COUNTYWIDE : Firm Named to Plan for Perinatal Care

County officials expect that a system for helping to ensure adequate perinatal care for poor women in the county should be in operation by summer following a key hurdle cleared Tuesday by the Board of Supervisors.

The supervisors named a Topanga firm to devise a plan for overcoming some of the problems in perinatal care that have plagued Orange County doctors and patients working within the Medi-Cal system.

The plan grows out of the controversy touched off in 1989 when UCI Medical Center in Orange began a policy of “obstetrical diversion” under which some pregnant women in labor were met at the door and advised to try another hospital.

That policy, and several studies since, pointed up the difficulty that pregnant women--particularly the poor--often have in Orange County finding delivery rooms, much less facilities for adequate prenatal and postnatal care. And with the number of pregnancies for Medi-Cal eligible women growing sharply in Orange County--there were an estimated 13,000 in 1991, contrasted with 8,464 the year before--the problem is worsening, officials say.

Under the board action Tuesday, Emile Gavreau, heading the Mountain Consulting Group in Topanga, was named to design a system for perinatal care--encompassing the period both before and after birth.

At $17,200, his bid for designing the plan was the lowest among four finalists for the job, county officials said.

Dr. Marianne E. Maxwell, director of policy and planning for the County Health Care Agency, said a county task force identified several major problems in the delivery of perinatal care to Medi-Cal patients.

Since many Medi-Cal patients are immigrants, the doctor-patient relationship is often stalled by a language barrier, she said. Many poor pregnant women aren’t sure if they are eligible for Medi-Cal--and they don’t know how to find out.

And many doctors are interested in taking a few Medi-Cal patients but are deterred--both by a very complicated billing system and by “the Floodgate Fear Phenomenon”: They’re afraid that if they take a few Medi-Cal patients, “all of a sudden they’ll be inundated,” Maxwell said.

The plan to be designed by Gavreau’s firm is aimed at overcoming these problems.

Maxwell said the new system will be a public-private partnership, operating in part through grants and private contributions, and it is expected to aid mothers from pregnancy through infancy.

The system will provide eligibility information and a referral “hot line” to pregnant women, integrate private and public facilities that accept Medi-Cal patients in Orange County, and provide billing and payment services for participating doctors, Maxwell said.

Supervisor Harriett M. Wieder said: “This will be the vehicle to give (pregnant women) the care that they need. It keeps them out of the emergency room.”