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Calif. Mulls Anesthesia Procedure

August 31, 1998

LOS ANGELES (AP) _ Patricia Tinajero will never forget the day four years ago when her first child, Alexander, was born. In the throes of labor, the pain unbearable, she cried out for relief.

The anesthesiologist took her boyfriend into the hallway of the maternity ward at Whittier Hospital Medical Center and asked him for about $400 cash to administer an epidural, a common method of relieving pain during childbirth.

``I was like screaming really bad, so bad they had to close the door,″ Ms. Tinajero recalled Friday.

Her boyfriend, Adrian Simon, who was 21 at the time, didn’t have the cash on him, so he rushed to a nearby bank to withdraw all the money he had _ a little more than $200 _ from his savings account. The anesthesiologist accepted the sum.

The couple had not thought about the transaction much until recently, when they read newspaper accounts of Medi-Cal patients who had experienced similar demands for cash while in labor at some Southern California hospitals. Ms. Tinajero, who was 17 when Alex was born, had been on Medi-Cal, the state’s insurance program for poor people.

The scandal _ the latest controversy to hit the managed health care industry _ emerged in June when Ozzie Chavez sued Northridge Hospital Medical Center. The former Medi-Cal patient claimed an anesthesiologist demanded $400 in cash before she would administer pain relief.

When Mrs. Chavez offered a check or credit card, the anesthesiologist repeated that she would only accept cash. Mrs. Chavez ended up delivering her fifth child last summer without anesthesia.

During the epidural procedure, a catheter is inserted into the mother’s back and her lower body is numbed. She remains awake and can still push the baby out. The infant is born without narcotics in its system.

After the allegations surfaced, the state Department of Health Services began investigating. In addition, state Assemblyman Martin Gallegos sponsored legislation that would forbid doctors from withholding pain relief from women in labor. It would allow the state medical board to discipline doctors who do so, or threaten to do so.

That bill was approved Thursday by the state Legislature and goes to Gov. Pete Wilson for his signature. The governor has not yet taken a position on it, spokesman Ron Low said.

``We’re sworn as doctors to provide care to people who need it,″ said Gallegos, who is a chiropractor. ``It’s a terrible breach of ethics when doctors try to blackmail patients in this way.″

The Northridge hospital has been ordered by the state to reimburse about 300 Medi-Cal patients who were forced to pay for anesthesia during childbirth from 1992 to August 1997.

The state has identified three other hospitals where some women on Medi-Cal were required to pay for anesthesia: Whittier Hospital Medical Center, where Ms. Tinajero gave birth, Providence Holy Cross Hospital in Mission Hills and Queen of Angels/Hollywood Presbyterian Hospital.

None has been ordered to reimburse their patients because the investigation continues. Authorities are trying to determine how many patients may have been involved.

Five other centers also are under investigation, said Ken August of the state Department of Health Services.

Sherry Slade, director of business development at the Whittier hospital, said the practice ended in 1996 when a new president took over.

That doesn’t relieve Ms. Tinajero, who wants the state to reimburse her for the payment or order the hospital to do so.

``I’m mad because I had to pay for it when I really didn’t have to,″ Ms. Tinajero said. ``That was a lot of money to us back then. It was really unprofessional conduct.″

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