UCI Neonatal Center Vastly Overcrowded

UCI Medical Center’s nursery for its smallest, sickest babies is severely overcrowded, and a top administrator Thursday blamed the problem on a shortage of Medi-Cal beds in Orange County.

There is no health hazard for these tiny patients, hospital officials maintain. But since August, the neonatal intensive-care unit, a top-level nursery licensed for 30 babies a day, has cared for an average of 40 to 44 babies daily, deputy director Herb Spiwak said Thursday.

“We’ve not been able to transfer some of these babies out of here” because several nearby hospitals with neonatal units recently quit the Medi-Cal system, Spiwak said. “And we’re taking new babies. So we’re getting jammed.”

The number of sick babies in Orange County also appears to have increased recently, he said.

To handle the crunch, the hospital has hired more part-time nurses and moved some incubators into an area normally set aside for older children. “We haven’t refused anybody,” Spiwak said. “But our ability to continue is getting strained.”

Two weeks ago, the neonatal unit’s census rose to its highest level yet, 51 babies, and by midday Thursday, it was approaching that level again, with 47 babies tended there.

Local health experts worry that Orange County hospitals might be approaching a crisis in neonatal care similar to one in obstetrical care here two years ago.

In June, 1989, UCI Medical Center was delivering more than 500 babies in a maternity ward designed for 250 babies. Hoping to slow the flood, its leaders announced a controversial “obstetrical diversion” policy to send some women in labor to other, nearby hospitals. At the time, local Medi-Cal hospitals also reported crowded maternity wards.

For now, the obstetrics crisis has eased, in part because state Medi-Cal officials have allowed hospitals to contract for labor and delivery services alone, without requiring a full-service Medi-Cal contract that would cover other services.

During this latest crunch, local hospitals want to work with state Medi-Cal officials quickly--”to resolve this problem before it becomes a crisis where patients are being turned away,” said Russ Inglish, vice president of the Hospital Council of Southern California, whose members discussed crowding at UCI’s neonatal intensive-care unit earlier this week.

So far, no other Orange County hospital has complained of overcrowding in a neonatal unit, though Children’s Hospital of Orange County reports that its 28-bed unit is full or nearly full every day.

The latest difficulty for UCI comes, Spiwak explained, because the medical center’s top-level neonatal unit can accept a baby from any hospital in Orange and Los Angeles counties. The problem develops once the baby recovers and needs less intensive care. At that point, if the child is a Medi-Cal patient but the sending hospital was not a Medi-Cal contractor, under current regulations “I can’t send it back,” Spiwak said.

The result: an overload of babies.

Alerted by a reporter to the crowding, a state licensing official said Thursday that her staff would immediately investigate conditions in neonatal intensive care.

State law requires at least 80 square feet per bassinet so that quality care can be provided, according to Jacqueline Lincer, district administrator in charge of licensing for the State Department of Health Services. State law also mandates isolation for infants with diarrhea and airborne infections. It is not known if any of these requirements have been violated at UCI.

But Lincer said: “We need to go over there right away.”

Because of concern about the crowding, other state health officials are considering a special contract that would let non-Medi-Cal hospitals be reimbursed for taking Medi-Cal babies--especially transfers from UCI--into their neonatal intensive-care units.

“We’re going to try to help them (UCI) out,” said Sally Lee, the state’s chief of Medi-Cal operations in the state Department of Health Services. “It’s not fair that they should carry the burden.” Lee said she expected to reach a decision within a few days.

For now, at least two Orange County hospitals that lack a Medi-Cal contract would like to take UCI’s overflow but cannot.

“We’re having to turn away transfer requests,” said John Cochran, chief executive officer of Martin Luther Hospital in Anaheim, which has 14 neonatal intensive-care beds, six of them empty recently. “We’ve been ready, rolling and able to accept transfers as has (an affiliated hospital in) La Palma. But neither one of us can do it.”

At UCI Medical Center, officials could not estimate how much the overcrowding has cost their hospital, which was nearly closed this spring because of multimillion-dollar deficits. But neonatal intensive care is one of the most expensive kinds of medical care. The incubator alone costs $2,000 a day, hospital official Elaine Beno noted.

In addition, by law, the ratio of nurses to babies in a neonatal unit must be at least one to two, but frequently, with a sick, premature, one or two-pound baby, it is one to one, with a single nurse assigned to a one- or two-pound baby--giving medicine, checking blood gasses, monitoring a respirator--and sometimes cuddling this tiniest of humans 24 hours a day.

Recently, in a move that can only boost costs, the hospital has kept up with its growing census by hiring “a substantial number” of part-time nurses from local nursing registries, Spiwak said. Officials would not say how many.

“The nurses are actually pretty satisfied with the situation,” said Maureen Anderson, spokeswoman for the California Nurses Assn., which represents UCI nurses. They are being paid fairly for overtime “and they feel it (the unit) is safe,” she added.

Currently, there are 20 to 27 nurses, including registry nurses working on each shift, but “Before this, they used to have 18,” Anderson said.

Medical center officials declined to let a reporter visit the unit Thursday, but officials from the March of Dimes who toured it two weeks ago described it as “very crowded.”

“It was not like all these little beds on top of each other,” said March of Dimes community affairs director Dottie Anderson. “The thing you notice is the numbers of staff it takes to serve these babies. It makes for limited space . . . but I saw nothing that indicated they weren’t maintaining quality of care.”

Still, acting on recommendations from 30 experts who reviewed health care needs in Orange County, the local March of Dimes chapter will be urging a review of neonatal intensive care by county or private health officials, Andrews said. She said she did not know if the problem could be called “a crisis” yet, but she was worried that the medical center’s unit was so crowded while neonatal units at other Orange County hospitals were empty.