Baby Boom Delivers Growth Pains : Maternity wards: A 193% increase in births overburdens Olive View Medical Center. Hospital officials are not hopeful that a county plan to relieve overcrowding at public hospitals will work.

The hastily planned takeover of a portion of Olive View Medical Center’s emergency room turf began one day in September before daybreak.

Within hours, the area where emergency room patients are kept for observation was transformed into a maternity ward, as have other parts of the Sylmar hospital lately.

As housekeepers moved in beds for the new mothers, emergency room physicians squared off with an obstetrics nurse, arguing over who needed the room most.

“I tried to be very diplomatic,” said Latisha Stewart, an obstetrics nurse manager, recalling her stand-off with the angry doctors. “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 is a scenario that has become all too familiar at the county-operated hospital, which is grappling with a baby explosion that has surpassed expectations.

Two of four intensive care units, half the pediatrics floor and some outpatient clinic space have also been gobbled up to house the swollen obstetrics department.

County administrators have gotten 21 private hospitals to agree to take more of the county’s maternity cases, but Olive View staff members say the plan will not go far enough to reduce their caseload.

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 ward of the four county-operated maternity wings, a situation that routinely requires medical heroics.

In an internal memo, Douglas Bagley, hospital administrator, called the surge in deliveries during September “an internal disaster.” Physicians worry that the integrity of the hospitalas a full-service medical center will be 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 represents the most dramatic challenge Olive View has faced since the hospital, rebuilt after its devastation in a 1971 earthquake, returned to Sylmar more than three years ago. The 350-bed hospital, a glass and steel battleship designed to withstand the most powerful earthquakes, has been rocked from within by too many patients, too few doctors, too little money and not enough space.

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

Physicians, nurses, technicians, and 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 conduct 350. The laboratory needs to hire 44 more staff members just to keep up, but cannot, said Dr. Phyllis Thorton, who oversees it.

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

On busy days, seriously ill patients wait on stretchers in an emergency room hallway for an open bed. Patients with gallstones or hernias must wait several months for surgery.

Recent budget cuts have further threatened the hospital’s ability to treat everyone who shows up. Doctors must turn away some 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.

Still, physicians, nurses and the community seem to be fiercely loyal and proud of this gleaming hospital with state-of-the-art equipment. Many were lured there by Olive View’s connection with UCLA’s School of Medicine. Almost all of its physicians are affiliated with UCLA, as are 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.

One of Olive View’s most influential supporters 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, chief of surgery, was angry the day after obstetrics took over the emergency department’s observation room. “Because of the OB problem, it sets us against each other,” he complained. “It’s pretty unfortunate.”

When Olive View was still a set of blueprints, a maternity ward was not even in the picture. The medical center was nearly finished before 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. This year, physicians are expecting a total of 7,500 to 8,000 babies at Olive View.

Olive View’s obstetrics service worked at 203% of capacity last year, according to the county Department of Health Services. At the other three public maternity clinics, County-USC operated at 115% of capacity, Martin Luther King Jr./Drew Medical Center at 92% of capacity and Harbor-UCLA at 148% capacity.

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

“Patients tolerate labor really poorly in the hallway,” said Paulette Nakamura, nursing supervisor for labor and delivery. “It’s noisy and they lose control. Once they lose control of the pain and they start screaming in labor it’s very, very difficult to get them out of that stage.”

In June, the administration allowed obstetrics, which had already expanded throughout the hospital, to spread a little more. And there is talk of needing more space.

The county hopes to ease the baby burden that doctors face at Olive View and the other public hospitals by encouraging private physicians to bail them out. County health officials are trying to make it more financially attractive for private physicians and hospitals to provide prenatal care and deliveries to indigent mothers.

The plan, which could be implemented within two months, would divert up to 300 deliveries a month from county maternity wards to private hospitals countywide. At Olive View, officials say that is a drop in the bucket.

“I’m afraid we’re going to get squeezed even further,” said Thompson, anticipating a continuing surge of births.