C-Section Policy at County Hospital

Re “County C-Section Rule Took Heavy Human Toll,” Jan. 25: For the last two decades we obstetricians have been criticized for doing too many C-sections (for financial gain, of course); care must now be taken to avoid simply going to the opposite pole.

The Women’s Hospital at L.A. County-USC Medical Center was a unique place with unique demands. I know because I had my internship and residency there in the 1970s. We averaged 35 deliveries per day, and sometimes as many as 50, which became the average in the late 1980s. I remember times when there were as many as 11 deliveries, including four C-sections, occurring simultaneously--a stretch for the four interns, three junior residents and a senior resident to handle. Fortunately for us that kind of tidal wave did not happen too often.

In the mid-1980s it was decided that, because physicians were “ripping off” the MediCal system, only certain physicians would be permitted to be MediCal providers. The effect of this was that most physicians, even those who were only seeing a few MediCal patients, dropped out of the system, knowing that the choice for your practice was, in fact, all or nothing. MediCal patients then flooded county emergency rooms and labor and delivery areas. Some of the decisions made at the county hospitals were in response to this crisis.

From a medical point of view, caesarean section rates should be as low as possible, but without raising the risks of complications. Let’s not create an artificial bandwagon by demonizing physicians who have been responding to public demands and local circumstances.

RICHARD ZALAR MD

Rancho Palos Verdes