Hospital Broke Rules in Births, State Says

In denying anesthesia to poor women in labor unless they could pay cash, Northridge Hospital Medical Center has failed to comply with health care regulations, officials said Friday.

If the failures are found to be ongoing, they will consider shutting down the hospital’s obstetrical unit and terminating its contract to handle Medi-Cal patients, said Department of Health Services spokeswoman Carla Agar.

“The egregious nature of these problems justifies taking a variety of actions,” said state health director Kim Belshe.

The failures include:

* Failing to provide medical care without regard to a patient’s ability to pay.

* Failing to provide medication or treatment as ordered by a patient’s own doctor. Investigators found that a patient was denied an epidural after her obstetrician had ordered it.

* Failing to provide enough anesthesiologists or nurse anesthetists to meet the needs of obstetrical patients.

* Failing to develop an anesthesia policy for a perinatal unit, the part of the hospital where newborns receive care.

* Failing to properly monitor patients’ pain.

The state investigation, which officials said consisted of reviews of hospital records and interviews with employees, was prompted by stories in The Times detailing the facility’s practice of demanding money in exchange for epidurals.

State investigators conducted an inspection of the hospital earlier this week and confirmed that not only were maternity patients asked to pay separately for epidurals, but that doctors required cash up front, Agar said.

“The [hospital] governing body was aware or should have been aware that the [anesthesiologist group] was denying epidural pain relief,” said Brenda Klutz, who conducted the investigation for the health department.

Additional failures to comply with state rules may be found as the department continues to investigate the hospital’s practices, Klutz said.

In addition, the health department, which licenses hospitals and runs the Medi-Cal program, plans on Monday to turn over the names of two anesthesiologists at the facility to enforcement officials at the Medical Board of California, the agency that licenses doctors, Klutz said.

Reports that anesthesiologists at Northridge Hospital denied epidurals to women in labor have touched a nerve with women and men across the nation, many of whom have contacted The Times to report similar experiences at other hospitals.

Leading anesthesiologists have called it “barbaric” and “unethical.” But some doctors defend the practice, saying that Medi-Cal pays too little for obstetrical epidurals and that doctors must charge patients in order to make a living.

Besides the problems cited by the health department, such a practice violates a state law that forbids charging Medi-Cal patients for a benefit that the agency covers, Belshe said.

The hospital has 10 days to respond to the state’s findings. The hospital was notified of the deficiencies Thursday night, Klutz said.

“We have received the statement of deficiencies and we will respond within a 10-day period with a plan of correction,” said hospital spokesman Wendell Mobley.

He would not comment further, except to say that the original problem had been corrected.

Earlier this week, however, the hospital blamed its anesthesiologists for any improprieties in administering pain relief to women in labor. The anesthesiologists released a statement blaming the hospital.

Hospital President Roger Seaver said in an earlier interview that the facility had stopped charging extra for epidurals some time ago. He would not specify when the practice had stopped, nor would other administrators, who said that it had ended after Ozzie Chavez sued the hospital, alleging that she had been denied one.

But two women said they were denied epidurals after Chavez had her baby last July.

One, Mary Pendleton, said she paid $400 for an epidural at the hospital’s Van Nuys campus last Sept. 29.

Nakia Johnson said she was denied an epidural at Northridge Hospital just last month.

“They told me if I didn’t give them $500 they wouldn’t even call the anesthesiologist,” Johnson said.

Catherine Beatty, Chavez’s attorney, welcomed the state’s findings.

“We feel vindicated,” Beatty said. “One result of this will be that this won’t happen to other women.”