Area Medi-Cal Agency Inspects Files It Demanded

Officials with CalOPTIMA, which administers Medi-Cal coverage to 202,000 Orange County residents, were reviewing documents Monday provided by Garden Grove Hospital and Medical Center to determine whether to drop it from the county program.

The agency had threatened to revoke its contract with the Noble Mid-Orange County Medical Group, a health plan consortium encompassing the Garden Grove hospital and a physicians network, serving 9,500 patients. CalOPTIMA issued the threat believing the hospital had balked at supplying documents it requested.

CalOPTIMA had sought information on the hospital’s peer review and quality improvement practices, which involve how the hospital evaluates physicians’ actions and quality of care, often in response to complaints. Hospital officials then can take disciplinary action, if warranted, that can be as severe as revoking a physician’s authorization to practice there.

The specifics of the peer review information requested by CalOPTIMA--which doctor or doctors were involved and why--cannot be disclosed because of confidentiality requirements, CalOPTIMA spokeswoman Kathleen Crowley said.

Last week, CalOPTIMA froze the Noble Mid-Orange County health plan’s enrollment of Medi-Cal patients and threatened to revoke its contract unless the hospital supplied the requested information by 3 p.m. Monday.

Hospital officials delivered two 3-inch-thick binders of documents to CalOPTIMA on Friday. Agency officials this week will assess whether all the requested information is included.

“We are confident that it will meet the expectations of CalOPTIMA, and we will continue to comply with them,” Garden Grove Hospital spokeswoman Donna Wolf said.

The freeze “means basically it is business as usual and we will continue to treat patients with the highest quality of care,” Wolf said.

Noble Mid-Orange County is the sixth-largest health plan within CalOPTIMA.

While officials said they could not reveal specifics about the requested peer review information, Crowley said CalOPTIMA is examining reports of complaints about an obstetrician at the Garden Grove hospital alleged to have routinely performed a painful procedure on women after childbirth without anesthesia.

According to the Medical Board of California, the obstetrician’s medical license is valid, but state officials have determined he has not met requirements for continuing education.

The medical director of Noble Mid-Orange County, with which the obstetrician is affiliated, is Dr. Richard Frankenstein, who is the immediate past chairman of CalOPTIMA’s Board of Directors. Frankenstein could not be reached for comment.