Physicians Volunteer to Reduce No-Care Pregnancies

The San Diego Gynecologic Society on Thursday took the unusual step of asking its members to voluntarily treat at least one pregnant woman a month who would otherwise go without care because of a lack of funds or medical insurance.

The new program was inspired by the fact that San Diego County now has the state’s highest rate of no-care deliveries. Since January, 2,187--or 9.8%--of 22,309 women who delivered babies at 13 area hospitals received no medical care before delivery. There were 3,264 no-care births in 1988 and 1,671 during the last eight months of 1987.

“That’s a horrendous statistic,” said Ann Bush-Sheresh, director of the county-funded Comprehensive Perinatal Care program at UC San Diego Medical Center, which cares for 200 low-income pregnant women each month. “It ends up costing everyone lots of money. Babies are ending up ill, they’re born too early, and some end up in intensive care.”

The Gynecologic Society’s unique volunteer approach is an “excellent program because (prenatal care) is where the real problem is,” said Ken Todd, a spokesman for the San Francisco-based California Medical Assn. “It takes a lot more to care for babies after they’re born.”

On average, each dollar spent on prenatal care generates a $3 to $4 reduction in the cost of care needed after birth, according to studies in San Diego and elsewhere.

The Gynecologic Society has “been wrestling with this for three years,” Dr. Galen Hansen, the society’s president, said Thursday. The unusual program was formulated after doctors decided “we should take the bull by the horns.”

“There is such a void and no other (apparent) solution to the problem,” said Dr. Josephine von Herzen, one of several local doctors who will serve as a director of the new program. “It keeps on getting worse.”

The society, which represents about 167 of the county’s 230 gynecologists, endorsed the program during a recent meeting. Then, 63 of 66 in attendance voted in favor of it.

The new program should decidedly improve the health of newborn babies and mothers, according to Bush-Sheresh, whose program turns away hundreds of women each month because of financial constraints.

“It’s been heartbreaking,” she said. “Eighty percent of those delivering at (UCSD) have tried to get into my program. There’s a huge demand for perinatal services, but the university is saturated.”

Doctors who deliver babies of mothers who don’t seek--or can’t find--perinatal care are at an extreme disadvantage because mothers typically rush into an emergency room after labor has begun, Hansen said. Those doctors have never seen the patients before, so “we have no idea what the complications will be.”

“We’re the ones who see them at 3 a.m. and we have to deal with them,” said Hansen, who, like most gynecologists, spends time on call at a local hospital emergency room. During a recent 24-hour on-call shift, Hansen handled one miscarriage and a fairly routine delivery. “But it can just as easily be four walk-ins, perhaps one with a” serious delivery problem. “You could end up being there day and night.”

Gynecologists on call at local emergency rooms often are forced to “cancel the next day’s office visits,” Von Herzen said. “They can’t take care of their own patients because they’re stuck taking care of walk-ins.”

The voluntary approach makes economic and business sense for gynecologists because “we’ve already got a high liability and no pay” for deliveries that occur at emergency rooms, Hansen said. By treating women earlier in their pregnancies, doctors can prevent some complications and better handle complicated births.

Hospitals should benefit from the program because improved perinatal treatment “will help unclog the emergency rooms,” Todd said.

Medi-Cal Rejected

In addition to making perinatal treatment more accessible, the new program is designed to channel low-income women into programs that will pay for some--if not all--of their perinatal care.

Many low-income women who actively seek care are turned away because less than 20% of the county’s gynecologists accept Medi-Cal payment for pregnancy.

That reluctance to accept Medi-Cal has been prompted by the fact that the state program historically has not covered the actual cost of treatment. Also, many doctors find Medi-Cal to be a bureaucratic nightmare marked by complicated paper work and late payments.

In a related development, the County Board of Supervisors recently petitioned state health care regulators for permission to act as an intermediary between Medi-Cal and local doctors. The county would guarantee payment to doctors and be reimbursed by the state. Medi-Cal officials are “interested in this proposal as a demonstration project,” Bush-Sheresh said.

The number of women who qualify for Medi-Cal payments for neonatal care has grown in recent months as state legislators broadened eligibility limits. Legislators also have increased payments to doctors to $1,000 per pregnancy, up from $700.

That increase, coupled with the county’s possible role as an intermediary and the program unveiled Thursday, should influence more doctors to accept Medi-Cal patients, Bush-Sheresh said.

The program will be funded through a $240,000 grant from The Irvine Foundation, a Newport Beach charitable trust. The Gynecologic Society will hire a program coordinator and publicize a telephone number through which pregnant women can learn more about the program.

Although gynecologists expect a positive response from women who want but can’t afford medical care, they are not convinced that it will succeed with women, particularly drug users, who don’t seek out treatment.

“A lot of (potential patients) who are drug addicts don’t want to get into perinatal care,” Von Herzen said. “We’ll have to convince them that it’s worth it.”