Grand Jury Urges New Prenatal Approaches : Health care: A poll also shows 81% of obstetricians in survey would treat Medi-Cal patients if their hospitals accepted only pregnant women on the program.

The county is in a crisis over obstetrical care to poor pregnant women, the Orange County Grand Jury said Tuesday in a critical report that noted that 2,500 women were turned away from prenatal clinics last year because of overcrowding.

Jurors recommended that the county expand its prenatal clinics and create a network of birthing centers to serve low-risk women. That network could be established as a public-private partnership similar to the arrangement under which Orangewood Children’s Home was built with private money but is run by county officials, their report said.

The study was issued the same day that doctors released a poll indicating that more than half of the county’s obstetricians would agree to treat Medi-Cal patients if their hospitals could accept only pregnant women on Medi-Cal and not have to treat other indigent patients, often at a financial loss. Just 35% of the county’s obstetricians now treat pregnant women on Medi-Cal.

The crisis in perinatal care began last year, when several local hospitals canceled money-losing Medi-Cal contracts, causing indigent patients to flood UCI Medical Center in Orange. That hospital became so full that in June it began asking some women in labor to deliver elsewhere, because its maternity ward was overcrowded and unsafe.

To ease the crisis, doctors, hospitals and health care advocates have asked the California Medical Assistance Commission, the state commission that negotiates Medi-Cal contracts, to add hospitals to the network for indigent care and change some of their contracting procedures. The commission is scheduled Thursday to hold a hearing in Irvine on obstetrical care.

The obstetrician survey was conducted jointly by the Orange County Medical Assn., the Orange County Obstetrics and Gynecology Society and UCI Medical Center to show top Medi-Cal officials that doctors would support new obstetrics-only contracts with hospitals.

Just one hospital in the state--AMI Medical Center of Garden Grove--now has such a contract. Medi-Cal leaders have indicated that they will not sign more limited-care contracts for fear that other hospitals would drop full-service indigent care.

Of the county’s 378 obstetricians, 190 participated in the survey. Of those, 66, or 35%, said they are now Medi-Cal providers.

Among other survey recommendations were:

* The Medical Assistance Commission should permit more obstetrics-only Medi-Cal contracts or do away with the Medi-Cal contract ing system in Orange County altogether. The report did not elaborate.

Hospitals, obstetricians and prenatal clinics should work together for the planned delivery of indigent patients.

Doctors cited many factors as discouraging them from joining Medi-Cal. Chief among them were: inadequate reimbursement (Medi-Cal pays $1,073 for an uncomplicated delivery, plus prenatal care when the cost averages $2,200); denial or delays in payment; excessive paper work, and increased liability exposure when caring for indigent patients.

Still, 81% of the doctors polled who are not with Medi-Cal said they might join the system if given protection against malpractice lawsuits. Another 72% said they might join if they were given a free or low-cost billing service.

And when asked what they would do if their hospitals were to sign obstetrics-only Medi-Cal contracts, 54% of those responding said that move would lead them to accept one to three Medi-Cal maternity patients each month.

Such a move, the report noted, could help “disperse the indigent obstetrical patient load throughout Orange County.”

Obstetricians were not enthusiastic about one other strategy: birthing centers. Just 15% of those queried said they would work in one.

The grand jury’s human services committee recommended that county supervisors meet the growing need for prenatal clinics by expanding county services to care for at least 4,700 women, the number of women who sought care in 1989.

The panel also asked supervisors to establish a network of birthing centers in which malpractice insurance for staff would be covered by the county.