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Pay-or-Pain Medical Care

“Barbaric.” That’s how a spokesman for the American Society of Anesthesiologists characterizes forcing a woman to endure the pain of active labor without an epidural anesthetic. Yet that’s apparently what happened to Ozzie Chavez last summer, to six other women under the care of anesthesiologist Lori Berke and to an unspecified number of women patients at the Northridge Hospital Medical Center.

Chavez was covered by Medi-Cal last summer when she went to Northridge Hospital to deliver her fifth baby. When labor became acutely painful and she asked for the spinal-based anesthetic block, safely and commonly used in childbirth, she was told to first produce $400 cash--no checks or credit cards accepted.

It should be obvious that a woman in late labor is in no position to hop off the delivery table and run to her ATM or arrange a loan. Medi-Cal does authorize and pay for epidural anesthesia but pays less than private insurers. So at Northridge Hospital last summer the practice was: For Medi-Cal patients, no cash, no pain relief. That’s appalling, not to mention unethical and inhumane. It’s also a violation of state and federal law, and local officials have, appropriately, begun investigating the extent of this odious pay-or-pain policy.

The hospital says it no longer requires Medi-Cal patients to pay cash up front for epidural anesthesia. Chavez’s lawsuit against Berke and the hospital--and the prospect of losing far more than the $400 epidural charge--may have prodded it in that direction.

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As grotesque as Chavez’s experience was, it is all the more appalling in light of recent reports that poor women at county hospitals were forced to deliver babies vaginally, even in high-risk cases. This policy--another sick attempt at cost saving--has resulted in lifelong traumatic injuries to many babies and mothers. It has also cost the county millions in legal settlements and has prompted legislation, now pending in the state Senate, designed to end the practice.

It’s true that hospitals and doctors are under enormous fiscal pressures in this era of managed health care. But those who attempt to withhold such basic medical procedures as anesthesia and Caesarean deliveries richly deserve the punitive legal settlements and prescriptive legislation that inevitably follow the pain and trauma they have wrought.


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