‘Obstetric Diversion’ at UCI Delivered Change

The announcement came without fanfare, on a quiet Friday in June.

In a letter to county officials and other hospitals, administrators at UCI Medical Center declared that their maternity ward was often so crowded that it had become unsafe.

So, the letter explained, the hospital was implementing a new policy called “obstetrical diversion.” Whenever both the maternity ward and emergency room were full, UCI security guards would meet women “in active labor” just outside the hospital, advise them that conditions were unsafe and suggest they have their babies somewhere else.

That June 2 notice touched off a furor.

County legislators and health care advocates expressed alarm that a Medi-Cal hospital might be turning poor, pregnant women, many of them Latinas, into the street. And state and federal officials, questioning whether the unprecedented diversion policy was legal, launched separate investigations.

But by September the investigators decided UCI’s policy was not illegal. By then, hospital leaders such as Dr. Thomas J. Garite, chairman of obstetrics and gynecology, had made it clear that no woman would actually be turned away. If she insisted on having her baby at the medical center after guards talked to her during a several-hours-long “diversion,” she could still deliver at UCI--and many women did just that, hospital officials said.

Now, nearly a year and 60 separate diversions later, health care experts--even some who dislike the policy--say the controversial move has been a catalyst for change, focusing attention throughout Orange County on the difficulty that poor, pregnant women face in finding obstetrical care.

The diversion policy was “the sparkplug” that got politicians, doctors, county officials, civic activists and hospital leaders working together much of last year on this problem, said Herbert Rosenzweig, director of medical services for the County Health Care Agency.

Garite agreed: “First and foremost it raised consciousness to the problem in the entire community. I think very few people knew there was a problem”--severe overcrowding in a major Medi-Cal hospital’s maternity ward as well as a shortage of obstetrical beds around the county.

Garite, Rosenzweig and other health experts also ticked off a list of events that resulted directly or indirectly from the diversion policy.

The March of Dimes commissioned a study on Orange County’s obstetrical capacity. That report, released last month, revealed a countywide shortage of maternity beds and warned that rich and poor women alike may face crowded delivery rooms and rising infant mortality.

State officials last June bent their rules, allowing AMI Medical Center of Garden Grove to have the first “obstetrics-only” Medi-Cal contract in California.

Because of low reimbursement rates and other complaints, Garden Grove’s doctors were unwilling to accept a Medi-Cal contract serving all indigent patients. But they were willing to accept Medi-Cal maternity patients--and relieve crowding at nearby UCI.

UCI’s maternity ward is still crowded but its census has declined steadily since last June. Built for 250 deliveries a month, it handled 396 births in March, down from 558 last June. “Our census went down because Garden Grove is taking 150 patients a month,” said medical center director Mary A. Piccione.

The Orange County Grand Jury in March reported that low-income pregnant women have difficulty getting both prenatal and delivery services.

Reacting to the situation at UCI as well as to aggressive lobbying by United Way’s Health Care task force, county supervisors set up a Perinatal Task Force to study problems in access to health care for pregnant women.

Supervisors in March recommended that part of the county’s allotment from a new state tobacco tax should go for services to low-income pregnant women, including $2.3 million to start two birthing centers, facilities for low-risk mothers that are to open in 1991.

For all that, some people are still unhappy with UCI’s “diversions,” calling the policy of sending security guards to meet pregnant women “insensitive,” even “inept.” Since last June, 187 women have been advised that UCI is unsafe and 38 have gone elsewhere, according to medical center statistics. The most recent diversion, on Tuesday, lasted 2 1/2 hours and two pregnant women chose to enter the hospital anyway.

But Garite is convinced that diversion was UCI’s only recourse. When the policy began, the obstetrical ward had been severely overloaded for four straight months and his staff was ready to quit, Garite said. He said he “anguished” over the decision, worrying that if a woman left UCI for another hospital, her delivery would involve “bad results. It has not happened, to my knowledge,” Garite said.

Also, he said, “I was worried about the way I would be perceived. I’m probably as strong an advocate for indigent patient care as you’ll find. But the perception was that we were doing this because of (fiscal) problems at UCI and trying to get rid of poor people.”

That was simply not true, Garite said. He added: “Sometimes you have to do what’s right regardless of what people think of you.”

MONTHLY BIRTHS UCI Medical Center began an “obstetrical diversion” policy June 2, 1989. Babies born at UCI Medical Center since Jan., 1989 ( Capacity is 250) 1/89: 490 2/89: 462 3/89: 505 4/89: 515 5/89: 495 6/89: 558 7/89: 520 8/89: 564 9/89: 551 10/89: 493 11/89: 452 12/89: 413 1/90: 419 2/90: 408 3/90: 396 Source: UCI Medical Center