Pregnant moms forced into public health care

Jeffrey Libby

Friday, Sept. 27, 2002 | 11:17 a.m.

Two weeks overdue, Rita Lahey, 22, sneaked a chicken quesadilla and cheese fries with friends Thursday, as she sat up in Bed 6 on the Labor and Delivery Unit at University Medical Center. An intravenous Pitocin drip, a labor-inducing drug, slipped through a clear tube snaked to her wrist.

"It's my first baby, I'm nervous," she said, smiling with pride. "I've already been up here eight times."

When Lahey found out she was pregnant, at three months along, she spent a month calling obstetricians with no luck. Nobody was taking anybody, she says. She only found prenatal care after she began to bleed and checked in at an emergency room.

It's a story women and health care experts say is becoming more common in the Las Vegas Valley. Because of rising insurance premiums, doctors have quit delivering babies or taking new patients as a way to cut their costs. Other doctors have left the state because of the crisis. That has sent women into the public health care system in ever-increasing numbers.

"For Southern Nevada, UMC is frequently the canary in the mine shaft," said Larry Matheis, executive director of the Nevada Medical Association. "It's where people end up who have problems navigating the system."

"What you're seeing now is the front edge of those who don't have many options, who don't have insurance, who couldn't find an obstetrician."

The increased numbers of women coming to the public hospital for care is the first clear sign that financial aspect of the OB/GYN medical malpractice crisis, as yet unsolved, has morphed into a health crisis as well, doctors say.

"It's already happening," said Dr. Warren Volker, who works four times a month at UMC as an attending obstetrician for the resident doctors in training. "We've seen dramatic increases."

Clark County hospitals expect only a slight increase in babies delivered this year, about a 4 percent increase, but the number of pregnant women seeking obstetric care at University Medical Center has already jumped 22 percent since January.

So even as lawmakers, lawyers, doctors and insurers attempt to pinpoint exactly how many obstetricians have stopped delivering babies in the face of skyrocketing insurance rates, day-by-day more women are being forced to seek care at UMC, the safety net of last resort.

Susan Castronova, a registered nurse at the UMC delivery unit, said, "This is happening across the board. There are no socio-economic barriers."

The limited available care causes women to arrive at clinics later in their pregnancies, Volker and other doctors say. In cases such as Lahey's, doctors came into the picture too late to screen for potential complications, provide optimal nutrition supplements, and provide other care. Typically, less prenatal care means a more high-risk birth and a longer hospital stay, doctors say.

The increase in high-risk deliveries, doctors say, could push insurance rates even higher before legislation passed in a special session this summer has a chance to reduce them.

Doctors expect that trend to worsen in the coming months as fewer obstetricians come to Clark County and more leave or stop delivering babies.

Through mid-September just four obstetricians obtained licenses, down from 15 last year, according to the state Board of Medical Examiners. Of those who continue delivering babies, most will deliver fewer than 125 during their next year of coverage because of surcharges imposed by insurance carriers in August. That's about half the 200 to 230 babies many obstetricians delivered last year in an attempt to cover increased costs.

Bill Welch, president of the Nevada Hospital Association, says his organization is already considering a large-scale recruiting drive by hospitals to bring more obstetricians to Clark County to help deliver the more than 24,000 babies expected in 2003. It's a solution Welch said he wants to avoid.

But the "simple math," as he calls it, leaves his organization little choice. The hospitals must provide services by federal law or close, he said.

"The best case scenario I've heard is that we have about 100 Clark County OB/ GYNs. That means we'd have to find enough new OB/GYNs to increase their numbers by another 70 percent," Welch said.

"At worst, we need to double the number of OB/GYNs. And that's today. Not next week or next year."

The Clark County OB/GYN Society says 35 obstetricians have stopped delivering babies since December. Some retired, some left the state. Others have limited their practices to just gynecological care, the society says.

But the state Board of Medical Examiners confirms only a handful of obstetricians leaving the state.

So far, those smaller numbers have led Gov. Kenny Guinn's office to speak mostly of its concern about the situation, but to stop short of attributing the few exits to anything other than normal ebb and flow.

The governor's office remains reluctant to say the state has a crisis on its hands, despite a designation last week by the American College of Obstetricians and Gynecologists' designation of Southern Nevada as the worst place in the nation for a woman to have a baby.

Welch and other doctors are already calling for new legislation, looking past laws effective Oct. 1 that were passed this summer in an attempt to limit insurance premiums.

But Jenny DesVaux Oakes, a spokeswoman for Sierra Health Services, a sister company of Health Plan of Nevada, the largest managed care provider in the state, said Thursday those calls are premature.

Of 80 obstetricians providing care to Sierra members, 67 percent are accepting new patients, Oakes said.

"All I can tell you is our network of OB/GYN providers is stable," she said. "We're in a situation now where we have to wait and see what the results are of the legislation that was passed."

But Karen Gordon, a marketing director for UMC, said the exodus of Clark County OB/GYNs would continue and few would replace them. She was perplexed that anyone would argue that fact when suddenly half of most obstetricians annual pay is going directly to insurance premiums and there are few ways to increase their reimbursements.

"Why would anyone want to come here?" she said of doctors looking to relocate.

Many obstetricians say recruiters call every week, attempting to lure them to other states with true tales of premiums one-tenth the cost in Nevada, and other incentives.

"Right now it's almost impossible to recruit an obstetrician to Las Vegas," said Volker, who is a member of the national OB/GYN group and of the Clark County OB/GYN Society.

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