

The medical center announced June 2 that conditions in obstetrics had become overcrowded and “unsafe” and that from then on, whenever the hospital was full, medical center security guards would meet women in labor at the curb, hand them a map to other hospitals and invite them to leave.

Some county legislators and health care advocates immediately denounced the policy as inhumane and probably illegal. Some also claimed that the medical center, the former county hospital, has a moral if not legal responsibility to care for these pregnant women, many of them indigent Latinas who received no prenatal care.

But in his letter to Piccione, Kizer said he and licensing officials believed that the diversions--at least four so far involving as many as 10 women--were legal.

“The procedure of deflecting patients at times of overload in labor and delivery does not violate any state or federal statute as long as the courtesy guard makes it clear that a patient may, if she chooses, enter the emergency department,” said Kizer, who could not be reached for comment Monday.

Patricia Chase, state licensing consultant, who drafted much of the letter, explained that the policy was legal because the medical center guards “were not indiscriminately turning people away. . . . They don’t say simply: ‘Don’t darken our doors. Go away.’ They say they are on overload and there may be a long wait. If she chooses to go in, she can go in.”

Medical center officials and one county leader expressed interest in Kizer’s letter.

Piccione could not be reached for comment Monday, but in a brief prepared statement, she said: ‘We are gratified that the Department of Health Services has cleared us from a legal perspective, but that doesn’t solve the problem.

“As the letter points out, this is not just a UCI problem, but the problem of many groups in this area, including physicians, government agencies and other hospitals.”

Dr. Thomas J. Garite, acting chief of obstetrics at the medical center, was impressed with Kizer’s response.

“Their (state health officials’) expression of willingness to help us is something we are all grateful for,” Garite said. He said he hoped that Kizer’s involvement would help “put Medi-Cal straight” by encouraging that state agency to reimburse doctors and hospitals more generously so that many more would care for indigent mothers. At the moment, Garite estimated, the medical center sees two-thirds of Orange County’s indigent maternity patients because most doctors and hospitals don’t get sufficient state or county reimbursement to make it worth their while.

Also, Garite said, “Any pressure that (Kizer’s letter) puts on the county is something to be extremely grateful for.”

Medical center officials have repeatedly chided county officials for not providing more money for indigent health care and suggested recently that maybe the county should buy back the hospital from the university.

Meanwhile, Tom Uram, director of the Orange County Health Care Agency, said: “I’m not sure it’s (the obstetrical problem is) a county responsibility. It’s a battle between the hospitals and Medi-Cal.

But “we would willingly participate in any meeting” involving Kizer and hospital administrators, Uram said. He added that he hoped that county officials could play a leadership role in such a meeting.

He added: “The basic premise I’m working from is there are enough doctors and hospitals and beds and facilities in Orange County to handle the problem (of obstetric care for the indigent). It’s a matter of getting together to resolve the problem.”

In his letter, Kizer also said licensing officials have reviewed modifications that medical center officials made in their overloaded obstetrics ward and decided that they were “appropriate,” although a design change in the nursery still is being reviewed.