Malpractice crisis hurts prenatal care programs

Monday, July 1, 2002 | 10:53 a.m.

Two major community programs that help pregnant women get access to prenatal care regardless of their ability to pay are being stretched thin by the medical malpractice crisis.

Ultimately if the programs -- Baby Your Baby and the Maternal/Child Health Program -- are lost, it would be more difficult for a pregnant woman to get prenatal care, according to a position paper drafted by the Governor's Maternal and Child Health Advisory Board, which oversees the programs.

Sunrise Hospital has lost more than half of its OB/GYNs who worked with the Baby Your Baby program, manager Janice Smith said. The program serves mostly as a referral service for expectant mothers, helping connect them with private doctors, financial aid or insurance, she said.

The Maternal/Child Health Program, which helps poor women pay for prenatal care, is down to 31 providers from 97 last year in Southern Nevada. All of the doctors who dropped the program said it was because of rising malpractice insurance or caps placed on the number of babies they could deliver, according to the report.

The advisory board reviewed the report today and voted unanimously to call on the Legislature and Gov. Kenny Guinn to provide immediate and long-term solutions to fix the malpractice crisis.

While the Baby Your Baby program has not had to turn away expectant mothers, Smith said, it is losing resources at the same time more women are turning to it for help.

And if the prenatal care programs ultimately are unable to reach the would-be mothers who need them, the report says, society will pay with children who are underdeveloped because of the lack of that care.

The malpractice insurance crisis, which has made the cost of coverage rise up to 400 percent for many OB/GYNs, has prompted some private obstretricians close their practices or to turn away regular patients, and many of those women are calling Baby Your Baby for referrals, Smith said.

But the low-income women Baby Your Baby was designed to help may be squeezed out if the program continues to lose doctors, the report says. Women who can pay the full $2,500 to $4,000 delivery charges will get easier access to financially hurting obstetricians, Smith said.

Besides providing referrals, Baby Your Baby helps women who qualify file applications for Medicaid or state welfare programs and provides discounted lab tests and ultrasounds as well as childbirth classes and information.

For women without insurance, the program arranges for provider doctors to accept payment plans or provide their services at a lower fee, something the doctors can no longer afford to do because of the rising malpractice insurance premiums, the advisory board found.

In addition to charging more for coverage, many insurance companies have asked obstetricians to reduce the number of babies they deliver, Smith said, making it difficult for them to take on any new patients. This has caused both privately insured and non-insured pregnant women to scramble to Baby Your Baby to find doctors.

Privately insured women may win out if the crisis continues, but they are also feeling the squeeze. The women who get referrals through Baby Your Baby are finding that they have to pay cash out of pocket, because the doctors Smith can find for them don't accept their insurance.

In addition to losing doctors, the Baby Your Baby program has lost major financial sponsors for its hotline just as more and more mothers are calling for help.

Washoe Medical Center has joined Sierra Health Services in its decision to stop funding the hotline, saying they would pursue other community medical programs.

Only Sunrise Hospital continues the hotline support, though Washoe Medical Center and Sierra Health continue to provide doctors to mothers seeking prenatal care.

Ultimately the cost for discontinuing prenatal programs will be felt by everyone, officials said.

Lack of early prenatal care leads to an increase in sick infants, which in turn has long-term social and economic consequences, said Judith Wright, chief of the Bureau of Family Health Services at Washoe County District Health Department, who works with the advisory board.

"This is impacting all the gains we have made," Wright said.

Poor or nonexistent prenatal care is linked to increased infant mortality rates, pre-term labor or birth and low birth weight infants, Wright said.

And that can get costly, the advisory board report notes.

In 1996, the most recent year for which data was available, it cost an average $16,767 for health-care services for infants born with birth defects due to inadequate prenatal care, the report says. The cost for healthy babies was $1,608.

"From a public health perspective, early entry into prenatal care and continuous care is extremely important, and helping women to get that care remains one of our top priorities," Yvonne Sylva, administrator of state health services, said.

If the Baby Your Baby program ended, Smith said, hundreds of women each month would not receive prenatal care.

"I think you're going to have a much higher increase of clients that drop in at the hospital, a lot more sick kids and sick moms," Smith said.