Probe Expands in Alleged Cash-for-Anesthesia Case

Federal officials have joined state and county investigators to probe a Northridge hospital’s alleged demand for cash before poor mothers could receive a common form of anesthesia during childbirth.

Meanwhile, the county expanded its investigation into Northridge Hospital Medical Center’s practice of charging Medi-Cal patients $400 for epidural blocks during childbirth after a county supervisor called it “the worst aspect of medical care.”

Los Angeles County supervisors directed medical officials to examine other hospitals as well, after two mothers who were on Medi-Cal told The Times they were denied epidural anesthetic at Northridge when they could not come up with cash fast enough.

“This is the worst aspect of medical care these days,” Supervisor Zev Yaroslavsky said. “The greed of the anesthesiologist to have done this is beyond me.”

Also Tuesday:

* The California Medical Assn. called the practice “unethical.” CMA Chief Executive Jack Lewin deplored charging upfront, saying that patients should not be made to suffer because doctors are frustrated with low reimbursement rates from Medi-Cal for anesthesia.

“What I want to say to doctors is, ‘Let’s not solve it that way,’ ” Lewin said. “Let’s provide the care and then stand together and solve the problems.”

* State and county medical investigators plan to conduct an inspection of Northridge Hospital this week to determine whether the hospital’s practice violated state and federal laws.

Hospital President Roger Seaver, along with others, confirmed that the hospital, until recently, had a practice of charging Medi-Cal patients extra for epidurals. The anesthesiologist involved in the case of Ozzie Chavez--reported in The Times on Sunday--said in court papers that she had refused epidurals to six women prior to Chavez.

John Schunhoff, the county’s acting director of public health, said that enforcement officials planned to visit Northridge Hospital within the next few days to examine records and interview staff about Chavez’s allegations and other claims of impropriety regarding epidurals.

At issue for the county, which is charged with overseeing hospital licensing for the state, is whether the hospital violated state law that mandates that physicians accommodate “reasonable requests” by patients for care.

Medi-Cal officials will be seeking information on the hospital’s billing practices in order to determine whether a state law prohibits doctors from charging Medi-Cal beneficiaries for procedures, like epidurals, that the agency covers.

Chris Peacock, spokesman for the federal Health Care Financing Administration, said investigators would work closely with state and county officials to see whether any federal rules were violated at the hospital.

State officials have said the practice at Northridge Hospital may have violated federal protections for women in labor that were passed in order to avoid so-called “patient dumping,” in which hospitals refuse to treat poor patients.

Demanding cash before treating a patient might also violate federal rules governing hospitals that accept federal Medicaid funds, which in California make up about half of the monies used for Medi-Cal.

At the county level, Yaroslavsky said the allegations about Northridge Hospital point up the need for an increase in local oversight of medical facilities. He said the allegations “make my hair stand on end.”