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 told the commission, which oversees the state's Medi-Cal contracting program, that he expects more than 46,000 babies to be delivered at county hospitals this year, severely overtaxing a system in which possibly 35,000 babies "could be safely delivered."
For example, Gates noted that 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. Births were also beyond capacity at Los Angeles County Harbor-UCLA Medical Center, Martin Luther King Jr./Drew Medical Center and Olive View Medical Center, he added.
"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.
While Gates was making his comments before the panel, the 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 stopped short of saying that the county would copy a controversial policy adopted by the UC Irvine Medical Center in June in which security guards are used to turn away women in labor.
"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. "Up to this point I have not been willing to entertain a (patient) self-referral policy, but our situation has deteriorated."
The so-called "obstetrical-diversion" policy, adopted by UC Irvine because of overcrowding, has been sharply criticized by health care officials as inhumane and possibly illegal.
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." Women would still have the right to refuse to go, he said.
However, the county proposal did little to appease critics, who insist that it is the county's responsibility to care for all patients that enter its hospitals.
"I understand why they feel they have to make the decision, but the fact is that hospitals have not just a legal but a moral obligation to treat these patients," said David Langness, a spokesman for the Hospital Council of Southern California. "But there's no doubt that until (the commission) works out this policy, the situation will only get worse."
Gates also suggested that wider use of contraceptives could help ease the problem. He asked the panel if it could flex its political muscle and try to persuade Gov. Deukmejian to restore $24 million in family planning funds that forced the county to close 13 women's clinics and reduce services at more than a dozen others this month.
The commission said it would consider the requests and report back at its December meeting.