UCI Medical Center Cited for Overflow Nursery Unit : Health: Surprise inspection finds severe overcrowding, with 47 infants in intensive care wing licensed for 30. Lack of transfers is questioned.

State health officials have cited UCI Medical Center for severe overcrowding in its nursery for the smallest, sickest babies.

Because the neonatal intensive care unit was licensed for 30 babies, Thursday’s census of 47 babies was much too high, a licensing inspector reported after a surprise inspection.

Also, the nursery--one of the most sophisticated neonatal units in Orange County--was required to have at least one nurse for every two babies, but the overall ratio was slightly higher than that, up to 14 nurses for 33 babies on Thursday, the report says. But “there was no jeopardy to the babies,” said Jacqueline Lincer, district administrator for licensing with the state Department of Health Services. Her division is now demanding a corrective plan--but no fines--from the medical center within 10 days.

Other state health officials, including some from California Children’s Services, had been monitoring the overcrowding for some time, Lincer said, adding: “The care is being provided.”

The UCI nursery is reportedly near compliance now, with 35 babies there Tuesday night, instead of the average 40 to 44 a day housed there since August. Some of the 12 babies discharged over the weekend were sent home and others were transferred to other hospitals, hospital spokeswoman Elaine Beno said.

But those recent transfers raised the question of why UCI wasn’t transferring babies all along.

Medical center officials have said the overcrowding occurred because they could not move Medi-Cal babies who no longer needed such intense care to other nearby hospitals. Hospital deputy director Herb Spiwak last week said UCI’s problem came because other local hospitals with neonatal units were not Medi-Cal contractors and so would not accept a Medi-Cal babies.

Typically, three-fourths of the babies in UCI’s neonatal unit are covered by Medi-Cal.

But some state officials and administrators at other hospitals, including one who runs a regional network to transfer sick babies, said they did not understand why UCI had not announced that it was full and stopped accepting babies once its nursery was well beyond the licensed capacity.

Dr. John Vogt, director of the Pasadena-based Southern California Perinatal Dispatch Center, said UCI never told his network that its nursery was overcrowded, but rather has regularly reported it had at least one bed available. Also he said, UCI never asked his aid in helping to transfer sick babies.

Sally Lee, in charge of Medi-Cal operations with the state Department of Health Services, also said she doesn’t understand why UCI had so many babies. “It seems odd to me that they would want that many babies,” she said. “I hope they did it out of the goodness of their heart, that they cared.”

One hospital staffer claimed UCI kept the babies because the care was profitable under the medical center’s Medi-Cal contract, whose precise terms, by law, are confidential. In a July-August internal publication, “Visions,” hospital director Mary Piccione described the neonatal program as one of several “historically successful programs” that helped the hospital turn a profit last year.

Hospital spokeswoman Beno, however, said she did not know if the care was profitable. She said that that UCI’s interest was always to give the best medical care to a baby.

“We have accepted those babies needing specialized level III (neonatal care) with the care that only UCI offers in Orange County,” Beno said. (Actually, two other hospitals--Children’s Hospital of Orange County in Orange and Saddleback Medical Center in Laguna Hills--have Level III units, which offer the highest level of neonatal care. Neither is overloaded at the moment, though they do offer some different services than UCI.)

Also, UCI doctors might not want to transfer babies to distant hospitals if local spaces weren’t available, Beno said.

“If it means sending an Orange County baby to Kern County, I’m not sure it’s the best idea,” she said.

Last week, UCI administrator Spiwak had complained that some hospitals in Orange County would transfer desperately sick Medi-Cal babies to UCI, but then would not accept them back when their condition improved.

However, officials at several Orange County hospitals maintained that they would re-admit Medi-Cal babies born in their hospitals.

Mission Hospital Regional Medical Center in Mission Viejo, for instance, has a 10-bed neonatal unit that is not quite as sophisticated as UCI’s. The hospital does not have a Medi-Cal contract. Hospital spokeswoman Nancy Gasho said, “It’s not our role to be an overflow unit for UCI regardless of the payer.” But Gasho added: “If the mother was here and the baby was transferred there (to UCI),” Mission will readmit the baby when its condition has improved.

The state health agency’s Lee said she believed UCI had not been actively looking to transfer babies in recent months.

“They’ve never had to transfer babies before,” she said. “They’ve never done it in any significant number.”

UCI also failed to use Medi-Cal’s longstanding system for transferring patients by contacting Medi-Cal hospitals first, then others. Only if such a system is used can a non-Medi-Cal hospital be reimbursed for that patient, Lee said.

She said this system has just been explained to UCI officials.

Suggesting the system was new, Beno called this explanation of “the hierarchy of hospitals” a “great start” and said she hoped it would make transfers out of UCI Medical Center easier.

“Hospitals that maybe would not have accepted a baby can now be assured that they will accept a baby and get paid for service,” she said.