As the MediCal Wound Festers, the Poor Keep Coming

The last Saturday in July was a pretty typical day in Santa Ana. Sticky hot.

By nightfall it had cooled a bit--there was even a hint of a breeze--but Irma Garcia was having trouble keeping an even keel. The physical pain of childbirth, rhythmic, merciless, was pulling at her strength, draining what little she had left.

She’d already been to UCI Medical Center, where somebody had told her they’d be able to help, but she was turned away.

The hospital has been doing that, on and off, for more than a year. “Diversion” is what they call it. “Please go somewhere else” is what it means.

Officials there say they don’t like it, but economics and demographics have forced their hand. Too many women are giving birth, too few of them are able to pay. That means not enough labor rooms, not enough beds and not enough obstetricians willing to take a risk on helping those with nowhere else to turn.

MediCal isn’t working as its planners had hoped.

So Irma Garcia went to a hospital closer to home, with the pain clawing at her from the inside. Nurse Catherine Maxey reports that the first time she saw her, Irma was on her side, clutching at the rail of her bed, in a labor room.

A fetal monitor was strapped around her belly. An I.V. ran from her arm. Irma’s eyes were wide. Her breath, heavy, caught as the contractions wracked her, the internal explosions that were heralding new life.

The obstetrician, though, had other concerns circling his mind. Tired and angry, he’d seen a lot of “Irmas” before. Their names, really, were interchangeble. These were strangers who were taking up his time.

He didn’t speak Irma’s language, Spanish, and because of that, nurse Maxey had been summoned to his side. After three years as a public health nurse in Santa Ana, she had picked up the Spanish she heard spoken at every turn.

This is Catherine Maxey’s recollection of what went on that night. The doctor declined to speak to me.

Irma told Catherine that she had had no prenatal medical care.

“Ask her why!” the doctor said, barking his command.

Catherine stared, at the doctor, then at Irma. She was holding her hand. When a contraction subsided, she relayed the doctor’s demand.

Irma said that she had felt fine. Doctors were for the ill.

“Ask her why she didn’t go to UCI hospital!” the doctor said. “Why here?”

Irma told Catherine why.

“Ah,” the doctor said, impatient. His eyes flashed at the nurse.

“Tell her that we won’t accept her either,” he said. Then he winked. A little joke.

“Tell her that!”

But Catherine said that she would not.

Now Catherine, too, was angry; her weariness was showing through. Yes, the names of these patients are interchangeable. The refrain, on the floor, seems always put to the same tune. She could hear it, now, running through her mind.

These people... These people.... Oh, these people always have MediCal. Never pay a dime. Our hard earned money goes to taxes, to pay for them.... Did you know that half the census tonight in the hospital is OB and yet this department loses money?... Oh, these people know English. Just play dumb till the baby’s out, and then they can speak just fine.... These people.... These people.

Then the doctor broke Catherine’s train of thought.

“Tell her that she’s stupid to have never seen a doctor,” he said. “Tell her that just yesterday a woman came in and had a dead baby. Tell her that!”

“I won’t tell her that,” Catherine snapped. “Why tell her now? She won’t understand. How can she listen now. . . .”

“Oh, yes, they can listen now,” the doctor said.

“After the baby’s out, they won’t listen anymore. I want them to know that they can’t not take care of themselves during their pregnancy, never see a doctor, and think that they can just walk into any hospital and be received with open arms. Do you understand the risk I take to deliver a baby blind like this?”

Catherine understands, and so do I. This doctor is one of the comparatively few in Orange County who treat poor pregnant women, many of them who walk in off the street only when it is time to give birth.

For most obstetricians, the risks--of a malpractice lawsuit if something goes wrong and a paltry, late MediCal payment to boot--are simply too high. The latest survey in Orange County showed that less than 35% of area obstetricians will accept a patient on MediCal.

And this comes at a time when births are booming--an official 12% countywide increase from 1988 to 1989--with no immediate end in sight. The percentage of indigent patients, meantime, is on the rise. Government funding continues its decline.

“I still accept MediCal, though they don’t pay me beans,” the doctor told Catherine. “I deliver these people, with the risk to be sued every time. I do this! Yet do I ever get thanks? I get nothing. I’m tired tonight. I had to leave my family again; my daughter cried. So I’m not going to tell this woman, ‘Oh wonderful that you have come here.’

“Ask her if she’s applied for MediCal,” the doctor said.

The nurse did, and the answer came that she had applied two weeks before.

But this really mattered little, just then. The law says MediCal will reimburse delivery charges for families with no way to pay. The payment, however, is rarely enough. The medical establishment, and advocates for the poor, are fed up.

Task forces have been formed. Calls for solutions--more money, prenatal care, hospital beds, doctors, family planning, and the list goes on and on--abound. Frustration and anger are rife.

It shows, in the words and expressions, of everybody concerned.

Back in the labor room, the doctor left to prepare for the delivery of Irma’s child. Nurse Maxey, bending over the patient, was angry, confused, and on the verge of tears.

“You are doing so well,” she told Irma. “The time is very near.”

Irma squeezed Catherine’s hand. Her contraction was debilitating and she let out her first little scream. Within minutes after that, Irma’s son, wailing, strong and healthy, a U.S. citizen, arrived in the nursery.

Later, I tried to visit this new mother at her home, but the address that she gave the hospital did not exist. This happens a lot.

So perhaps the name Irma Garcia, too, is just a private myth. I don’t know. It certainly wouldn’t be the first time.

But the story of this indigent mother, ubiquitous, with the interchangeable names, is all too real. It’s as typical as a hot, sticky day at the end of July.

Dianne Klein’s column appears Wednesday, Friday and Sunday. Readers may reach Klein by writing to her at The Times Orange County Edition, 1375 Sunflower Ave., Costa Mesa, Calif. 92626, or calling (714) 966-7406.