Sobering Statistics

New perinatal death rate figures for Martin Luther King Jr./Drew Medical Center and Los Angeles County-USC Medical Center are a sobering reminder of the desperate need for additional funding at those two vast institutions. King ranked worst in the state in 1986, the year studied. County-USC was among the worst.

“It seems clear that they are having too many births for their facilities,” according to the project coordinator, Frank P. Rust of UC Santa Barbara’s Community and Organizational Research Institute.

Both institutions deal with disproportionate numbers of high-risk patients, including drug- addicted mothers and others who have had no prenatal health care. These are the very patients who “need the best care that medical science can provide,” the researchers noted. In the year under study, County-USC delivered 17,088 babies with 319 perinatal deaths, King, 8,121 with 138 deaths.

County efforts to relieve the pressure on the obstetrics departments at the congested hospitals have been frustrated by low state Medi-Cal fees that discourage other hospitals and some doctors from accepting the patients, according to Robert Gates, director of the Los Angeles County Department of Health Services. Private hospitals have been willing in some cases to accept low-risk patients but have been reluctant to accept the high-risk patients because Medi-Cal makes no distinction between low-risk and high-risk cases in its fees.

The state has blocked county efforts to use private hospitals that do not have Medi-Cal contracts. Medi-Cal fees for obstetricians have been greatly improved, but Medi-Cal fees for anesthesiologists and pediatricians needed in high-risk cases are not adequate, a further deterrent to expanded use of private facilities. As a result, the county system has been forced to accept an increasing share of all births. County hospitals handle 21% of all births in Los Angeles County, including a constantly increasing proportion of high-risk cases, and the county contracts for an additional 5% of the deliveries in other hospitals.

Researchers agree that not all of the deaths could have been prevented even with the highest quality of services, but some could have been. In other words, there is a direct life-and-death consequence of the level of public funding.