Patients Denied Epidurals
Re “Childbirth Anesthesia Refusals Spur Probe,” June 14:
Your article regarding an anesthesiologist’s refusal to provide childbirth anesthesia fails to explain a number of important considerations. First, there are viable alternatives to epidural analgesia, including administration of intravenous narcotics and pudendal nerve block.
Second, you fail to point out that an epidural anesthetic may last as long as 24 hours (or longer) and an anesthesiologist will need to remain readily available for this patient. Medi-Cal will only reimburse for time spent at the bedside, despite the fact that the anesthesiologist will be unable to participate in any other reimbursable activity for the duration of the epidural. Thus, the hourly rate received by an anesthesiologist for a Medi-Cal epidural may drop below minimum wage during a long labor.
Yes, a Medi-Cal patient should receive an epidural if parenteral analgesia (intravenous narcotics) or natural childbirth methods do not provide adequate pain relief. However, a physician performing a long-duration anesthetic procedure with potential major risks to both mother and child should receive realistic compensation.
ROBERT WELTI MD
Santa Barbara
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I read the article with horror and disgust. So now anesthesia for the sometimes excruciating pain of childbirth should be considered “not medically necessary.” What’s next? Tie down patients and give them a bullet to bite on?
The anesthesiologists say that alleviating the pain of a difficult birth is low-paying and “a hassle.” How soon doctors forget the Hippocratic oath: Caring for and healing patients is their ethical and professional duty, not a “hassle.”
Sadly, this is the inevitable result of reducing medical care to strictly a business, where profit becomes the only priority, where care is “managed.” Mismanaged is more like it.
CLIFF OLIN
Alhambra
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Some very interesting issues were raised in your article. Why hadn’t Ozzie Chavez arranged for all the financial details during the previous nine months? If Chavez must rely on Medi-Cal to pay for her medical expenses, why is she having a fifth child? Having children is, or at least should be, an elective procedure and should not be done over and over at taxpayer expense. How about a little discussion on these issues.
TOM G. MOORE
Big Bear Lake
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So walk me through this. I’m a pregnant Medi-Cal patient to whom Northridge Hospital has advertised heavily to attract to its Medi-Cal obstetrics program. Besides worrying about having enough cash to receive adequate pain relief during my delivery, do I also need to worry about the hospital providing a Medi-Cal-accepting neonatologist if my baby has problems or a Medi-Cal-accepting radiologist if I have complications and need a MRI or CAT scan interpreted? How much cash on hand do I need?
CHARLEEN SIEGLER
Granada Hills
