Inquiry Into Childbirth Practices Is Expanded

Federal officials have joined state and county investigators in a probe of 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 the hospital’s admitted 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 in addition to Northridge Hospital Medical Center, where two mothers who were on Medi-Cal told The Times they were denied epidural anesthetic 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.” Chief Executive Jack Lewin deplored the idea of charging up front, saying patients should not 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 the Northridge hospital this week to determine whether its practice violated state and federal laws.

Hospital President Roger Seaver, along with others, confirmed that the hospital until recently charged Medi-Cal patients extra for epidurals. The anesthesiologist involved in the case of Ozzie Chavez, disclosed in the Sunday Times, 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 plan to examine hospital 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 to determine whether a state law prohibiting doctors from charging Medi-Cal recipients for benefits, like epidurals, that the agency covers.

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

State officials have said that the hospital may have violated federal protections for women in labor 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 account for about half of the monies used for Medi-Cal.

Peacock would not comment on possible sanctions against Northridge Hospital, but said his agency has the power to decertify a hospital’s lucrative contract to treat Medicaid patients.

At the county level, Yaroslavsky said the allegations point to the need to increase local oversight of medical facilities. He said the allegations “make my hair stand on end.”

The county contracts with the state to supervise licensing of hospitals and clinics, and serves as the provider of last resort to the region’s poorest residents.

But supervisors have been frustrated in recent months, unable to clamp down as a number of problems in private health-care facilities have surfaced--including reports of unlicensed doctors dispensing prescription drugs and the suspicious deaths of 11 people that may have been linked to rogue alcohol-treatment programs.

“The county has to begin to flex its regulatory muscle,” Yaroslavsky said. “We need to be out there protecting the public.”