ot: Demand for Prenatal Care for Poor Strains Localities - The Wealthy Get an Extra Shield for Wildfires

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August 28, 2007

The Wealthy Get an Extra Shield for Wildfires

By WILLIAM YARDLEY

http://www.nytimes.com/2007/08/28/us/28idaho.html

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Demand for Prenatal Care for Poor Strains Localities

By Delphine Schrank

Washington Post Staff Writer

Tuesday, August 28, 2007; B01

http://www.washingtonpost.com/wp-dyn/content/article/2007/08/27/AR2007082701724.\

html

Glenda Ordo?ez gave birth to her son on a cold night in September 2005 on

a wooden bench outside her basement apartment in Leesburg.

For months, the uninsured woman from El Salvador had sought access to

prenatal care, which studies show reduces the chances of infant mortality,

low birth weight and a variety of health troubles. She said her

boyfriend's $13-an-hour paycheck disqualified her for care through the

Loudoun County Health Department, where patients must fall within the

lowest brackets of the state poverty levels. He had left her, Ordo?ez

said, but she couldn't prove it. The Loudoun Community Free Clinic in

Leesburg didn't offer prenatal services. She couldn't afford a doctor in

Herndon who would charge $3,000 for several months of care. Another doctor

in Sterling refused to take her five months into her pregnancy.

Like many women in the Washington area, Ordo?ez, now 25, fell through the

cracks. She was too poor for insurance but not poor enough to get the help

she needed from the county.

But recent efforts in Loudoun and Prince counties to expand

services to keep up with the demands of the growing population of

uninsured or low-income pregnant women have stalled, and local health-care

communities are scrambling for solutions.

" So many are going through pregnancy without care. And the only option is

to deliver the baby as an emergency, " said Nora Lobos, a case manager with

MotherNet/Healthy Families Loudoun, a nonprofit group that provides

support to low-income families in the county, including Ordo?ez and her

two children.

The Loudoun County Community Health Center was supposed to provide help,

with prenatal care provided through a family practitioner. But the week

before the center opened May 22, its director, Debra Dever, discovered

that the insurance the center had bought would not cover prenatal care.

Purchasing adequate additional coverage would have been too expensive,

Dever said. The Loudoun center is funded through grants and donations and

charges patients as little as $10 a visit, based on their ability to pay.

" To give you an example, the insurance costs of a family practice in minor

surgery is $14,400 per physician " each year, Dever said. " If we add

prenatal, that's $62,413 for every year. " Costs rise more for extra

insurance to cover doctors after they leave a practice -- coverage most

doctors expect, Dever said.

" It's not an unreasonable request, " she said. " If we're going to recruit

an excellent provider, we need to provide excellent malpractice coverage, "

she said.

Goodfriend, director of the Loudoun Health Department, pushed for

six years for creation of the center as demand for low-income health care

grew in the county. He said he had hoped the center would provide

continuous care to indigent pregnant women that his department is unable

to offer. He and his team of nurse practitioners see about 300 patients a

year for the first two-thirds of their pregnancy before sending them to a

physician at the hospital.

" It's not the best care because it's disjointed, " Goodfriend said. As a

primary care physician, he is also unable to offer the specialized care

that high-risk patients often need. In some instances, pregnant women who

are carrying twins or who have diabetes are sent hours away to a hospital

in Charlottesville, " a big inconvenience for women who are often working

full-time jobs, " he said.

Prince faces a similar situation.

" Last year, we were absolutely swamped " with requests for low-income

prenatal care, said Alison Ansher, director of Prince 's Health

Department. Because of limited staffing and resources, the department had

to restrict eligibility to patients at its clinic to the lowest income

bracket of the federal poverty guidelines, Ansher said. As of Aug. 1, the

clinic has been able to raise the eligibility threshold to 180 percent of

the poverty level, but that still leaves many women with few options, she

said.

Demand is also high at an obstetric clinic for low-income patients at

Potomac Hospital in Woodbridge, health-care professionals said. In

addition, the Greater Prince Area Community Health Center, which

serves uninsured and low-income patients, does not offer prenatal care.

But it has considered doing so since 2003. In a needs assessment that

year, prenatal care ranked second after care for such chronic conditions

as diabetes, hypertension and high cholesterol, Corey R. Riley, the

center's executive director, said.

" We knew it would be a challenge " to add prenatal care, Riley said. But,

he said, " the costs of obstetrics coverage have gone through the roof "

since he first heard an estimate four years ago.

The Loudoun and Prince community health centers plan to apply for

a federal grant that would cover their malpractice insurance costs for

prenatal care. But Dever said that competition for the grants is high and

that Northern Virginia's wealth might prove a hindrance.

This month, the Loudoun Health Department received a $54,000 grant from

the Kaiser Permanente health organization that Goodfriend said he intends

to use as seed money for the health-care community to forge a solution.

Elsewhere in the Washington region, experts said, women sometimes move or

fake residency to obtain care because eligibility for most charity

programs is based on income and proof of residency within a jurisdiction.

" We don't ask, but when we try to contact them, it's not uncommon to find

they are not where they say they're from, " said Fred E. Mecklenburg,

chairman of the Department of Obstetrics and Gynecology at Inova Fairfax

Hospital, which runs a large clinic for low-income pregnant women.

Many low-income or uninsured women also face language barriers or other

problems, including domestic abuse, that require complex solutions,

health-care workers say. Illegal immigrants sometimes skip care to avoid

notice.

" Some will say: 'It's prenatal care. What's the big deal?' The big deal is

even those five minutes with a doctor is an opportunity to see the size of

baby, that it's growing correctly, " said Gomez, president of 's

Center for Maternal and Child Care, a center in the District that provided

1,092 women with prenatal care last year.

The 's Center is expanding to Long Branch in November in partnership

with Washington Adventist Hospital, which has been " overwhelmed " with

demand for prenatal care since it expanded its services to indigent people

in July 2006, said Lydia Parris, the hospital's communications director.

" The most important thing is for a future mother to come in early to take

care of problems sooner rather than later, " Gomez said.

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