Dealing With the Tragedy of No-Care Moms, No-Hope Babies

Jonathan Freedman’s eloquent articles “No-Care Mothers--No-Hope Babies” (Commentary, May 15-16) graphically describe the crisis in access to obstetrical care for the poor in California. An unbelievable 40% of the problem occurs in Los Angeles County. This year, the four Los Angeles County hospitals must provide for an estimated 45,000 deliveries, 12,000 beyond their capacity. Within eight years the number of county deliveries will double.

The Los Angeles County Medical Assn. (LACMA), and the county’s Department of Health Services (DHS) are poised to implement an imaginative cooperative plan to solve the OB access problem here.

The county DHS will make a concerted effort to identify women early in their pregnancy and enroll them in the Medi-Cal program (for which nearly all poor women are eligible). Then the county will contract with private obstetricians to provide full care for routine pregnancies in private hospitals participating in the program. Complicated pregnancies will remain in the county system. Payment will be at Medi-Cal rates, but will be made within 30 days of service, eliminating the major problem of long delays or non-payment which have plagued the Medi-Cal system, and which have discouraged physician participation. The county will provide malpractice coverage for these services. The county will assist pediatricians and anesthesiologists who participate in the program.

LACMA and the specialty societies for anesthesiologists, obstetricians and pediatricians have begun to publicize the new program. We all recognize that much more remains to be done, especially to reach the “no-care” women who do not enter the health care system until they are in hard labor. However, we believe that we will make a substantial contribution to the solution of this disastrous problem.

DAVID CHERNOF, MD

President-Elect

Los Angeles County Medical Assn.