Mothers, Babies Paid the Price for County’s Attempt to Save Money

It was with feelings of anger and disgust that I read how county hospital doctors forced poor women to try to deliver their babies vaginally, even if such births endangered the lives of the babies and mothers.

If my wife and daughter had given birth under the county rules, the babies probably wouldn’t have made it. Given the uncertainties of the birth process, the mothers might not have survived, either.

Alert nurses and a physician moved quickly when my wife, Nancy, suffered premature tearing of the placenta during our daughter Robin’s birth in the late 1950s. Without the operation, Robin would have died from a lack of oxygen.

Last October, our youngest daughter, Jennifer, was six weeks away from expected delivery. A pain in her side sent Jennifer and her husband, John, to Cedars-Sinai Medical Center. A series of ultrasound examinations revealed the same sort of problem that had afflicted her mother.

An emergency caesarean delivered a healthy girl, Anabelle, who weighed more than 5 pounds despite her early birth.

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Even though I knew I would hear a bureaucratic response that would explain nothing, I went up to the Los Angeles County Board of Supervisors to hear what health director Mark Finucane and his medical director, Dr. Donald Thomas, had to say about the now-discontinued policy.

They were there because Supervisor Mike Antonovich ordered them to provide answers to questions raised by the story by Times reporter Sharon Bernstein.

I listened while they explained that the reluctance to perform caesareans was part of a national movement to reduce the number of the time-consuming and expensive operations. They denied that the policy was financially motivated, but I don’t buy that.

I was there in the middle and late 1980s, when county hospitals became increasingly overcrowded, especially in maternity wards. A huge number of the patients were poor immigrants from Mexico, many of them here illegally.

Beds with women in labor lined the hallways of Women’s Hospital at County-USC Medical Center, Harbor/UCLA Medical Center and others in the system.

At Women’s Hospital, C-sections were performed every day in each of the seven operating rooms. It was the MASH of maternity wards. Residents engaged in triage, leaving one mother when another was in even worse condition, handling two or three deliveries at a time. Exhausted residents, burdened with cases beyond their experience, often finished the day in tears.

Meanwhile, far from these scenes of despair, bean counters and ideologues were at work at the county Hall of Administration.

The Board of Supervisors’ conservative majority, including Supervisor Antonovich, mounted an unrelenting assault against illegal immigrants being treated at the county hospitals under Medi-Cal, the government medical aid program for the poor.

In addition, they forced cutbacks in the county health budget, insisting that private enterprise could do a better and cheaper job. Residents and interns were on the phone with our reporters each week with new horror stories from the hospitals.

As the pressure on the hospitals worsened, county doctors tried to reduce the number of C-sections. They adopted a system of having women first try labor before a caesarean was undertaken, a method known as trial of labor.

At least that’s what they called it. But at County-USC, in many cases, it turned out to be trial by torture.

Antonovich is the only survivor of those conservative days. His aides tell me that there’s no contradiction in his efforts to reform the health system and his horror at the disclosures in The Times’ story.

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The policy was abandoned in 1995, but that’s no reason to close the books on this chapter of health history.

For as we watch the evolution of the nation’s health care system, we can learn some lessons from the grim wards at the county hospitals.

Poor Spanish-speaking women were forced into labor without being told of the consequences.

It was done to save money.

Sound familiar to you members of hardheaded HMOs?

Think of where we’re heading: a two-tier medical system. At the bottom would be the poorest, forced to seek help at county hospitals.

But those of us in the upper tier shouldn’t count ourselves free from worry.

For what we all will have in common is that medical decisions will be made by bean counters instead of doctors.

That’s the lesson of the county hospital maternity wards.