Solving Prenatal Crisis

In 1989, about 2,500 women in Orange County were turned away from prenatal clinics because of overcrowding. Most hospitals and doctors in the county do not even treat Medi-Cal patients. That leaves poor, pregnant women no place to turn. They are left with only the dangerous option of going through their pregnancy without care, and then showing up at some hospital’s emergency room when in labor.

Unless the deplorable situation is corrected, such conditions are bound to cause health, social and economic problems for the mothers, their infants and entire community. That fact was brought home again in the last few days in two reports, one from the March of Dimes and the other released by the Orange County Grand Jury.

The March of Dimes’ six-month study, done by a UCLA researcher, predicted a shortage of maternity beds that could, if not corrected, cause “severe disruption” for the nine hospitals in the county contracting with Medi-Cal to care for low-income patients, and for many other hospitals and for women from all economic backgrounds.

The grand jury’s report said the county was in a crisis over obstetrical care for the poor, and it recommended that the county expand its prenatal service clinics. The county should follow that advice. The Board of Supervisors has been weak in its commitment to health care for the poor. The increased dangers to mother and child of providing no prenatal care and added costs to the community are well-documented.

The jury’s report also urged the state to permit more obstetrics-only Medi-Cal contracts, a change that a poll conducted by doctors in the county has indicated would encourage more obstetricians to treat low-income pregnant women. Nearly seven out of 10 obstetricians and about three out of every four hospitals in Orange County now refuse to treat Medi-Cal patients. That is a shameful statistic for the doctors and hospitals.

The obvious answer to the shortage of maternity beds is for hospitals to provide more of them--and for more doctors to commit themselves to more deliveries, even if only one, two or three a month. Although the state made an exception in granting its first obstetrics-only contract to AMI Medical Center in Garden Grove (assuming it would become a full-service contract later), it has, with understandable reason, been reluctant to sign more of them.

Although limited-care Medi-Cal agreements could provide a short-term solution and help ease the pressure on some overloaded delivery rooms by spreading the indigent patient load throughout the county, it has potentially serious drawbacks. The creation of a medical menu of services for hospitals to pick and choose from could, as the state fears, cause other hospitals to try to drop their full-service indigent care. Another major shortcoming is that limited-care arrangements do not address the basic issue of public underfunding of medical services.

More doctors should be delivering more babies. But for that to happen, more hospitals must agree to treat Medi-Cal patients. Medi-Cal must do more to ease the delay and red tape in processing and make reimbursements more realistic for hospitals, as already has been done for the obstetricians. Until that happens, pregnant women will continue to face overcrowded delivery rooms and increasing medical risks.