Elective Aspects of Epidural, Medi-Cal

* In response to the media’s interpretation on the Medi-Cal patient who was denied an epidural and your June 16 editorial, I feel a physician’s viewpoint is necessary.

As an obstetrician, I deal with patients of all socioeconomic classes. Many patients who are paying cash for their pregnancy and delivery, or those with traditional or private provider organization insurance, will try and deliver without an epidural to decrease expenses.

An epidural is an elective procedure, so doctors should not be forced to provide this service. Other less costly drugs are available for pain relief. Obviously, anesthesiologists provide epidurals for emergencies and caesarean sections, even though Medi-Cal reimbursement barely covers cost.

In the recent past, many HMOs, such as Kaiser, did not offer epidurals unless it was necessary. Other elective procedures, such as circumcisions, are not covered by Medi-Cal, and patients are forced to pay upfront for such procedures.

Medi-Cal does pay for epidurals, but an anesthesiologist does not have to accept Medi-Cal. Any doctor has the right to not accept Medi-Cal patients. To say that they don’t accept Medi-Cal because reimbursement is less than regular insurance is misleading.

In reality, Medi-Cal pays so little for a labor epidural that an anesthesiologist essentially loses money in providing one, not to mention the liability associated with a procedure that is not risk-free.

And to say that the patient was forced to endure pain is untrue. Many patients go through labor utilizing only intravenous medications, especially patients having their fifth child, as these labors tend to be so rapid that an epidural is not necessary, whether they have insurance or not.

So instead of condemning a doctor for trying to collect for services rendered, your contempt should be directed at the patient who has her fifth child on welfare and shows up at the hospital demanding an elective procedure.

She should be grateful that the state is able to help her pay for another pregnancy. Patients need to stop viewing Medi-Cal as another type of insurance, but instead as a program designed to assist patients during a difficult financial time.

JEFFREY ILLECK, M.D.

Los Alamitos