пятница, 14 сентября 2012 г.


Byline: Alex Roth Daily News Staff Writer

In the hours after his home birth, Willem and Barbara Kernkamp's baby boy turned an alarming shade of blue, so the Burbank couple contacted their private doctor and rushed to the nearest hospital.

But when their pediatrician arrived at Providence Saint Joseph Medical Center, she was barred from the neonatal intensive care unit. Instead, the baby was handed to a doctor the couple had never met. The reason: The hospital gave exclusive rights over the neonatal unit to three pediatricians.

``It was strange,'' said Willem Kernkamp, 39, whose baby turned out not to be seriously ill. ``We came in there with our own doctor and then magically she was gone.''

On Tuesday, in a case that has captured the interest of the state's most prominent medical organizations, the private Burbank hospital agreed to change its policy of exclusivity, a Department of Health Services spokesman said.

The controversy highlights a pressing medical issue: Whether exclusive contracts are an economic necessity of modern-day health care or a violation of the right to choose one's own doctor.

Michael Madden, Providence's chief executive officer, said the settlement with the state is a solution ``that we can work with,'' but he declined to provide details.

State regulators say no hospital that accepts Medi-Cal patients can legally enter exclusive contracts, except in very limited specialties, such as radiology and anesthesiology.

Critics say exclusive contracts promote an assembly-line approach to health care.

But some hospital operators and powerful allies want such contracts, saying they can guarantee round-the-clock care, a high quality of service and hospitals' survival in an increasingly difficult market.

What's more, they say, the contracts are widespread among the 271 hospitals in California that receive Medi-Cal reimbursements. If regulators targeted every illegal contract, ``the system would be in disarray,'' said Dr. Bruce Spurlock, executive vice president of the California Health Care Association, a hospital trade group.

Spurlock said the association wants the state to change a 1982 law that restricts such contracts for hospitals that get Medi-Cal money. The law is ``not applicable in 1998,'' he said. In the modern world of specialized medicine, exclusive contracts guarantee consistent care at high volume, he said.

The state Department of Health Services began investigating the nonprofit Providence Saint Joseph Medical Center in March after receiving a complaint from Dr. Pejman Salimpour, clinical chief of pediatrics at Cedars-Sinai Medical Center. He also is on staff at Providence.

Salimpour said the hospital has refused on ``dozens of occasions'' to let him or other qualified doctors in his medical group use the neonatal intensive care unit even though they have privileges to practice at Providence. The hospital's policy applies to all neonatal intensive care cases, even if the babies aren't Medi-Cal recipients.

``To not allow parents to make the right choice for their babies is wrong, immoral, illegal and disrespectful,'' Salimpour said.

On Tuesday, after hospital officials and state regulators met in Sacramento, hospital officials agreed to change the policy to comply with the law, Department of Health Services spokesman Ken August said.

Although state law prohibits exclusive contracts only at hospitals that receive Medi-Cal funding, they have become a source of controversy among medical staffs.

Last year, the California Medical Association sponsored a bill that would have required a hospital to give ``great weight'' to the opinion of its own medical staff before entering an exclusive contract. The Legislature approved the measure but Gov. Pete Wilson vetoed it.