HEALTH : Baby’s Death Focuses Senators on Question of Hospital Stays

WASHINGTON — The child born to Virginia Leigh Fallon of Petaluma entered the world last year with heart and breathing problems and after an extraordinarily difficult labor that ended only when doctors performed a Cesarean section.

Yet three days after the birth, the hospital--under pressure to hold down costs--discharged mother and son, even though baby Jesse had been diagnosed with a heart murmur and Fallon was, in her words, “in continuous pain and physical distress.”

Several days later, Jesse was rushed to the hospital, where emergency heart surgery failed to save the boy’s life, Fallon told a Senate committee Tuesday. “Why were my baby and I discharged after 72 hours when we were so obviously unfit to be released?” a tearful Fallon asked.

Unfortunately, Senate Labor and Human Resources Committee members said, Fallon’s tragic experience was not unique. Health care providers, under growing pressure to cut costs, discharge new mothers as quickly as possible--sometimes far too soon, in the opinion of many doctors and patients.

Faced with growing concerns over this national trend, a bipartisan group of 11 senators headed by Nancy Landon Kassebaum (R-Kan.) and Bill Bradley (D-N.J.) are sponsoring a bill to guarantee mothers at least 48 hours of hospital recuperation--with up to 96 hours for C-section patients.

The legislation may be a sign of things to come as the government, which is pressuring the health care industry to cut costs, intervenes to keep medical providers from taking steps Congress believes go too far toward compromising patient safety.

Opponents of such measures worry that if lawmakers take such precedent-setting steps, Congress will find itself involved in legislating health care standards in a way few imagined in the drive to reform medical care.

Kassebaum’s measure is modeled after new state laws in New Jersey and Maryland. California legislators are considering a similar bill to ban insurers from discharging mothers and newborn babies from the hospital in less than 48 hours, except under certain circumstances.

The bill allows a discharge earlier than 48 hours if the mother and her doctor agree it would be best. Doctors would be required to consider medical guidelines established by the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists.

Health insurers who discharge mothers earlier than 48 hours would be required to pay for one home visit by a nurse or other health care provider within two days of discharge.

The issue grew in California after The Times reported that a Kaiser Foundation Health Plan hospital in Los Angeles had begun a program to discharge healthy mothers and newborns as soon as eight hours after delivery.

Kaiser officials say the program is voluntary and was begun because women were asking to go home earlier. Some Kaiser nurses, however, have contended that the program was not always voluntary.

In Washington, the bill has drawn support from prominent physicians’ organizations but opposition from such providers as the Group Health Assn. of America. The Washington-based association, representing health maintenance organizations, said it opposes federal mandates for maternal care. Officials said most problems can be solved with good prenatal and postnatal care. Many federal lawmakers seem to favor the bill, but prospects for passage are unclear.

Some prominent physicians told Kassebaum’s committee that the potential consequences of discharging infants less than 48 hours after birth are still unknown.

According to the American Medical Assn., studies have shown that early release of infants can result in jaundice, feeding problems, respiratory difficulties and infections of the ears and eyes.

Referring to baby Jesse’s emergency open heart surgery and his last few days of life, which cost nearly $80,000, his mother asked: “How much does one or two more days in a hospital cost?”