Roger Seaver

When the Los Angeles Times reported that MediCal patient Ozzie Chavez was denied an epidural during childbirth at Northridge Hospital Medical Center, a torrent of negative publicity surrounded the facility. News broadcasts reported the story across the country, and the physician accused of denying the anesthesia when Chavez could not produce $400 in cash to pay for it was publicly denounced.

Roger Seaver, hospital president and chief executive officer, has expressed concern for Chavez and, along with other hospital officials, apologized to her for the 1997 incident. But he also criticized MediCal regulations and denounced its meager physician payments. Seaver, a South Dakota native who received an MBA from Pepperdine University in 1981, was interviewed in Glendale, where he formerly was president of Glendale Memorial Hospital.

*

Question: When the epidural controversy erupted [in July], you told a reporter that the anesthesiologist's actions may have been understandable due to MediCal regulations. How?

Answer: There's a long MediCal history of regulations overlaying regulations. The original system established lower payment processes than any other system, especially for outpatient care, physician care and emergency care. [MediCal] provides access with minimal reimbursement. Because MediCal's funding is 50% federal and 50% state, many states did not expand benefits because they couldn't afford it. But here in California, the political goal was to expand benefits, so MediCal has become a very rich benefit, though the payment system never matched the benefits. It's really the first example of the government writing benefits without funding them. They kept fees very, very low. For decades, hospitals have been trying to get funding for outpatient services. The physician payment, at the core of MediCal, is seriously underfunded.

Q: How are physicians paid by MediCal?

A: In the case of pregnancy, we had what I would call a Third World crisis. Potential MediCal beneficiaries were not seeking prenatal care; they were arriving at the hospital for deliveries without any prenatal care. We really had Third World mortality at childbirth. So MediCal was extended to cover prenatal care, and payment for the obstetrician was increased to near-market rates--but not payment for the anesthesiologist, nor for the pediatrician, nor for the surgeon. As a result, patient access improved and we've avoided higher morbidity. However, it accentuated a differential in physician payment.