4 Hospitals Required Cash for Epidurals, County Finds

Poor women were forced to pay cash to obtain epidural anesthesia during childbirth at four area hospitals, a top county health regulator said Thursday.

Meanwhile, in response to public outrage over the practice, which was discovered at Northridge Hospital Medical Center, the state Legislature on Thursday gave final approval to a bill that would forbid doctors from withholding pain relief from women in labor, and declare it unethical to deny or threaten to deny pain relief to any patient based on the patient’s financial resources.

The majority of cases of denials of epidurals appear to have occurred at Northridge. But investigators have discovered that some women on Medi-Cal also were required to pay for anesthesia at Whittier Hospital Medical Center, Providence Holy Cross Hospital in Mission Hills and Queen of Angels/Hollywood Presbyterian Hospital, said Jean Olander, health facilities manager for Los Angeles County. A fifth hospital, San Dimas Community Hospital, is still under investigation, Olander said.

In addition to declaring such practices unethical, the bill passed by the Legislature would make it illegal for any county hospital or general acute care hospital to have differing standards of care among obstetrical patients based upon their insurance carrier or their ability to pay.

“We cannot allow a patient’s ability to pay or source of payment to dictate treatment,” said Assemblyman Martin Gallegos (D-Baldwin Park), who introduced the legislation after reports in The Times that Medi-Cal recipients at Northridge Hospital had been either denied epidurals or forced to pay cash for them over a period of several years.

The bill, which passed the Senate on Thursday, closes a key loophole in medical regulations by declaring it to be “unprofessional conduct” for a doctor to deny or threaten to deny pain management based on a patient’s ability to pay.

Gov. Pete Wilson has not yet taken a position on the legislation, but if he signs it when it reaches his desk next week, the Medical Board of California will be able to discipline doctors who engage in such practices.

State health administrators have said repeatedly that physicians and hospitals are prohibited from charging Medi-Cal patients for a service that the agency covers.

“We’re sworn as doctors to provide care to people who need it,” said Gallegos, who is a chiropractor. “It’s a terrible breach of ethics when doctors try to blackmail patients in this way.”

So far, the cases of about 20 women who allegedly were charged for epidural anesthesia have been referred to state medical regulators, Olander said. All of them were asked to pay cash, she said.

The investigation stemmed from reports in The Times that Northridge Hospital Medical Center had routinely denied the commonly used form of spinal anesthesia to Medi-Cal recipients if they could not pay $400 in cash.

The stories described the experience of Ozzie Chavez, a North Hills mother of five who was refused the procedure after her doctor had ordered it, as well as other cases. As a result, the hospital has been cited for breaking six state regulations and ordered to refund payments made by as many as 300 women who were forced to pay cash for epidurals.

Whittier Hospital Medical Center confirmed that Medi-Cal patients were charged for epidurals, but said that the practice ended after a new hospital president demanded a change.

Sandra Chester, chief executive officer at Whittier, said she learned of the practice shortly after taking the reins in 1996.

“I was uncomfortable with it,” Chester said.

Sherry Slade, Whittier Hospital’s director of business development, blamed the practice on anesthesiologists practicing at the hospital, whom she said were independent contractors who set up their own billing practices.

Slade said that she did not know whether the anesthesiologists had demanded cash.

“I believe some of them accepted checks,” she said.

At Providence Holy Cross, investigators confirmed that a woman was required to pay cash in advance to an anesthesiologist, but the payment was made before she went into labor, said spokeswoman Daphne Cohen.

“I’m not going to deny that it happened,” said Cohen, who would not comment further.

The hospital said in a statement that state officials had found that care at the hospital “was within acceptable standards” and had discovered only one case of a woman who was asked to pay extra for an epidural.

At Queen of Angels/Hollywood Presbyterian, which was recently purchased by Tenet Healthcare Corp., Chief Executive Officer John Fenton confirmed one case of a woman who was asked for cash, but said he did not know the extent of the practice under the hospital’s previous owners. Nonetheless, he said, “one case is too many,” and the hospital has taken steps to ensure that it does not continue.

To this end, he said, anesthesiologists have been sent a letter detailing their responsibilities under Medi-Cal and required to sign a statement in response showing that they read and understood it.

San Dimas hospital did not return repeated telephone calls Thursday.

In an internal report to the Board of Supervisors dated Aug. 7, county health Director Mark Finucane said the four hospitals found to have asked for cash for epidurals appeared to have ended the practice, a contention that Olander confirmed.

Finucane also told the supervisors that the state had denied their request for a sweeping investigation of every hospital in the county, citing a lack of resources.

Instead, the health chief said, the state would investigate only in response to specific complaints or allegations.

Supervisor Zev Yaroslavsky cautioned against slowing down the investigation, and called for further tightening of legal restrictions on the way doctors charge for pain management during labor.

“This practice of shaking down pregnant women in their most vulnerable moment . . . was practiced at some of the most respected hospitals in our community,” said Yaroslavsky, who praised the Gallegos bill. “If these hospitals can allow that to take place under their noses, then it can happen anywhere--and it can happen again.”