NORTHRIDGE HOSPITAL: Denied Anesthesia To Medi-Cal Patients In Labor
Anesthesiologists at Northridge Hospital Medical Center refused to administer pain-killing epidurals to women in labor because they could not afford to pay for the procedure in cash, the Los Angeles Times reports. One woman who was denied an epidural has filed suit against the hospital. Barry Silbermann, attorney for the anesthesiologist group at Northridge, "confirmed that doctors there had refused to provide epidurals for Medi-Cal patients who could not pay." The hospital says it has revised its policy. The lawsuit has prompted the Los Angeles County Department of Health Services to launch a probe at Northridge and other hospitals across the state that may be withholding epidurals -- a practice that is in violation of state and federal laws, according to state Department of Health Services Assistant Deputy Director Stan Rosenstein. Also, health care providers say the practice is medically unethical. "To withhold an epidural from a women in active labor is barbaric. How can you deny an effective form of pain management," said American Society of Anesthesiologists spokesperson Phil Weintraub.
Medi-Cal To Blame
Roger Seaver, president of Northridge, said in an interview "that until recently the hospital's anesthesiologists demanded separate payment from Medi-Cal patients who wanted epidurals." He said Medi-Cal reimbursements for epidurals are "too low" and that "over-regulation" in the state program led the anesthesiologists to demand more money. "When you have a regulated system that uneconomically addresses those types of issues, you can't expect behavior to be perfect across the system," he said. The Times reports that Medi-Cal only pays $57 for the initial insertion of the catheter for an epidural and $14 for every 15 minutes the anesthesiologist spends with the patient. Private insurance, on the other hand, pays $175 to $300 for the initial procedure and $35 to $60 for every 15 minutes spent with a patient. A Medi-Cal payment for an epidural "is so nominal, it's nothing," said Silbermann. Dr. Jerry Bissell, immediate past president of the Society for Obstetric Anesthesiology and Perinatology, said many anesthesiologists view administering epidurals during labor "as low-paying and 'a hassle.'" He said, "It doesn't pay as well as other forms of anesthesia. It takes a lot of hours."
While the problem may be most prevalent at small hospitals that do not have teams of anesthesiologists devoted to obstetric anesthesia, the Times reports that the "issue is coming to a head" across the state as officials attempt to lure hospitals to accept Medi-Cal patients by offering higher reimbursements for obstetricians -- but not anesthesiologists. The doctors "have become so bitter" the Times reports, that at a recent California Society of Anesthesiologists meeting, they considered a resolution declaring epidurals not "medically necessary," thus making the procedure payable upfront by patients. The resolution failed, but not before some anesthesiologists decided they would refuse to accept Medi-Cal recipients as patients. "It is not unethical to be selective," said Silbermann. But the Times reports that classifying epidurals as elective "goes against" American College of Obstetrics and Gynecology and American Society of Anesthesiologists guidelines. "[A]n epidural ... is good for both the mother and the child," said Dr. Julian Gold, cochair of anesthesiology at Cedars-Sinai Medical Center. "In the last years, however, I think there has been some concern over the use of epidurals on the part of lots of people -- mostly because it costs more," he said. But the problem is not the doctors or hospitals, said Dr. Patricia Dailey, an anesthesiologist on the Society for Obstetric Anesthesiology and Perinatology's board. She blamed the state Legislature's refusal to increase Medi-Cal reimbursements for the procedure. "You have to start working to improve reimbursement at some other venue. I don't think you can do it at the bedside," she said (Bernstein, 6/14).