Clinic Shuts Out Patients Seeking Prenatal Care : Health: Major county facility acts at a time of federal and state efforts to improve such care. A shortage of obstetricians and nurse practitioners is cited as the waiting list exceeds 800.
In the midst of a statewide and federal push for improved prenatal care, Los Angeles county officials disclosed Friday they are turning away new patients seeking care at the county’s largest public clinic for pregnant women.
In the last few weeks, short staffing has forced the H. Claude Hudson Comprehensive Health Center to turn away about 30 patients a day, adding them to a waiting list that now includes more than 800 women.
No new patients, except emergency cases, will be seen until vacancies for obstetricians and nurse practitioners are filled, officials said. Non-competitive salaries were blamed for recruiting difficulties.
The news came as a shock not only to patients--who include many low-income women living in the city’s central area--but to health advocates and even the state’s director of health services, Molly Joel Coye, who have all worked hard on programs promoting prenatal care.
They said that outreach programs are only effective if there are medical services available to treat the women when they call for help. “The idea of turning away these women is overwhelming,” Coye said.
“We really have made prenatal care a major priority in California,” said Wendy Lazarus, vice president of Children Now, a statewide nonprofit advocacy group. “The fact that these women now can’t get in the door (at Hudson) is just plain shocking. It flies in the face of all the good words about the need for prenatal care.”
In an effort to promote better preventive health care in the state, Gov. Pete Wilson this year launched two new multimillion-dollar programs to improve prenatal care for both poor and lower-middle-class women. President Bush endorsed the cost-effectiveness of prenatal care by asking Congress in May for $171 million to support a prenatal care outreach program called Healthy Start.
Studies have shown that, compared to babies whose mothers received prenatal care, those whose mothers went without it are four times as likely to die during their first year of life and three times as likely to be born at dangerously low weight that can lead to costly medical intervention.
Lazarus praised these new programs for attempting to make prenatal care available to women who in the past have gone without. But she said that the situation at the Hudson clinic shows “we’re letting the most basic safety nets--which traditionally have been the county prenatal clinics--develop larger holes.”
In Los Angeles County, 44 clinics provide prenatal services to varying numbers of low-income women. But the prenatal program at Hudson, at 2829 S. Grand Ave., is the largest, serving a section of the city that is densely populated with recent immigrants. All pregnant women living in the area must be examined and evaluated at Hudson before they are referred for follow-up care to a neighborhood clinics close to their homes. High-risk patients continue to be seen at Hudson.
Irwin Silberman, director of maternal and child health for the county of Los Angeles, said Hudson has been forced to stop seeing new patients for lack of staff.
The center has two obstetricians and has been trying for months to fill four vacancies. But Dr. Carol Henneman, Hudson’s medical director, said the salaries are not high enough to attract qualified applicants. The county, Henneman said, offers an $86,000 starting salary to a junior physician who has just completed an obstetrical training program, compared to about $100,000 offered in the private sector.
During the last five years, county health officials have worked to improve access to prenatal care by reducing the waiting time for appointments at county prenatal clinics.
“As recently as four or five years ago, the wait for prenatal care was 16 to 19 weeks at some clinics,” recalled Lazarus. “Sometimes, women would have their babies before they could get an appointment for prenatal care.”
The county Board of Supervisors responded with additional funds that dramatically reduced the waiting time at county clinics.
This fall, the average wait for a prenatal appointment was 2.2 weeks, according to the most recent county health department statistics. But this is almost double the wait of 1.4 weeks in June, indicating that the problem of prenatal clinic overcrowding has “raised its ugly head again,” said Silberman.
The two new state prenatal care programs--Baby-Cal and AIM, or Access for Infants and Mothers--are run and funded separately from the county’s prenatal clinics. AIM uses tobacco tax revenue to subsidize private insurance for pregnant women. Baby-Cal is an outreach program to recruit private physicians to treat low-income women and to urge pregnant women to seek care through the government-sponsored Medi-Cal program.
The federal Healthy Start program funds special outreach programs in various parts of the country--but not Los Angeles.
Coye, the state’s health chief, said the state can do nothing about county pay scales. She noted that there is a shortage of obstetricians nationwide “who are willing to care for poor women.”
There are areas across the state, she said, where the demand for prenatal care outstrips the available services. But she added, “‘I’m overwhelmed that the shortage is that acute in central Los Angeles.”