Officials Say Lives at Risk in Maternity Crisis

Warning that the lives of thousands of poor women and their babies are at stake, the March of Dimes on Thursday convened a meeting of Orange County obstetricians, hospital administrators and consumer advocates to seek solutions to what they called a “crisis” in obstetrics care.

In the three-hour forum, officials at two large hospitals--Fountain Valley Regional Hospital and Medical Center and UCI Medical Center in Orange--described crowded delivery rooms in which doctors now care for twice the number of women the rooms were designed to handle each month.

Len Foster, deputy county health director, reported that as access to obstetrics care becomes difficult, mortality rates for mothers and babies may rise, although that has not yet happened.

And many of the 60 participants complained that unreasonable Medi-Cal contracting policies with reimbursement levels far below the actual cost of care have caused the crisis. These policies, they said, discourage hospitals from caring for poor women and flood the county’s few Medi-Cal providers with patients. In response to overcrowding, UCI Medical Center has adopted an “obstetrical diversion” policy in which security guards ask women in labor to leave when the hospital is full.

The Medi-Cal contracting program is so bad that “there needs to be a dismantling of that system,” said Dr. Richard Meidell, director of neonatal intensive care at United Western Medical Center-Santa Ana, which several months ago dropped out of the Medi-Cal system.

“It is time to be innovative, and unfortunately the people running Medi-Cal are unwilling to be innovative,” Meidell said.

But Dr. Thomas J. Garite, acting chief of obstetrics at UCI Medical Center, said he and leaders of the county Obstetrics and Gynecology Society believe that many obstetricians are still willing to care for Medi-Cal patients. “The only real impediment is that so few hospitals will contract to Medi-Cal,” he said.

Last week, in the first move of its kind, officials with the California Medical Assistance Commission reached an agreement with AMI Medical Center of Garden Grove that allows the hospital to take, on a limited basis, only maternity patients on Medi-Cal.

Because of favorable Medi-Cal reimbursements to obstetricians, those doctors were willing to take Medi-Cal patients, while other AMI doctors declined, hospital administrator Mark Meyers has said. But under terms of the contract, the hospital is supposed to become a full-service Medi-Cal provider after six months or phase out of the program.

As the session ended Thursday, meeting participants agreed that their newly formed committee would poll hospitals in Orange, San Diego and Los Angeles counties to see how many would accept “obstetrics-only” contracts with Medi-Cal.

The next step, they said, would be to put political pressure on the commission, which negotiates Medi-Cal contracts, to allow more limited contracts like the one with AMI in Garden Grove.

UCI Medical Center handled 558 deliveries in June, most of them Medi-Cal patients, in a labor and delivery area designed for 250 deliveries a month, according to hospital officials. The hospital has announced five obstetrical “diversions,” advising at least five women they should go to another hospital, Garite said.

Meanwhile, the Fountain Valley hospital has been delivering 400 women a month in a facility planned to handle 250 deliveries monthly, Assistant Administrator Margaret Patton said Thursday.

Dr. Ralph W. Rucker, a March of Dimes official who organized Thursday’s meeting, said the issue of improving access to maternity care will require putting pressure on public officials.

The question, he said, is: “How do you get the public agitated, rising up in arms and solving this problem--and it is a public problem.” (No legislator attended Thursday’s meeting, although several county and state officials sent aides to listen.)

It is also an ethical problem, said William W. Noce, executive director at St. Joseph Hospital in Orange and president of the Hospital Council of Southern California.

Because of overcrowding and the “diversion” policy at UCI Medical Center, “an unethical situation . . . now exists in our community--the inability of many poor women to obtain care,” Noce said. “We must show more respect for pregnant women in Orange County.”