Health Chief Criticized for Lawsuits

An angry Los Angeles County Supervisor Gloria Molina scorched county health officials Tuesday for the number of malpractice cases arising from obstetrical care at county hospitals, saying that the problems have continued long after the Health Services Department pledged to correct them.

Molina berated Health Services Director Mark Finucane and his top medical aide, saying that they have failed to address many of the concerns about obstetrical care raised in a recent Times article, including whether poor women were not given potentially lifesaving medical procedures at public hospitals due to budget constraints.

The Times reported last week that the county had a policy in the early 1990s of forcing women at public hospitals to attempt to deliver babies vaginally before undergoing caesarean section surgeries.

That policy, which was discontinued several years ago, resulted in deaths and severe injuries to mothers and babies, and cost taxpayers $24 million in 49 separate malpractice cases, according to The Times’ report.

Last week, the supervisors told Finucane to investigate and report back to them Tuesday on whether there was such a policy that led to inappropriate vaginal deliveries, and what the department had done to remedy the situation.

Finucane also was told to look into whether the care of any other hospital patients had been compromised by budgetary constraints or because they were not fully informed of their options.

But when Finucane and Associate Director Dr. Donald Thomas came before the board Tuesday with their report and a verbal briefing, Molina lashed out at them, saying that they were trying to sidestep the larger issues of poor patient care.

Finucane and Thomas said the county never forced any women to forgo or delay a necessary caesarean section because of any policy or even an informal guideline--or because it would save the county money.

Instead, they attributed the malpractice payouts to the overwhelming number of births at a time when there weren’t enough doctors or hospital beds to care for the women during the early 1990s, and said such problems have been corrected.

The malpractice cases, Thomas said, “were due to complications of delivery or bad decisions, as opposed to any conscious suppression of the [caesarean] numbers.”

Several county doctors who were medical residents at the time have flatly contradicted Finucane’s assertions. They were taught not to allow the caesarean rate to rise above 10%--which is half the rate now considered safe by most medical experts, including the county’s own doctors.

In his report, in fact, Finucane appeared to confirm the view that budgetary pressures had limited the availability of caesarean sections, as well.

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He said that in the late 1980s and early 1990s, public hospitals were swamped with deliveries and that resources--such as doctors, nurses and operating rooms--were “inadequate to accommodate these [caesarean] rates and as a strategy, resource intensive procedures such as C-sections were suppressed as much as possible.”

Finucane and Thomas conceded that the county hospitals each worked with their own set of internal regulations when it came to deciding who should get caesarean sections and when. As a result, they said, they will adopt a systemwide set of uniform regulations that will ensure that all women giving birth in county hospitals have an opportunity to deliver by caesarean section.

But that just made Molina even angrier. As Thomas explained the new guidelines to Supervisor Mike Antonovich, Molina interrupted.

“Dr. Thomas is giving you nothing but bunk,” she said to Antonovich. “And I really don’t appreciate it.”

Molina accused Finucane and Thomas of glossing over years of continued problems in the county’s delivery wards by suggesting that a new set of guidelines would fix things.

She said that “mere guidelines” aren’t nearly enough, and that far tighter supervision of doctors and interns and an overhaul of the entire accountability process is needed to stem the tide of malpractice cases.

Molina cited the case of a mother whose caesarean section at County-USC Medical Center was improperly delayed in 1992, resulting in serious injuries to her baby daughter, including cerebral palsy. The county Tuesday approved paying the girl $500,000 and lifetime medical care.

Molina said that there were guidelines in place then too, and that they couldn’t have saved the girl from inattentive doctors and poorly trained and unsupervised medical interns.

Those problems, Molina contended, still exist.

For instance, she said, the county didn’t move to institute a corrective action plan at the hospital until last year--almost six years later.

“My concern is that we are trying to create a set of standards that are baloney,” Molina said.