UCSD Backtracks on Ending Prenatal Program

Stinging from criticism of its plan to close a prenatal care program for the poor, UC San Diego has begun intense efforts to find a way to keep the program alive.

UCSD Medical Center officials did not return phone calls to ask about the negotiations Thursday, but the talks were confirmed by a UCSD spokeswoman.

“The medical center administration is working with the reproductive medicine department and the community clinics to work something out. Any details beyond that I don’t know,” Nancy Stringer said.

She declined to comment further, explaining that “there has been a lot of misinformation generated as a result of trying to discuss this while it was in process.”

Stringer also denied that anyone had ever made a final decision to close the Comprehensive Perinatal Program, despite an Oct. 16 memo to that effect and confirmation Tuesday by Dr. Robert Resnik, head of reproductive medicine at the medical school.

“That was a draft memo that was not for release,” Stringer said. “It was in process. It was still being discussed.”

She would not comment on what pressures may have come to bear on the medical center since Resnik’s closure plan was publicized this week.

However, among the calls to the hospital was one from county Supervisor Brian Bilbray. Bilbray characterized the UCSD decision as “myopic” and expressed hope that the university would reconsider.

“It’s not just a university issue. The university is part of the community, and it has to understand that they can’t walk away from the community’s needs,” Bilbray said.

“I really can’t believe that, when they look at all the realities that we have in San Diego County . . . that they will really continue with this sort of myopic approach of shutting it down.”

Bilbray and Supervisor Leon Williams constitute a supervisors’ subcommittee that has been trying to find a way to augment existing programs that provide prenatal care to poor women in the county.

They had prepared a proposal that was to have been presented to the supervisors for consideration Nov. 6, when the UCSD perinatal program shutdown was announced.

With the closure, the county’s efforts would just be backfilling the void, rather than increasing access for poor women, Bilbray said.

San Diego had nearly 4,000 births last year to women who had no prenatal care, and thus were more likely to have sick or premature babies.

Stephen Shubert, director of the San Diego Council of Community Clinics, said he is involved with UCSD in the negotiations on how the clinics could help rescue the Comprehensive Perinatal Program.

He hinted that the entire episode may have been caused by staffs at the medical school and the hospital, which technically are separate, not communicating with each other.

“I’m sure that there are ways that the medical center and the school of medicine can accommodate each other--once they decide they will accommodate each other,” Shubert said. “And my hope is that they do that right away.”

In a state-funded project that was later judged a success, the Comprehensive Perinatal Program gave pregnancy care and did the deliveries at UCSD for up to 130 women a month for the last several years. The state used the UCSD model as a basis for increasing reimbursement rates for prenatal care and delivery more than a third under the Medi-Cal program. It ended the grant a year ago.

Resnik said in his Oct. 16 memo that the loss of the state grant made the program no longer financially viable. It would have cost $250,000 to $300,000 a year in unreimbursed fees to obstetrical faculty at the medical school, and $100,000 in administrative costs, the memo said.

UCSD officials were asked Tuesday to explain how those figures were arrived at and what alternatives were considered. They still hadn’t done so by Thursday.

Told earlier this week that UCSD was planning to shut down the perinatal project, state officials expressed puzzlement.

The higher reimbursement rates have been found acceptable by other doctors all over the state, said Dr. Rugmini Shah, chief of the maternal and child health branch of the state Department of Health Services.

Stringer said the university disagrees with state officials on what the reimbursement rates are for Medi-Cal deliveries, but she was not specific.

The total potential fees for a normal delivery, including reimbursement for special prenatal care, is $2,155.20, said Jim Taylor, chief of the Medi-Cal provider rate section for the health services department. However, the fees are broken down into many smaller items, any of which can be denied by Medi-Cal.