County Obstetrics Plan Seen as Mere Stopgap : Health care: Proposal to ease overcrowding in the system calls for diverting poor pregnant women to private hospitals with empty beds. But because of the soaring birthrate, even that wouldn’t be enough.

A plan to relieve overcrowding in the county obstetrical system has received a significant financial boost from state health officials as well as encouraging response from private hospitals and doctors willing to take greater responsibility for the poor.

But a new report issued by the Los Angeles Department of Public Health has revealed that the plan--involving diversion of poor pregnant women from overcrowded public hospitals to private hospitals with empty beds--is little more than a stopgap measure.

If all of the private hospitals with maternity service agreed to take indigent patients, there still wouldn’t be enough obstetrical beds in Los Angeles County to cope with the births projected for this year, said Dr. Gary A. Richwald, lead author on a study of obstetrical capacity.

Richwald’s study, commissioned by the health department a year ago when Richwald was on the faculty of UCLA’s School of Public Health, projects 209,000 births in Los Angeles County this year, a 7.8% increase over last year’s record 193,517. That will be 10% more than the combined capacity of every existing obstetrical service in the county.

“Gary’s study is good and it is accurate and it means that we’ve got real trouble coming at us,” said Anthony J. Abbate, a senior vice president of the Hospital Council of Southern California. “All we’ve been doing is identifying wiggle room in the system. There isn’t the capacity really to make you comfortable in the next 12 to 18 months.”

The study’s conclusions have given health officials a dual mission in their negotiations with private hospitals: get them to shoulder part of the load of indigent patients as well as convert underutilized sections of their hospital to obstetrics. A significant number of hospitals in Los Angeles County have empty beds in the medical and surgical specialties, a money-losing occupancy problem generally handled by reducing staff and closing down units.

Converting those units to obstetrical use costs money--in very short supply in the health care system. But Audrey Bahr, chief of health resources development for the county health department, says the financial hurdle must be overcome.

“I have 24 (private) hospitals with 1,200 delivery slots and I need 2,000 right now,” Bahr said. “And by the year 2000, I’ll need 4,000.”

The immediate problem, Bahr said, is the critical need for room for 800 more deliveries per month to relieve the patient load on the county’s four public hospitals with obstetrical units.

The Board of Supervisors is to vote Tuesday on a plan that would allow the health department to act as an intermediary between participating hospitals and Medi-Cal, cutting much of the red tape and payment delays that have made the public insurance program unappealing to the private sector. The proposal also would boost the state’s daily rate for hospitalization of obstetrical patients from $600 to $790, and make it possible for hospitals without Medi-Cal contracts to participate.

The state generally has required hospitals receiving Medi-Cal money to provide a full range of services to poor patients and not just one, such as obstetrics. County health officials have been seeking an exemption from this rule for more than two years to deal with the county’s soaring birth rate. Last month, bolstered by support from the hospital council and the Los Angeles County Medical Assn., the county’s latest plan won the approval of state Medi-Cal negotiators.

Jim Ringrose, the state’s chief negotiator, said he was persuaded by the severity of the problem in Los Angeles County and by the active role the county health department pledged to take in supervising the care of patients.

For their part, the hospital council and medical association have been instrumental in getting the private sector to cooperate.

If the supervisors approve the contracting proposal before them, Bahr said, she has three private hospitals ready to sign up--adding 110 obstetrical beds per month to the system.

The hospital council has a list of 10 more hospitals that are close to agreements, and another 20 that are “very interested,” according to David Langness, the council’s vice president for community affairs. The latter group, he said, are still negotiating with their medical staffs and others whose cooperation is needed for success.

“There are so many players . . . that it takes time to iron out the details,” Langness said. “But we think they will be ironed out. It just takes time.”

Carl A. Williams, the county’s administrator for hospitals, said he hopes the state’s decision to raise the daily hospitalization rate to $790 will attract more private hospitals to the program. And as doctors and hospitals get used to the program, he would like to see women referred into private care earlier in their pregnancies. That would be the best way to reduce the stress on the county hospitals, he said.

As for the doctors, 50 have signed contracts to participate in the program, according to Dr. David Chernof, the medical association’s president, who wrote a letter of endorsement accompanying the health department’s mailing of contracts. Chernof said the response is encouraging, but he is considering a follow-up letter to push for more volunteers.

“It is a little frustrating that you just can’t push a button and make this work,” said Abbate, who has been in the thick of the negotiations. “But it is a people system. It is one doctor delivering one baby for one woman. So it involves a great many people and that is hard to pull together.”