Obstetrics Crisis

Your coverage of Los Angeles County’s obstetrics crisis (“Crowded County Hospitals Suffer Crisis in Obstetrics,” Feb. 20, and “Money Problems From Birth,” editorial, Feb. 23) identified increased Medi-Cal funding as essential to resolving the overload of Los Angeles County’s childbirth facilities. Medi-Cal reimbursement for obstetrical care, particularly for high-risk deliveries, falls far below private insurance payments. State officials have implemented interim measures. However, more comprehensive reform of Medi-Cal is needed.

The doctors and nurses of the county’s obstetrical facilities have worked gallantly to provide quality childbirth services to low-income women. These professionals need relief. Private hospitals, physicians and their professional associations are beginning to respond. Several hospitals and physicians have agreed to accept county referrals.

We estimate that the annual demand for obstetrical services in county facilities will surpass 52,000 deliveries in 1990. This projection exceeds the county’s capacity by over 19,000 deliveries.

While there is sufficient capacity in the private sector to meet the immediate need, many hospitals and physicians are unwilling to participate because of the Medi-Cal limitations. I do not favor procedures such as those implemented in Orange County which would divert pregnant women from crowded county facilities. However, without continued efforts to expand capacity in the private sector, such standby procedures become inescapable.

To avoid such a possibility, the obstetrical overload and other deficiencies in our perinatal health care system must be kept at the forefront of the state’s health care policy development.

ROBERT C. GATES

Director of Health Services

Los Angeles County