UCSD Obstetricians’ Planned Ties to La Jolla Hospital Raise Questions

Obstetricians in the UC San Diego School of Medicine are negotiating to deliver the babies of at least some of their privately insured patients at Scripps Memorial Hospital’s La Jolla facility, rather than at UCSD Medical Center in Hillcrest.

The proposal would position the physicians to develop private practices in La Jolla, even though UCSD’s planned Thornton Hospital there will not have an obstetrics unit.

If those private practices flourished, they also would raise issues about how the UCSD doctors could serve those patients as well as help deliver the more than 4,200 babies born every year at the Hillcrest hospital.

One of the reassurances UCSD officials gave in planning the La Jolla hospital was that it would lack an obstetrics unit, and therefore not contribute to the “ghetto-ization” of the Hillcrest facility into a place where only poor people go.

Leslie Franz, director of communications for the medical school, denied that there is any hidden agenda to the discussions about UCSD faculty providing obstetrical care in the La Jolla area.

“It’s not an effort to move anybody,” Franz said.

“We will be drawing patients in from a whole new geographic area, and, if those patients prefer to deliver their babies in that area, then we would like to provide a facility where that can happen,” she said. “That doesn’t suggest that the patients who are patients already in our system and are living in the areas around UCSD Medical Center wouldn’t continue to deliver down here, private or not.”

No decision on using Scripps Memorial facilities has been made, and discussions are very preliminary, she said.

“Talks are continuing,” said Michael Dabney, a spokesman for Scripps. “They are under way and they are progressing well--although I should add that there is still a long way to go on what the final outcome might be.”

One of the options under consideration at Scripps is building a new birth center similar to those planned or completed at Grossmont, Alvarado and Sharp Memorial hospitals.

Scripps La Jolla now has a 29-bed conventional birth unit that has only two combination labor-delivery-recovery rooms, which are the norm at the newer centers.

If UCSD does have doctors doing deliveries at Scripps La Jolla and also at Hillcrest, it will raise questions about how to meet the needs of both groups of patients.

Obstetricians often find it very difficult to practice at two hospitals, because of the possibility that they would have two women delivering at different institutions at the same time.

But the realities of Medi-Cal, the state’s medical funding program for the poor, would require that UCSD faculty obstetricians maintain a regular presence at Hillcrest.

That is because Medi-Cal will not pay for deliveries done by residents in training, so UCSD faculty physicians must be in attendance for the 70% of Hillcrest deliveries that are publicly funded.

The only other UCSD deliveries for which Medi-Cal will pay are those done by nurse-midwives. But they technically are employed by a perinatal access project, which UCSD is negotiating to hand off to community clinics.

Michael Stringer, director of UCSD’s hospitals and clinics, said the issue in considering obstetrical work in La Jolla is “economic balance.”

“It’s not so much location, it’s funding,” Stringer said. “It gets more private funding into the system, whether it’s here at Thornton or through other relationships. It helps us to balance our overall missions.”

But the only UCSD-linked reimbursement for deliveries outside a UCSD hospital would be to the doctors themselves. The facility fee would go to Scripps La Jolla.

Stringer pledged that, if the negotiations result in an agreement between the two institutions, UCSD will maintain a consolidated balance sheet for both its hospitals. Even if there were a shift of privately insured obstetrical patients to La Jolla, there would be no attempt to point to the Hillcrest operations as less profitable and therefore more expendable, he said.

“It’s a single financial entity, from a financial perspective,” Stringer said.

He cited a major renovation project at Hillcrest as evidence that the medical center will remain important to the medical school.

The 120-bed Thornton Hospital, planned for the east side of Interstate 5 just south of Scripps La Jolla, is scheduled for completion sometime in 1991. Construction bids on the project are being taken.