Bill Barring Denial of Anesthesia Is Signed

Hospitals will be prohibited from denying anesthesia to women during childbirth based on their ability to pay, under a bill signed Sunday by Gov. Pete Wilson.

The legislation stems from a case involving a Medi-Cal insurance patient who was denied an epidural while in labor at Northridge Hospital Medical Center last year. An anesthesiologist demanded she pay $400 in cash for the pain-control procedure--an amount the patient could not muster.

Northridge later was cited for breaking six state regulations and ordered to give refunds to as many as 300 women. The state also accused five other Southern California hospitals of demanding cash for the anesthesia even though Medi-Cal covers the epidurals.

“It is unconscionable for physicians to withhold pain medication from women in labor simply because their care is covered by Medi-Cal,” Wilson said in a statement. “Women entitled to Medi-Cal benefits should receive the same standard of care as women enrolled in private health care plans.”

The law goes into effect Jan. 1.

An investigation was prompted by reports in The Times that women who were on Medi-Cal had been told they had to pay cash before an epidural would be administered.

It was the case of Ozzie Chavez that provoked much outrage. Chavez went to Northridge Hospital Medical Center to deliver her fifth baby. As she stumbled into the birthing room, her contractions became strong and painful. When she asked for a spinal-based form of anesthesia known as an epidural, a nurse said it would cost $400.

The anesthesiologist refused a check and credit cards, Chavez recalled. The birth was more painful than usual because the baby got stuck, requiring the obstetrician to reach into the birth canal. Chavez had been administered no pain relief.

“No one should have to go through that type of suffering when state-covered medical care provides reimbursement,” said Sean Walsh, a Wilson spokesman. “Childbirth is traumatic enough without having to be in a panic about money.”

The legislation closes a key loophole in medical regulations by declaring it to be “unprofessional conduct” for a doctor to deny or threaten to deny pain management based on a patient’s ability to pay.

“We cannot allow a patient’s ability to pay or source of payment to dictate treatment,” said Assemblyman Martin Gallegos (D-Baldwin Park), the author of the legislation.

The majority of cases of denials of epidurals appear to have occurred at Northridge.

But investigators have discovered that some women on Medi-Cal also were required to pay for anesthesia at Whittier Hospital Medical Center, Providence Holy Cross Hospital in Mission Hills and Queen of Angels/Hollywood Presbyterian Hospital, said Jean Olander, health facilities manager for Los Angeles County.

In addition to declaring such practices unethical, the bill makes it illegal for any county hospital or general acute care hospital to have differing standards of care among obstetrical patients based on their insurance carrier or ability to pay.

The Times disclosures triggered county, state and federal investigations.

State health officials in July ordered Northridge Hospital Medical Center to pay refunds to hundreds of poor mothers who were wrongly charged cash for delivery-room epidural anesthesia during the last five years.

Hospital officials estimated then that the payments could total $120,000 to between 200 and 300 women, said John Lockhart, hospital spokesman. The reimbursement order was from the state Department of Health Services.

Wilson also signed a bill Sunday allowing families to carry out the last wishes of a relative and scatter remains on land or at sea.

The bill also reduces restrictions on scattering ashes at sea by allowing their dispersal within 500 yards of the state’s shoreline.

Previously, ashes were allowed to be strewn only three or more miles from the shore.