Valley Hospital Ordered to Make Epidural Refunds

State health officials have ordered Northridge Hospital Medical Center to pay refunds to hundreds of poor mothers who were wrongly charged cash for delivery-room epidural anesthesia during the last five years.

The payments could total $120,000 to between 200 and 300 eligible women, said John Lockhart, hospital spokesman. It was the hospital’s first acknowledgment that the practice was widespread since The Times disclosed it last month.

The Department of Health Services’ demand for the reimbursements, made in a June 9 letter to the hospital, comes as the agency is investigating the hospital’s past practice of denying the pain-killer to mothers on Medi-Cal unless they paid for it themselves. Federal regulators and the Los Angeles County district attorney’s office also are reviewing the case.

The hospital also must provide evidence of when the practice began and ended, and send letters to all Medi-Cal patients who experienced childbirth labor at the facility, to determine if they were required to pay for an epidural.

Hospital president Roger Seaver, in a written statement, said the hospital will make sure the payments are made, and promised to take “all other necessary actions” to ensure the state does not ban the hospital from caring for Medi-Cal patients.

At $400 apiece, the amount the women were improperly required to pay, the hospital will pay up to $120,000. The facility has been accepting Medi-Cal patients since 1993.

After reimbursing the women, the Northridge medical center will attempt to recover the money from the individual anesthesiologists who collected the fees, said Lockhart.

“The hospital will guarantee the payments will be made,” Lockhart said. “That’s not a small amount of money, especially for a nonprofit hospital. But they are dedicated to making this right.”

Last week Seaver apologized to Ozzie Chavez, a Canoga Park mother of five who was denied an epidural last summer when she could not produce $400 in cash. Her case led to the state investigation, and Chavez’s treatment has been criticized by leading anesthesiologists and obstetricians.

“There are a number of other cases we are investigating at the hospital at this time,” said Ken August, spokesman for the state health agency. “We’re looking at any reports that have been given to us.”

A Simi Valley woman filed a suit against the hospital July 2, making similar allegations to Chavez’s. Julie Tichenor is seeking $5 million for the “severe emotional distress” she suffered when she was denied an epidural while giving birth at the hospital last year.

In 1997, the hospital delivered 2,580 babies, 985 of which were paid for by Medi-Cal. More than 80% of the hospital’s obstetrical patients depend on Medi-Cal for health-care services, according to hospital figures.

As a result of the state investigation, the health agency cited the hospital for poor performance in six areas, from patients’ rights violations to failing to administer treatment as ordered.

If Northridge fails to comply with the state directive, the hospital will be sent a 30-day notice of termination of its Medi-Cal contract, August said. Medi-Cal provides health-care coverage for 5 million low-income and needy Californians.

Hospital officials have said its anesthesiologists mistakenly believed that epidural anesthesia--a partial spinal block considered by many doctors to be the safest form of pain relief for women giving birth--was not covered by Medi-Cal, a claim the state health agency dismisses.

“It is clear that epidurals are a covered benefit,” August said. “We have a whole series of forms explaining how to bill us for it.”

In a blunt official statement released Friday, the state health agency laid exclusive blame on the hospital, saying “it was the hospital’s arrangement that resulted in Medi-Cal beneficiaries having no alternative but to be charged for a Medi-Cal service.”

Seaver said the hospital ended the practice of charging Medi-Cal patients for the anesthesia in August 1997, a month after Chavez complained, but continued the practice at the hospital’s facility in Van Nuys until last month. Cash was collected from mothers since 1993, when the Northridge medical center first began accepting low-income pregnant women, Lockhart said.

The U.S. Health Care Financing Assn. began reviewing the hospital’s practices Tuesday, the same day the Los Angeles County Board of Supervisors asked state regulators to expand their investigation to include all anesthesiologists and hospitals in the county that accept Medi-Cal patients.