UCI Infection Rate in Cesareans Double Level Deemed Acceptable
The infection rate among some laboring mothers at UCI Medical Center is more than twice an acceptable rate because of patient overcrowding, the hospital’s acting chief of obstetrics said Sunday.
Dr. Thomas J. Garite said 30% to 40% of the obstetrical ward’s patients who have Cesarean sections now end up with an infection. An acceptable infection rate would be about 15%.
A hospital committee has taken some measures to control the problem, Garite said. But he and several other obstetricians said the ward was so busy, treating more than 500 patients a month in a unit designed for 250, that overworked staff members don’t always have time to maintain rigorous hospital standards for cleanliness.
“We can’t always maintain sterile technique,” said Dr. Joseph Lucci III, an obstetrician who is on a fellowship at the medical center.
The complaints came Sunday as a Times reporter and photographer toured the ward and heard some of its doctors and nurses describe what happens when a university hospital’s obstetrics ward, designed to offer state-of-the-art care, becomes inundated with more patients than it can handle.
In addition to rising infection rates, frustrated doctors and nurses complained that fetal monitors, which signal if a baby is in distress, are not always available and that patients often go through labor in hallways, where no oxygen units are on hand. Staff members are so overloaded with patients, they said, that they are not able to closely watch each woman.
Also three rooms that function as labor-delivery rooms do not comply with state licensing standards for that use, Garite said. “But if they tell us we can’t do this anymore, then we have to deliver in the hall. It becomes ludicrous after a while,” he said.
Conditions have become so bad recently, one young doctor said, that she would not want to refer private patients there nor would she want to deliver there herself.
“The way it is, absolutely not,” said obstetrician Jean Marie Costello, a second-year resident at the medical center. “We haven’t had a baby die in labor because somebody couldn’t get to them, but I just don’t think a woman should labor in the hall without a (fetal) monitor, period.”
Saying overcrowding has made conditions on the ward “unsafe,” Garite and Mary A. Piccione, the hospital’s executive director, warned other county hospitals on Friday that the medical center would begin turning away women in “active labor” when both its emergency room and obstetrics unit are full. Active labor occurs when a woman has regular contractions and dilation of the cervix. The only exception to the new policy would be women who have received prenatal care at UCI Medical Center, who would receive priority admission, according to the new policy.
Starting Friday night, when the medical center first notified area hospitals it had reached “obstetrical diversion” status, medical center security guards were to hand out maps and a list of area hospitals to women in labor. But Garite said he believed that only women who had received prenatal care showed up Friday, so all were admitted.
Ironically, medical center officials have criticized other hospitals and clinics for giving indigent patients maps to their hospital instead of caring for these patients themselves.
Poor patients around Orange County regularly come to UCI, in part because the 493-bed hospital in Orange is a former county hospital and has a reputation for treating the poor.
But part of the problem, medical center officials have said, is that other local hospitals have recently canceled Medi-Cal contracts, and their patients now come to the medical center.
Bankruptcy Threat
UCI Medical Center officials say they are treating 65% of the county’s indigent patients--many of these on the obstetrics unit. These patients are not only causing overcrowding at the teaching hospital but may force it into bankruptcy, hospital officials have said.
However, at least one administrator at another Orange County hospital was not entirely sympathetic to the medical center’s decision to turn away women in labor.
Michael Stephens, administrator of Hoag Hospital in Newport Beach said he was unsure whether the medical center had done all it could to ease the overcrowding situation before taking this “drastic action” of turning away women in labor. He said he was uncertain whether the action was legal.
Stephens also criticized state officials and Gov. George Deukmejian for failing to take action on improving Medi-Cal reimbursements to hospitals. He also blamed county supervisors for a lack of leadership in providing health care for the poor.
“Something more logical has to be done than just greeting patients at the door with (a map) telling them to go elsewhere. As health-care providers, we certainly have an obligation to patients,” Stephens said.
But rather than unilaterally turning women in labor away, Stephens said he believed that the medical center should petition the Hospital Council of Southern California to bring other hospitals together. “I understand UCIMC’s problems,” he said, “but as providers, we certainly have an obligation of care to the patients instead of telling them to go elsewhere.”
Meanwhile, Sunday began as an atypically quiet day on UCI Medical Center’s obstetrics ward.
As fetal monitors beeped in the background, Garite donned a yellow medical gown and showed visitors his unit’s three delivery rooms and 14 other beds.
Six Women in Labor
At midday, only six women were in labor when lately there have been as many as 25 at once.
But if most of the sparsely decorated rooms were empty now, Garite said he doubted that they would stay that way. “All you have to do is wait and it picks up,” the 45-year-old obstetrician said with a laugh.
At one point, he flipped through a thick patient registry that showed each day’s census.
In the first four days of June, 79 women delivered babies, Garite said, “so we’re cooking at about a 600 (patient-a-month) pace if we keep this up.”
Conditions have become so difficult that Garite, an expert on fetal monitoring who would like to be named the permanent chairman of obstetrics and gynecology, has also been “exploring other alternatives”--although, he added quickly, he would like to stay on at the medical center.
Garite was sympathetic toward his overworked staff and to patients who were sometimes “stuffed” together in a room.
Garite’s doctors and nurses agreed with him that the situation had become unusually difficult--stressful for the staff, sometimes “unsafe” for patients.
Said Dr. Lucci: “There are days when I put my name on a chart and I feel bad. I’m not implying any malpractice, but for a patient who had to wait several hours (to be taken care of), I do occasionally feel almost angry or upset.”
Added nurse Carol Patillo: “You give the best care. I think I give quality care to my patients. I’m the one who’s stressed out about it. I have to work harder, run further” between laboring women.
Like some of the other nurses and doctors, Patillo was also concerned about the women in active labor who will now be turned away when the medical center’s unit is full.
“It’s too bad we had to resort to that,” Patillo said. “If she comes here, she could deliver in the parking lot. Who knows if she is going to find her way to the next hospital?”
