Officials Are Warned of Obstetrics Crisis

Saying that obstetric services at Los Angeles County hospitals are “critically overloaded,” county health department chief Robert C. Gates told a state medical commission Tuesday that women in labor might be turned away from county hospitals unless an immediate solution to the overcrowding problem is found.

“It’s to the point now where we must seriously consider sending patients out to other (private) hospitals because the overload is so great,” Gates said at a California Medical Assistance Commission hearing in Burbank. “Our system is well beyond capacity and something must be done right now.”

Gates’ idea for turning away pregnant women followed a controversial plan instituted in June by UCI Medical Center in Orange, where conditions on the maternity ward have been described as not only overcrowded but also “unsafe.”

As a result, UCI Medical Center officials on June 5 began an “obstetrical diversion” program that is expected to continue indefinitely.

Whenever both the maternity ward and emergency room are full, hospital security guards wearing badges and blue blazers ask women in labor to go to a different hospital. However, those women are still admitted to UCI if they insist.

Gates told the commission, which oversees the state’s Medi-Cal contracting program, that he expects more than 46,000 babies to be delivered at Los Angeles County hospitals this year, severely overtaxing a system in which possibly 35,000 babies “could be safely delivered.”

Los Angeles County-USC Medical Center has a capacity for about 14,000 deliveries, but officials expect almost 25,000 babies to be born there this year. Harbor-UCLA Medical Center, with a capacity of 6,000 deliveries, expects to handle 8,000 this year.

“Right now we have patients (giving birth) in corridors,” said Dr. Charles Brinkman, chair of the obstetrics and gynecology department at Harbor-UCLA Medical Center. “Some patients are sent home in 12 hours, some are sent home in two hours. It becomes really battlefront obstetrics we’re practicing.”

Gates said that if the county is to remedy the situation, it must expand its contract agreements to hospitals that do not provide Medi-Cal coverage. Currently, private facilities with Medi-Cal coverage are able to accommodate only 9,000 referrals from the county, he said.

Gates said the commission could also help by easing Medi-Cal guidelines, which allow the county to send only low-risk patients to its contract facilities for obstetric care. And a number of hospital officials asked the panel to provide speedy reimbursements to obstetricians as an incentive to expand Medi-Cal services.

Orange County hospital officials, including UCI Medical Center’s acting chief of obstetrics, Thomas J. Garite, have been making similar pleas to Medi-Cal officials for months.

Since UCI’s policy began, more than 20 “diversions” have been announced when the maternity ward has been full, including one that began shortly after noon Tuesday. About 40 women have elected to deliver at other hospitals since the policy was enacted, a medical center spokeswoman said.

Despite the policy, though, overcrowding has continued at the medical center. In a maternity ward designed to handle 250 births a month, UCI Medical Center counted 452 deliveries so far this month.

Gates, however, stopped short of saying that Los Angeles County would copy UCI Medical Center’s plan.

“I have a problem with the concept (of security guards) and would only do it if there was no other alternative,” Gates said after the hearing.

Both state and federal health officials have scrutinized UCI’s diversion policy, but while some are unhappy with it, they have not declared it illegal.

Before Garite and hospital director Mary Piccione enacted the “diversion” policy, deliveries in hospital corridors were a regular occurrence, and obstetricians complained there were not always enough oxygen tanks and fetal monitors for their patients.

Garite also has asked Medi-Cal officials to consider special funding for a proposed UCI “birthing center”--a center for low-risk births--that would relieve crowding in the hospital’s maternity ward. But Garite said earlier this week that it will take “a major change in their thinking” to change Medi-Cal rules and make such a center a break-even proposition.

While Gates was making his comments before the state medical commission, the Los Angeles County Board of Supervisors adopted a motion directing him to develop a plan within two weeks to reduce the number of births at county hospitals. The current delivery rate “exposes patients to unsafe care and expands the county’s potential for legal liability,” supervisors said.

Gates said that Los Angeles County’s proposed “self-referral” plan would allow county health care workers to refer women in labor to other contract facilities “as long as it was safe for them to transport themselves.”