U.S. Health Official Says UCI Diversions Are ‘Inappropriate’

Although UCI Medical Center officials are not violating federal law when their security guards advise women in labor to go to other hospitals, their controversial “obstetrical diversion” policy is “inappropriate” and will continue to be monitored, a federal health official said Friday.

Gerald M. Moskowitz, San Francisco regional administrator of the U.S. Health Care Financing Administration, said he still would like medical center administrators to halt the unusual practice, which has been used since June 2 as a response to crowded emergency room and maternity wards at the hospital in Orange.

And until the policy is abandoned, his staff will monitor it closely, Moskowitz said.

“We think it’s inappropriate--oh yes,” he said, “because I think folks coming to the facility should be able to come into the facility. That’s what the law requires.”

But because the hospital allows pregnant women who insist on entering its crowded maternity ward to do so, it does not appear to be doing anything illegal, Moskowitz said.

Under federal and state laws, hospitals are required to examine and stabilize patients who show up for emergency treatment.

But for now, “there has been no documented instance of patients diverted inappropriately (from UCI) to another facility,” Moskowitz said.

In an Aug. 1 letter to the medical center, Moskowitz had demanded that administrators halt the diversion policy immediately because that action “intimidates” pregnant women and could endanger their health and that of their babies.

But after meeting with medical center Director Mary A. Piccione, her security director and other administrators on Thursday, Moskowitz said, “I am convinced the process they’re using is with compassion.”

Moskowitz’s agency handles Medicare and Medi-Cal reimbursements to hospitals, but none of those funds are now threatened by the diversion policy, federal officials have said.

The federal inquiry was the second to conclude that UCI Medical Center was not violating any law with its diversion policy.

In June, State Health Services Director Kenneth W. Kizer said the policy was not illegal as long as security guards made it clear that a patient could still enter the hospital if she wanted to.

Piccione said Thursday that Moskowitz appeared to understand that the medical center’s policy began because the maternity ward was so crowded. Recently, as several hospitals dropped Medi-Cal contracts and their patients turned to UCI Medical Center, the obstetrics unit has been swamped--handling more than 500 deliveries a month in a facility built for 250 a month.

Federal officials “would like us not to do these diversions,” Piccione said. But until there are other places that can handle these pregnant women--more doctors and hospitals that will accept Medi-Cal patients or perhaps a birthing center, “that’s pretty much what we have to do,” she said. “When we have enough places to put the babies, it will be resolved.”

Moskowitz agreed, saying: “One needs to look at the entire situation. Our main concern is to correct the system.” He added that his agency is encouraging state officials to add more Medi-Cal hospitals in Orange County and make reimbursements less cumbersome.

UCI Medical Center’s controversial diversion policy was announced in June as Piccione and acting chief of obstetrics Thomas J. Garite sought to relieve maternity ward conditions that they described as crowded and unsafe. Doctors there have complained that there sometimes are not enough fetal monitors, oxygen tanks or beds for all patients.

When a diversion procedure is in effect, security guards meet the pregnant women at the curb, handing them a map to other hospitals.

Since the policy began, 17 diversions have been announced, some lasting a few hours and three lasting more than a day, said hospital spokeswoman Elaine Beno. She said 27 pregnant women have gone elsewhere during diversions, and an unknown number have been admitted at their insistence.

Moskowitz said Friday that he had initially become concerned about the diversion from news accounts of the practice. “My personal impression was there would certainly be intimidation. Uniforms certainly produce that kind of intimidation--especially if there is a language barrier,” he said.

But Moskowitz said that in talking with Piccione and her staff, he learned that they consider their guards’ notification to pregnant women “advisory.” Also, Moskowitz said he was impressed that in one instance, seven or eight patients were admitted to UCI during a diversion period.