In Shasta County, a pregnant woman needing a Caesarean section cannot find a single obstetrician in the entire county willing to care for her.
In Ventura County, a 65-year-old disabled salesman has lost 10 teeth during the last two years while he has searched for a dentist who will treat his sore gums.
These cases are typical of tens of thousands of people statewide who are enrolled in the Medi-Cal health insurance program, but who have been unable to to find obstetricians or dentists willing to provide care, public-interest lawyers charged Thursday in a class-action suit filed in Sacramento federal court.
"Their Medi-Cal (enrollment) cards are often just a cruel joke, an empty promise of health care that's never provided," said attorney Stan Dorn, part of a legal coalition that filed the action against state Health Services Department Director Kenneth Kizer and other top officials.
The lawsuit seeks to force the state to comply with federal law by providing adequate health care to the poor.
A "statewide disaster" is occurring, Dorn said, as dwindling numbers of obstetricians and dentists are accepting Medi-Cal patients for treatment. He charged that doctors do not want to participate in the Medi-Cal program because the reimbursement rates for care are too low and checks are commonly delayed by bureaucratic snafus.
At the state Health Services Department, John Rodriguez, in charge of Medi-Cal, defended the $5.3-billion program as "very efficient." He said he is not aware of problems that Medi-Cal patients may be having with dentists but acknowledged that it appears that in certain parts of the state, "Medi-Cal moms are having more trouble finding doctors who will take them as patients."
Dorn charged that about 20,000 pregnant women in California are finding it "virtually impossible" to obtain prenatal care because obstetricians who accept Medi-Cal patients are in such short supply.
Ironically, attorneys pointed out that studies have repeatedly shown that spending money on prenatal care is cost-effective, because it helps prevent the birth of premature, low-weight infants who are prone to mental retardation and other handicaps that require costly medical care.
Attorney Robert Newman at the Western Center on Law and Poverty said that the shortage of obstetricians accepting Medi-Cal has forced thousands of women to go without prenatal care.
He said statistics show that in 15 counties, not a single obstetrician accepts more than a token number of new Medi-Cal patients. In 11 others, a shortage of Medi-Cal providers has made it practically impossible for pregnant women to get prenatal care.
In Oakland, where 1,500 Medi-Cal mothers give birth each year, only five maternity-care physicians in private practice treat Medi-Cal patients, according to Newman.
Dorn said the shortage in Los Angeles County has forced growing numbers of pregnant women to seek prenatal care at public health clinics. This may be contributing to the big backlogs of patients who must wait up to 16 weeks for an appointment in some cases, one survey last summer showed.
The Medi-Cal program reimburses obstetricians about $650 for both providing prenatal care to a pregnant woman and delivering her baby.
"This is about one-third to one-half of the fee doctors charge their other patients," Dorn said.
Rodriguez said the rate is "reasonable but not usual and customary" and that he would like to raise it a little.
Dr. Benson Harer, chairman of the California district of the American College of Obstetrics and Gynecology, said that about half the organization's 3,000 members in California accept new Medi-Cal patients. He said that obstetricians are increasingly frustrated by "long delays and incredible bureaucratic obstacles in order to obtain low payments that don't even cover the cost of providing care."
He cited a recent snafu where doctors were advised by Medi-Cal to begin submitting their bills using a different computer code. But when they did so, the bills were all rejected because the private company that contracts with the state to process the bills had not been advised of the change in computer coding.
Health Services Department spokeswoman Kassy Edgington acknowledged that there had been a problem, which has now been resolved, so that "these doctors can submit all their bills again."
Dexter Varnun of the California Dental Assn. said only about 1,000 of the organization's 16,000 members are accepting new Medi-Cal patients. He said the number has dwindled because of "hassles and red tape" in getting reimbursed at rates "that won't even cover the overhead."