UCI Calls Off Its Maternity ‘Diversions’

After three harried days of treating women in hallways and asking security guards to turn pregnant women away, doctors at UCI Medical Center called off their “obstetrical diversion” Wednesday and resumed admitting maternity patients.

Back to normal still meant crowded at the hospital in Orange, however. Designed for 250 deliveries a month, the medical center’s obstetrics ward had handled 439 babies in July as of Wednesday afternoon.

“It’s chaotic,” acting chief of obstetrics Thomas J. Garite said. “We’re doing our best.”

Because of what they called crowded and unsafe conditions in labor and delivery rooms, hospital officials in early June declared they would turn away women in labor when both UCI’s emergency room and maternity ward were full.

When the diversion is in effect, security guards greet women in labor at curbside, inform them that UCI is full and hand them a map to other nearby hospitals. Women who have received prenatal care at UCI clinics are still admitted, however.

Most of the medical center’s obstetrics patients are indigent Latinas, many of them with no prenatal care.

Since June 2, UCI officials declared six obstetrical diversions, most lasting only a few hours. But the latest, which began at 2:30 p.m. Monday and ended at 10:35 a.m. Wednesday was the longest and affected the most women--a total of 12 turned away, medical center officials said.

Previously, medical center officials said only two women in labor were turned away.

UCI officials have complained that the number of maternity cases increased sharply earlier this year when three nearby hospitals dropped out of the state Medi-Cal system. They have urged other hospitals to share these patients, threatening that UCI may quit Medi-Cal too.

United Way and March of Dimes officials have declared that Orange County is experiencing a crisis in obstetrics, with the health of thousands of indigent women and their babies at risk because of barriers to maternity care. But no immediate solution to the problem is in sight, Garite and other UCI officials have said.

Even with the diversion in effect, conditions on the maternity ward remained congested, Garite said.

“A lot of patients were laboring in the halls,” he said. “We had to make some difficult decisions about patients who needed to have labor induced, who needed C-sections.”

Much like battlefield triage, doctors “had to prioritize (care) in such a way as to take the ones who need it the worst first,” Garite said.

At one point in the last three days, his 13-bed ward had 20 maternity patients, Garite said. At moments like that, “we start poking a lot of people in rooms not planned for that purpose or putting them in the hall,” Garite said. Also, members of the UCI medical school faculty have worked extra hours day and night to help residents care for the additional patients, he said.

Garite said he doubted the situation would let up soon because July and August are typically the heaviest months of the year for deliveries. Still, “(obstetrics) is impossible to predict,” he said.

On July 19, another UCI doctor described the situation on the obstetrics ward as “busy but not overwhelming.”

Dr. Manuel Porto, assistant professor of maternal and fetal medicine, said there were 10 patients on the ward most of that afternoon. “Our critical mass for going on (diversion) is 13 patients at one time,” he said. “We’re not at critical mass--but who knows? As I walked out, there were 10 patients in labor,” Porto said. “It wouldn’t take too much to put us back on the blocks again.”