U.S. Raps Medical Center for Use of Guards in Diversion

Federal officials have asked UCI Medical Center to stop using security guards to turn away patients when its maternity ward is crowded, saying the action “intimidates” women and could endanger their health and that of their unborn babies.

In a sharply worded letter, Gerald M. Moskowitz, West Coast regional administrator of the federal Health Care Financing Administration, requested that medical center officials rescind their obstetrical diversion policy “immediately.”

Moskowitz did not threaten any punitive action, but his deputy, Patricia Shea, said Tuesday that if the hospital fails to retract its policy, the agency could open a formal investigation. Agency lawyers in Washington are now studying whether UCI’s unprecedented diversion policy is legal, she said.

Ultimately, the agency could refuse to pay Medicare and Medi-Cal bills of a hospital that has violated the law, Shea said, although no such action is indicated now. Such payments make up 36% of the medical center’s revenues.

Doubt Making Changes

Hospital officials reacted angrily Tuesday to Moskowitz’s letter and said they doubted that the diversion policy would change.

“I wonder what they would have us do with patients,” said Dr. Thomas J. Garite, acting chairman of obstetrics and an author of the medical center’s controversial diversion policy. “I don’t think there’s any legal basis for them to make this request.”

Added another UCI official: “It’s fine to write letters about not deflecting patients” and the need to transfer them to other hospitals. But, the official complained, “to where?”

UCI officials complain that in Orange County there is no viable network of Medi-Cal hospitals and doctors to which an overload of patients can be referred.

Garite recently wrote Orange County obstetricians at other hospitals asking if they would accept Medi-Cal maternity patients. Seven said they would, but “we calculate we need about 70” doctors, each taking three or four patients, to reduce UCI’s load significantly, he said Tuesday.

Voicing his frustration at Moskowitz’s letter, Garite said: “If they will recommend to us a viable alternative that takes into account patient safety, I would be happy to yield to better minds. Until then we have no alternative to warning people at the door when we are at unsafe conditions.”

The medical center’s diversion policy began in early June after doctors complained that the unit often ran out of fetal monitors, oxygen units and beds. As several Medi-Cal hospitals closed and their patients flooded UCI, the ward was handling 500 deliveries a month in a facility designed for 250, medical center officials said.

10 Diversions Announced

Since the policy began, the medical center has announced 10 diversions and about 16 women have gone elsewhere, a hospital official said. At such times, when both the emergency room and 13-bed maternity ward are full, security guards greet pregnant women at the curb. Explaining that conditions are now unsafe, they hand the women a map of other hospitals and invite them to leave.

But women who have received prenatal care at UCI clinics and women who insist on entering the hospital are still admitted during a diversion, hospital officials said.

In his Aug. 1 letter, Moskowitz termed this procedure “an inappropriate method of triage.” Because women who are persuaded to leave have never been medically examined, “they could be placing themselves and the unborn child in jeopardy before they reach another hospital,” he wrote.

According to Shea, the federal agency would like UCI to “drop this policy and follow proper procedures for transferring patients” to other nearby hospitals--examining them, stabilizing them if necessary and then transferring them, rather than having a guard ask them to leave.

Under state and federal laws, hospitals are required to examine and stabilize patients who show up for emergency treatment. Shea said UCI’s diversion policy skirts “a fine line” of the law because a security guard asks patients to consider leaving before they actually walk into the hospital.

Police Thought Legal

Meanwhile, state health licensing officials have already said they thought the medical center’s diversion policy was legal.

In a June 23 letter, Kenneth W. Kizer, state health services director, said the policy “does not violate any state or federal statute” as long as security guards make it clear that a patient can still enter the hospital if she wishes.