Baby Boom Pushes a Hospital to Limit : Care: Maternity cases are taking so much space and resources at Olive View Medical Center that some officials fear the overall services are being jeopardized.

The hastily planned takeover of the emergency room’s turf began before daybreak.

The prize was Olive View Medical Center’s observation room, where sick patients sometimes waited for beds upstairs. Within hours it had become a maternity ward, as have other parts of the hospital lately.

Flabbergasted emergency room physicians started yelling after watching housekeepers move in the mothers’ beds.

“I tried to be very diplomatic,” said Latisha Stewart, an obstetrics nurse manager, recalling her standoff earlier this month with the angry physicians. “I understand they were unloading. They unloaded on me until it got to be too much junk.”

The emergency room doctors lost the battle. It’s a scenario that has become all too familiar at the county-operated hospital, which is grappling with a baby explosion that has surpassed everyone’s wildest dreams. Two intensive care units, half the pediatrics floor and some outpatient clinic space have been gobbled up to create more room for the swollen obstetrics department.

Last year, 7,103 babies were born at Olive View, even though the institution is only equipped to handle 3,500 births. That gave the hospital the distinction of operating the most overextended maternity wing in the county system, a situation that routinely requires medical heroics.

In an internal memo, Douglas Bagley, the hospital administrator, called a surge in deliveries during this month “an internal disaster.” Physicians worry that the integrity of the hospital as a full-service medical center is endangered as more resources and space are diverted to obstetrics.

“Ob/Gyn does not want to be the entire hospital,” said Dr. George Mikhail, chief of obstetrics and gynecology. “If Ob/Gyn is very strong and the other departments are weak, the entire hospital is weak.”

The baby boom is the most dramatic challenge Olive View has faced since the hospital, devastated by the 1971 earthquake, returned to Sylmar more than three years ago. Since then, the hospital, a glass-and-steel battleship carefully designed to withstand the most powerful of earthquakes, has been rocked within by too many patients, too few doctors, too little money and not enough space.

The new Olive View opened on May 9, 1987. That morning, patients ate breakfast at the county’s aging Mid-Valley Hospital in Van Nuys, which had been in use since the earthquake. By lunchtime, everybody was comfortably settled into the new 350-bed medical center.

Little has been that easy since.

The medical center, which recently passed a rigorous accreditation process, is staggering from its own popularity. Since the move, admissions have jumped 306%. Physicians who used to treat 11,873 patients a month in the outpatient clinics for broken bones, hypertension, migraines and other maladies now see more than 17,000. Births have jumped by 193%.

In abundance, the medical staff observes, are sick people who have nowhere else to go.

Physicians, nurses, technicians, even typists are in short supply. In the obstetrics department, there is a 60% vacancy rate for full-time nurses. The hospital’s three general surgeons who used to perform 250 operations a month now complete up to 350 without any additional help.

The laboratory needs to--but can’t--hire 44 more staff members just to keep up, said Dr. Phyllis Thorton, who oversees it. Technicians must work overtime and in return get free counseling to cope with the constant barrage of yelling by physicians upset about tardy lab reports. Now, even routine autopsies are being canceled because pathologists say they are overwhelmed.

At Olive View, the shortages force just about everybody to play the waiting game.

Pediatricians said they place some premature infants on antibiotics without waiting for delayed lab results. On busy days, seriously ill patients are placed on stretchers in an emergency room hallway, waiting for open beds. Patients with gallstones or hernias must wait as long as six months for surgery. Of the gallbladder patients, 15% to 20% end up needing emergency surgery. They arrive at the hospital vomiting, feverish and in great pain.

But even patients who have made it into the operating room must wait for a bed when the intensive care unit is full. The surgeons say it happens all too often.

“Last Monday we had a big case--the patient was on the table nine hours,” recalled Dr. Robert Bennion, a general surgeon. “We tried to call for an ICU bed and we started getting a lot of flak. I wouldn’t call it negotiation. It was downright argument.”

Recent budget cuts have further threatened the hospital’s ability to treat everyone who shows up. For some, it’s no longer just a matter of persevering. Doctors must now turn away certain patients who do not need to be hospitalized. Most are referred to County-USC Medical Center in East Los Angeles.

“We’re creating a new specialty--how not to treat people,” complained Dr. Milton Greenblatt, chief of psychiatry. His new departmental guidelines dictate who should be turned away when the psychiatric emergency room becomes so crammed that the mentally ill begin sleeping on mattresses on the floor.

Still, physicians, nurses and even the community seem to be fiercely loyal and proud of this gleaming teaching hospital that offers cutting-edge medicine and state-of-the-art equipment to those who mostly live in abject poverty. Most of the medical staff was lured there by Olive View’s connection with UCLA’s School of Medicine. Almost all the physicians are affiliated with UCLA, many teaching on campus during part of the week. UCLA also provides the hospital with 118 residents, young doctors training to be specialists.

The institution received a vote of confidence earlier this year when it received full accreditation from the Joint Commission on Accreditation of Health Care Organizations, which inspects hospitals nationwide.

For the doctors and nurses, Olive View is medical frontier. Doctors encounter the same sort of cases that a doctor from Bangladesh or the mountains of El Salvador might. Nurses see women in labor who don’t have a clue as to how babies are born. Physicians see people in their 20s needing heart valve replacements because they never got inexpensive doses of penicillin when they had childhood fevers. Most of the patients were born in Third World countries and the majority speak little or no English.

“It’s a wild and crazy place. We get really challenging cases--that’s what makes this place fun,” said Dr. Robin Wachsner, chief of cardiology, who says her cases have shocked even the most veteran cardiologists in private practice.

One of Olive View’s most influential admirers is Dr. Kenneth Shine, dean of UCLA’s medical school.

“I think it’s absolutely remarkable the way the faculty at Olive View have managed to survive during an extraordinarily difficult time,” he said.

But Shine warned: “I am deeply concerned about the future of the hospital. The unrestrained increase in obstetrical cases . . . has compromised other programs and will ultimately have a serious impact on the rest of the hospital.”

No one is more aware of that threat than Olive View’s doctors.

Dr. Jesse Thompson, the chief of surgery, was angry the day after obstetrics took over the emergency department’s observation room. Obstetrics had pushed Thompson’s staff out of half of surgery’s clinic space several months earlier. What’s more, the intensive care units the surgery department had hoped to open one day also had been confiscated more than a year ago for mothers and their babies.

“Because of the OB problem, it sets us against each other,” Thompson complained. “It’s not OB’s fault. They are just here because of their needs and the heightened awareness of their needs. They get preferential treatment and it sets people off against each other. It’s pretty unfortunate.”

Thompson was still fuming when he spotted Mikhail, the head of obstetrics and gynecology, rushing down the hallway. “I would duck if I were you,” Thompson advised his colleague, only half jokingly.

“I’m going to duck forever,” replied Mikhail, who was psyching himself up for a meeting that afternoon where the hospital’s chief physicians intended to gripe about the OB situation.

When Olive View was still a set of blueprints, a maternity ward was not even planned. The medical center was nearly finished before its top administrator, Bagley--backed by Supervisor Mike Antonovich and others--received approval to reserve space for indigent expectant mothers. Previously, most delivered their babies at County-USC Medical Center in East Los Angeles, an intimidating prospect for someone in labor who must travel by bus because she doesn’t own a car and can’t afford cab fare.

The maternity service, started six months after Olive View reopened, proved to be too small within three months. This year, physicians are steeling themselves for 7,500 to 8,000 babies.

Olive View’s obstetrics service worked at 203% of capacity last year. In comparison, County-USC operated at 115% of capacity, Martin Luther King Jr./Drew Medical Center at 92% of capacity and Harbor-UCLA at 148% capacity.

In June, the Olive View team operated at 223% of capacity--once again beating the three other county maternity wards.

Until recently, the staff coped by practicing hallway medicine. When all the labor rooms were filled, women with fetal monitors strapped to their swollen bellies were lined up on gurneys in the hallway.

But Paulette Nakamura, the nursing supervisor for labor and delivery, got fed up. There weren’t enough electrical sockets in the hallway to hook up all the fetal monitors. There were no outlets for oxygen for the women, and the fetal monitors were not connected to the central monitor near the nurses’ station. The central monitor emits a loud alarm when a fetus is in trouble.

“I couldn’t take it anymore,” Nakamura said. “Patients tolerate labor really poorly in the hallway. It’s noisy and they lose control. Once they lose control of the pain and they start screaming in labor its very, very difficult to get them out of that stage.”

In June, the hospital decided that hallway labor should be curtailed. The administration gave its approval for obstetrics, which had already expanded throughout the hospital, to spread a little more.

Today, mothers occupy half of the pediatric ward, two intensive care units totaling 18 beds, half of surgical’s outpatient clinic and an area that was originally designated for the hospital administrative suites. Obstetrics uses the emergency room’s observation area when necessary. And there’s talk of needing even more space.

But Dr. Robert Galli, an emergency room physician, said it’s no secret that the 14-bed emergency room is already “oversaturated.” As gridlock settles in on bad days, there could be two dozen seriously ill patients vying for attention. That’s when the emergency room typically runs out of stretchers and wheelchairs and patients wait hours or even days in the hallway for a transfer to a scarce bed in the ICU or a ward.

Even before being seen by a doctor, patients may sit eight to 12 hours in a cramped waiting room, Galli said. A 20-hour wait is no longer considered freakish.

Emergency medicine is not the only department trying to swim against the maternity tide.

The pediatricians are being overwhelmed by babies. In July, pediatricians stopped routinely examining newborns twice before sending them home, said Dr. Douglas Frasier, chief of pediatrics. Now babies who appear healthy are only guaranteed one checkup.

“The potential of having a baby go home and die or come back and die is quite real,” Frasier said.

Dr. Sue Hall, a neonatologist, said the infants receive excellent care, but the crush of babies has prompted mistakes.

“I’ve seen residents miss very important physical findings because it’s 5 a.m. and they were too tired to examine babies,” Hall said.

She recently stood in the intensive care nursery, which is usually packed. Pictures of Donald Duck and Mickey Mouse smile down on babies that weigh less than a dictionary. The littlest newborn that day was just 1 pound, 5 ounces. Her chances: less than 50%. She oddly resembled an old woman with her bright red skin pulled tightly over her tiny features. When she cried she sounded like a muffled kitten.

“Sorry, honey,” a nurse cooed, after a doctor inserted an IV into her heart to provide her nourishment.

The county hopes to ease the burden that baby doctors face at Olive View and the other three public hospitals by encouraging private physicians to bail them out. County health officials are trying to make it more attractive for these physicians and private hospitals to provide prenatal care and deliveries to indigent mothers. So far, 21 private institutions have signed on.

Olive View also plans to start an aggressive sterilization program to cut down on repeat maternity customers. At present fewer than 50% of the women who request the procedure are sterilized because the obstetricians are too busy delivering babies, Mikhail said.

But even that doesn’t please everybody. The surgeons worry that obstetrics will monopolize the hospital’s fifth operating room.

Said Thompson, the chief of surgery: “I’m afraid we’re going to get squeezed even further.”