Panel OKs Bill on Caesarean Injuries

In an effort to monitor and avoid injuries to women and babies like those caused by Los Angeles County’s recent efforts to cut costs by reducing Caesarean births at public hospitals, an Assembly committee has approved a bill requiring all hospitals to report maternity ward injuries and develop procedures to correct problems.

The measure, sponsored by Assemblywoman Martha Escutia (D-Huntington Park), was prompted by stories in The Times detailing 49 claims on behalf of women and children who were injured or killed when the county attempted to reduce the number of costly Caesareans at public hospitals in the late 1980s and early ‘90s.

If enacted, the legislation would require every county to develop a database of maternal and fetal injuries, as well as a system to ensure that conditions that can lead to malpractice--such as crowding or overreliance on interns instead of experienced physicians--are corrected.

“There ought to be a way to prevent medical malpractice suits from accumulating to 49 claims before anything is done about it,” Escutia said. “Why were so many maternal and fetal deaths and injuries allowed to accumulate? Why didn’t the state Department of Health Services catch the problem before it made newspaper headlines?”

At a time when Los Angeles County hospitals were at the forefront of a nationwide movement to reduce the number of Caesarean births, doctors at county facilities forced nearly all women to attempt to deliver babies vaginally--even in high risk cases.

The practice, which was eased beginning in 1995, has cost the county at least $25 million in malpractice settlements.

Earlier this month, county health officials implemented a policy forbidding vaginal deliveries for women who have had previous Caesareans--the highest risk group--unless the women give written consent to undergo labor.

Escutia’s bill was voted out of the Assembly Health Committee Tuesday night with a sizable 13-7 majority.

Besides requiring counties to record and correct problems, the bill establishes state oversight of the database and corrective action plans.

Counties would be required to report all injuries, deaths or other problems in maternity clinics to state health officials, who would then monitor individual cases, as well as scout for trends.

“We’re trying to force the [state] Department of Health Services to do something,” Escutia said. If the bill passes, she said, Sacramento would be able to spot a problematic trend as it develops rather than waiting until it is too late.

“When I read the articles in The Times, I called the Department of Health Services, and they didn’t even know about [the injuries and deaths],” Escutia said. “When malpractice accumulates like that, the state ought to be aware of it.”

Another bill, sponsored by Assemblyman Martin Gallegos (D-Irwindale), would forbid a public agency to require doctors to undertake a particular course of treatment for any class of patients.

“It makes it illegal for a public agency to interfere in the doctor’s decision-making with regard to care or treatment of a patient,” said Gallegos, who chairs the Assembly Health Committee and supported Escutia’s bill. “So a bureaucrat would not be able to come down and say, “ ‘You’re not going to do any Caesarean sections.’ ”

Escutia’s bill is supported by the American College of Obstetricians and Gynecologists, which has urged caution about efforts to reduce the number of Caesarean births.

It was opposed, however, by state health department officials, who questioned the quality of information submitted by hospitals and said it would be too expensive to set up and monitor the databank.

Escutia’s plan is based on a program developed by Los Angeles County Supervisor Gloria Molina to combat malpractice at county hospitals.

Under Molina’s program, hospitals must report bad outcomes to the county medical director within 24 hours, and must develop corrective action plans to improve conditions when something goes wrong.