Wider Probe of Anesthesia Denials Urged by Officials

Following revelations that doctors at Northridge Hospital Medical Center demanded cash from poor women in labor before providing a common form of anesthesia, federal health regulators have begun a sweeping audit of the hospital’s practices and records.

At the same time, the Los Angeles County Board of Supervisors said the hospital “caused unnecessary pain and suffering to a number of women in our county,� and voted to ask state regulators to expand their investigation to include all anesthesiologists and hospitals in the county that accept Medi-Cal patients.

Supervisor Zev Yaroslavsky led the board’s action with a motion calling for the widened probe, saying that he had found the “smoking gun� that proved that hospital officials were “using false facts� when they claimed that doctors charged for epidural blocks because they thought Medi-Cal did not cover them, a claim that the state agency has repeatedly denied.

Last week, hospital President Roger Seaver apologized to Ozzie Chavez, who was denied an epidural last summer when she could not produce $400 in cash, but he said that her case was an isolated incident.

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But on Tuesday, Yaroslavsky presented the board with what he said was a copy of a receipt dated April 30, 1997, for $400 in cash printed on letterhead of Mid Valley Anesthesia Associates and signed by Dr. L. Berke, the same anesthesiologist who allegedly denied an epidural to Chavez.

Above the signature of the mother, whose name was blocked out but who Yaroslavsky said was not Chavez, was a statement from the anesthesiology group saying that a cash payment “at the time of the epidural placement� would be necessary. The statement said that “the practice limitations of the above doctors prevent accepting you as a patient for these services as a Medi-Cal beneficiary.�

“This means that your Medi-Cal sticker will not be accepted for the services . . . (including a C-Section or Post Partum Tubal Ligation), and that you will be solely responsible for payment of the doctor’s fee.�

The receipt was proof, Yaroslavsky said, that the anesthesiologists were not denying the procedure because it was not covered by Medi-Cal, but because they simply chose not to provide such a service to Medi-Cal patients.

“This proves that the physicians knew, and that the hospital would have known,� Yaroslavsky said. “It was right there in black and white--that it was not a Medi-Cal requirement, it was the practice limitations of the anesthesiologist group.�

Hospital spokesman John Lockhart said the hospital had reviewed the case of the woman who received the receipt, and determined that the institution was not at fault.

“She was not denied the epidural,� he said. “But she did have to pay for it.�

The demand for cash had come before the hospital told its anesthesiologists to stop asking for money up front, he said, reiterating that such a practice has been discontinued.

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He said that the federal probe, which included an investigation of the Yaroslavsky receipt, had ended, and predicted that it would show that doctors at the hospital no longer demanded cash for epidurals.

But Chris Peacock, spokesman for the U.S. Health Care Financing Assn., said the federal examination, known as a validation survey, began Tuesday and could take several days. He described the survey as an intensive look at a hospital’s practices and one that is more detailed than the routine inspections that accredited institutions normally undergo.

He said federal regulators, like others investigating the hospital and its doctors, became involved after learning of the allegations in a June 14 article in The Times.

“Since first learning of this we have been looking into it to make sure [Medicaid and Medi-Cal] beneficiaries get the services they need,� Peacock said.