Maternity Room Crowding in O.C. Has Disappeared

The severe overcrowding that struck UCI Medical Center’s maternity ward two years ago has vanished, and now the teaching hospital is pleading for patients to fulfill its obligation to obstetric students.

In June, 1990, the medical center sent shock waves through Orange County when it placed security guards in its parking lot to tell low-income women in labor that it might be better for them to go elsewhere to have their babies because of the overcrowding.

Officials at UCI said they were taking such drastic steps because the hospital was being swamped by expectant mothers who showed up at the emergency room. Equipped to handle up to 300 births a month, the center in Orange was delivering twice that many.

UCI was not alone: The problem had become countywide. But the tables have turned.

The dramatic turnabout is attributed to a strong and concerted response by the local medical community and state and county government agencies, abetted by changing economic conditions.

Later this month, a 14-bed birthing center, geared to provide low-cost care, is scheduled to open in a new wing at Western Medical Center-Anaheim. This follows the opening of another birthing center by UCI Medical Center less than a year ago.

These birthing centers, which employ specially trained nurse-midwives and encourage natural childbirth for low-risk deliveries, are considered models for the future of obstetrics.

The centers, which were originally planned two years ago to alleviate the shortage of obstetrical care for Medi-Cal patients, were established with the aid of $2.3 million in state cigarette tax money obtained by the Orange County Health Care Agency.

Also since the crisis emerged, nonprofit clinics throughout the county have added prenatal programs and outreach efforts to educate low-income women about the need to obtain early medical help.

Three years ago, four Orange County nonprofit community clinics provided obstetrical services. Now there are 10.

Realizing that many low-income mothers cannot arrange transportation, St. Jude Medical Center in Fullerton 16 months ago instituted “Healthy Beginnings,” a prenatal clinic in a van that brings doctors to women in low-income neighborhoods of Fullerton, Brea and Placentia.

And by the end of the year a program called the Maternal Outreach Management System--MOMS for short--is expected to be launched.

MOMS is organized as a partnership of county government and private groups including the March of Dimes, the Orange County Medical Assn., the Hospital Council of Southern California, the Orange County Coalition of Community Clinics, UCI Medical Center and the OBGYN Society of Orange County.

MOMS will “act like a matchmaker,” said Dottie Andrews, the program’s executive director, by helping expectant low-income women sign up for Medi-Cal and then find doctors and hospitals willing to serve them.

This “matchmaking” will be a lot easier to accomplish now than in the past, Andrews said, largely because the state has increased the rate it pays hospitals and doctors for obstetrical services under Medi-Cal.

Also in response to Orange County’s need, the state negotiated higher obstetrical reimbursement rates for hospitals in the county.

Since 1990, when a March of Dimes study revealed that the few Medi-Cal contracting hospitals in the county were severely overcrowded with maternity patients, more hospitals, including Western Medical Center-Santa Ana and AMI Medical Center of Garden Grove, entered agreements to deliver the babies of Medi-Cal mothers.

“There is no longer a shortage of delivery beds,” Andrews said.

Moreover, the demand for additional maternity beds has eased, if only temporarily, with a slowdown in the county’s once exploding birthrate, which increased from 44,491 births a year in 1988 to 54,536 in 1990, then tapered to about 54,432 last year.

Also, clinics report that there are more obstetricians willing to accept referrals of expectant mothers on Medi-Cal.

“We have been approached by a number of physicians in the community to send OB patients to them. That wasn’t happening three years ago,” said Faith Hagerty, executive director of the Coalition of Orange County Community Clinics.

Again, money is the biggest factor. Between 1986 and 1990, Medi-Cal reimbursement rates to obstetricians for routine births increased 85%, which was greater than for other medical specialties.

Doctors say Medi-Cal reimbursement rates for obstetrics are still Spartan, but now compare favorably with the rates of some “managed care” private insurance plans offered by employers.

The recession also has played a role in convincing a small but growing number of obstetricians to accept Medi-Cal payment.

Dr. Peter Park said his Santa Ana-based obstetrical group, Zemel, Goldstein & Associates, started taking Medi-Cal payments about eight months ago simply to retain its business. “Most of our patients lost their jobs and went on Medi-Cal,” he said.

Jennifer de Lima, executive director of the SOS Free Clinic in Costa Mesa, said that three years ago the clinic was obliged to care for Medi-Cal patients through their pregnancies because no private doctors would see them. When their due dates neared they were instructed to go to hospital emergency rooms with copies of their medical charts in hand.

Sarah Barragan, who received prenatal care at SOS, recalls having a friend drive her to UCI Medical Center three years ago when her daughter was born. “It was kind of scary,” she said. “I thought, ‘What if they won’t see me?’ ”

Barragan, 20, now works as a bilingual aide at SOS, where she coaches Latino women on how to make appointments with the 30 obstetricians on the SOS referral list, who in turn arrange for the women to be admitted to hospitals to have their babies.

Dr. Thomas Garite, chairman of obstetrics and gynecology at UCI, said all the new resources “are the result of the crisis and have been contributing to a very good solution. It is better than anybody could have hoped and has been bolstered by the changing economics of health care.”

Garite said alleviation of the crisis has slowed the growth of the birthing center that UCI Medical Center opened last December in Anaheim. “We would like 10% to 20% more (obstetrical patients) at the medical center and could use almost double the volume at our birthing center,” he said.

But he warned that “the good times we are seeing now are tenuous at best and it wouldn’t take much to disrupt the system.” If Medi-Cal lowers its rates or a couple of hospitals drop their Medi-Cal contracts, he noted, provider shortages could once again become acute.

The development of innovative and more cost-effective programs like birthing centers, Garite says, may give the county an important safety valve in the future.

Designed to handle “low-risk” pregnancies, the UCI birthing center, housed in remodeled office space at 300 W. Cerritos Ave. in Anaheim, is staffed entirely by nurse-midwives and uses a minimum of technology. The result is that patient charges for a routine birth at the center amount to about $3,500, compared to $5,000 to $7,000 in a hospital.

Although the birthing center is available to anyone, 85% of the patients are on Medi-Cal, many of them referred by public health officials, Planned Parenthood or the County Social Services Agency.

Tim Carda, chief executive officer of Western Medical Center-Anaheim, said he expects to fill that hospital’s new birthing center more easily because only four of the beds in the hotel-like labor and delivery rooms will be dedicated for exclusive use by the hospital’s nurse-midwives. The rest are available to obstetricians.

Thus the birthing center at Western Medical Center-Anaheim is carefully designed not to compete with private physicians.

While doctors who practice at the birthing center will not be required to see Medi-Cal patients, Carda said he expects many of them will--mostly because of the better reimbursement.

The keener interest of doctors and hospitals in caring for Medi-Cal patients is primarily economic, Carda said. “It is amazing how a little money can change attitudes dramatically.”

Births Funded by Medi-Cal

The number of Orange County births paid for by Medi-Cal nearly tripled between 1987 and 1991. It is projected that this year Medi-Cal will be billed at least $36 million to cover more than 16,000 deliveries. Births (In thousands), ‘91: 15.6 Amount spent (In millions), ‘91: $35.0 Source: California Department of Health Services Researched by JANICE L. JONES / Los Angeles Times