Hospital to Apologize for Denying Epidural

Northridge Hospital Medical Center plans to apologize publicly today to a woman who was denied epidural anesthesia because she could not pay cash up front while having a baby there last summer, and has promised the state of California that such incidents will not recur.

The hospital has also provided formal notice to anesthesiologists working at its facilities in Northridge and Van Nuys that any demands for cash or other advance payments for epidural anesthesia will be considered grounds for termination.

The moves, described in a report filed Wednesday with the California Department of Health Services and obtained by The Times, are part of the hospital’s legal response to six alleged breaches of state health regulations cited by investigators June 18.

The hospital’s response to the allegations, which included failure to appropriately manage the pain of patients and failure to provide care without regard for a patient’s ability to pay, comes just days after regulators turned over results of their probe to the Los Angeles County district attorney’s office for possible prosecution, The Times has also learned.

A spokeswoman for the district attorney’s office said it is too soon to know whether any crime was committed at Northridge Hospital. But investigators at other agencies have said areas of concern include whether Medi-Cal reimbursement was sought for the procedures, and whether taxes were properly paid on the cash provided by patients who wanted epidural procedures.

In Thursday’s report to the state, administrators promised several measures to ensure that no woman is denied an epidural for lack of funds. They include:

* Requiring that epidural anesthesia be available upon demand to all women who request it, provided such a procedure would not harm the mother or the baby.

* Making a demand for cash a material breach of the anesthesiologist’s contract, punishable by termination of the contract.

* Training all nurses that demanding cash for an epidural or refusing to administer one for lack of funds is against hospital policy. Any nurse who does not attend a training seminar will be removed from service.

* Asking all patients whether their requests for pain relief were accommodated, and whether they were asked for cash.

* Requiring all hospital employees to report any violations of the hospital’s policy on epidural procedures to their immediate supervisors.

State health services spokesman Ken August said the department had reviewed and accepted the proposal. But, he said, the state’s investigation into practices at the hospital is ongoing.

In an interview, hospital President Roger Seaver said he and his staff members “sincerely regret” that a Medi-Cal patient, Ozzie Chavez, was denied an epidural at the Northridge facility last July, and confirmed that anesthesiologists at both the Northridge and Van Nuys facilities had for years demanded separate payment from Medi-Cal patients for an epidural, a payment practice that has been condemned by Medi-Cal officials as illegal and unethical.

“On behalf of our entire staff, I want to extend our heartfelt sympathy to this patient and her family,” Seaver said in a statement the hospital plans to release this morning. “We sincerely regret this incident.”

Requiring money from Medi-Cal patients--which Seaver said was stopped at the Northridge campus after Chavez complained but continued at Van Nuys until last month--was disclosed by The Times on June 14. The practice has been roundly criticized by leading anesthesiologists and obstetricians.

“We feel very confident that this particular incident [involving Chavez] could never happen at Northridge Hospital again,” said Seaver, who described the case as an “isolated incident.”

Seaver decried the practice of demanding cash up front, but stopped short of criticizing the overall practice of charging extra for an epidural, saying the hospital’s responsibilities in such cases are “ambiguous.”

Seaver said the Northridge hospital is committed to providing health care for poor people and that its trauma center and planned new pediatric clinic would be jeopardized if the Chavez affair prompts state regulators to revoke the facility’s contract to handle Medi-Cal patients.

Regulators have said they would consider such a move if the hospital’s plan to correct the deficiencies found by the state is not acceptable, or if the plan is not carried out.

Last week the California Medical Assistance Commission delayed a renewal of supplemental funding that the hospital receives every year to help offset the cost of accepting Medi-Cal patients.

The international condemnation that has attended the practice of demanding cash for an epidural--which many experts and patients have said is occurring more frequently at small hospitals in the United States--marks “the height of embarrassment” for the hospital, Seaver said.

Hospital officials, he said, mistakenly believed that epidural anesthesia--a partial spinal block considered by many doctors to be the safest form of pain relief for mothers--was not covered by Medi-Cal, a claim the agency has repeatedly denied.

Hospital officials had thought, Seaver said, that as long as women were told in advance they would have to pay that the practice was ethical and legal.

“There was a knowledge of the practices, and it was viewed as being OK prior to a woman being in labor,” he said.

Seaver and other hospital administrators offered the first detailed explanation of how the hospital’s system worked, saying nurses would often serve as go-betweens for the anesthesiologists, informing the patients that cash was needed before an epidural could be provided.

They also said some obstetricians who worked at the hospital knew about the practice, and that some doctors and nurses had complained about it repeatedly.

“The obstetrical department was not happy with what was going on,” said Dr. Paul Buzad, an obstetrician who on Wednesday was named the hospital’s chief of staff. Buzad said the issue came up repeatedly at meetings of the hospital’s doctors, but that the practice was not eliminated until Chavez was denied an epidural last July.

The practice, however, continued at the Van Nuys facility, according to Seaver, because the anesthesiologists who practice there are not contractually obligated to accept Medi-Cal patients.

Catherine Beatty, an attorney who lives next door to Chavez and volunteered to represent Chavez after hearing the story of her labor and delivery, welcomed the hospital’s plan.

“We’re very pleased that the hospital has acknowledged its role, and that they are taking affirmative steps to make sure this does not happen again,” she said.