Many born, left in hospitals

A young woman conceals her pregnancy, gives birth alone and then feels desperate.

The image of a panicked new mother on the verge of abandoning or killing her baby is often invoked by those who support safe-haven laws as a way to save infants from harm.

But in Ohio and elsewhere, it appears to be just as likely -- and possibly more so -- that laws designed to permit the anonymous, legal abandonment of infants are being used by women who deliver in hospitals and leave without their children.

Some say that's OK because the babies remain safe, but others worry that the practice is short on safeguards and rife with potential consequences.

"I don't think these are the cases that safe havens were intended for," said Linda Spears, vice president of policy for the Child Welfare League of America. "We are very concerned that these laws are not responsive to the problems. We urge a lot of caution and a lot of care."

Lucas County Children Services in Toledo has handled six cases since Ohio's Safe Havens law took effect in 2002, Executive Director Dean Sparks said. All were infants born in hospitals and left there by mothers who claimed their right to legal abandonment without fear of prosecution.

"I've always had a huge problem with this," Sparks said. "I don't believe these are Safe Havens (cases). We already have the option for mothers to surrender babies for adoption -- they've been able to do that for 100 years."

One difference between the options is timing.

Under Ohio law, a parent who wants to have a child adopted must wait at least 72 hours after birth before signing the forms to voluntarily relinquish parental rights. Permanent surrender, which requires court approval, also requires a three-day wait.

The idea is to make sure that the mother is sure.

But safe-haven statutes, created to head off dire action and remove the threat of criminal prosecution, have no mandated wait, even if they play out in hospital wards instead of at police or fire stations.

"With Safe Havens, she can make a decision that cuts her out of her child's life forever while still under the influence of delivery-room medications," said a Grove City-area resident whose 20-year-old daughter surrendered a newborn at Doctors Hospital last month.

"There was no counseling requirement," said the woman, who asked that her name be withheld so that her daughter isn't identified. "My daughter wouldn't have harmed the baby. The baby wasn't in danger."

Franklin County Children Services says the 6-week-old girl remains in foster care. The baby's mother now is fighting to establish her parental rights so she can proceed with a private, open adoption.

"I'd never heard of Safe Havens," she said. "I actually thought it was a Christian adoption program."

Spears and Sparks said that safe-haven surrenders can permanently cut relatives out of the picture or deprive a child of family and medical information that becomes important later.

"With a surrender, you have disconnected a child, perhaps unnecessarily, from other family members who may have been willing to care for that child," Spears said.

Determining the scope and nature of safe-haven surrenders is difficult because data collection nationwide has been poor.

Franklin County documented three Safe Havens babies this year, two of which took place in the hospital where the babies were delivered.

Cuyahoga County has had two this year, both in the hospitals where the babies were born.

Neither of those counties, the state's most populous, could provide details on how and where all of their Safe Havens cases have occurred since 2002.

The state doesn't know, either. The Ohio Department of Job and Family Services cannot provide a statewide breakdown on how Safe Havens cases occur, because it doesn't keep track, said Jennifer Justice, chief of the Bureau of Family Services.

The raw numbers it reports have varied from 52 to more than 70 since the law went into effect. Justice said the discrepancy probably is due to a new child-welfare computer system.

In Michigan, a large majority of the 76 babies given up under the state's "Safe Delivery" law have been born in hospitals and left there, said Jean Hoffman, a consultant assigned to the program.

In Kentucky, 22 of 24 babies given up since 2002 under that state's safe-haven law were surrendered in the hospitals where they were born.

"That was something that the creators of the law did not intend," said Anya Armes Weber, a spokeswoman for the Kentucky Cabinet for Health and Family Services. "But at least the baby is safe."

Hoffman said the best way to avoid problems with safe-haven abandonment is to encourage adoption when possible. "This law is really supposed to be a last resort," she said.

Eric Fenner, executive director of Franklin County Children Services, said he strongly supports the law because its benefits outweigh risks.

Women in the hospital should be able to invoke Safe Havens just as those who give birth elsewhere or give up an infant at some other point during the 30-day window permitted under the law, he said. Those in the hospital should not be seen as trying to bypass legal processes, he added.

"Quite frankly, I find all of this conversation disturbing. I don't think this decision is as simple as one would think," Fenner said. "And even if the Safe Havens law saves one life, it's worth it."

Columbus lawyer Thomas Taneff, who handles many adoptions, said some women incapable of parenting need the option that safe-haven laws afford. "I can see a mom saying, 'I don't have the physical, mental or emotional energy to jump through all these hoops. I'm walking,' " he said.

"I think that this law then steps in to decriminalize her behavior."

Spears said the central but unanswerable question remains: Were the babies surrendered in hospitals at risk of harm? Infanticide is rare, and states generally don't compare it against rates of unsafe and safe-haven abandonment.

"Most mothers aren't going to leave a child to die," Spears said. "They're going to be afraid. And they probably need help."

On one point, the sides agree: The nation needs reliable data on safe-haven laws, which now are in effect in all 50 states.

"The intent is good as gold, but are these laws responsive?" Spears said. "We don't have enough information to know." Read More...

Health care overhaul bills await Schwarzenegger

As Congress and President Barack Obama began wading into national health care reform earlier this year, California's leaders were already embroiled in debate over what they could do on their own turf.

Congress might eventually enact changes that address consumer complaints about being denied insurance coverage or being thrown off individual plans, a practice called rescission.

Federal lawmakers also might get around to outlawing practices that allow some insurers to charge women more because of their gender, or extra to get maternity benefits.

But like other states, California has the power to pass its own laws to provide relief, absent federal solutions.

"It's critically important we do these things, whether it's rescission reform or maternity reform at the state level," said Anthony Wright, executive director of Health Access California.

"Things could change with federal reform," he said, "but we can't wait."

Three key bills that health care advocates lobbied for were approved by the Democratic-controlled state Legislature this year.

But the proposals didn't garner Republican support, and the insurance industry opposes them.

The bills are on Gov. Arnold Schwarzenegger's desk, awaiting his signature or veto.

More individual policies

More than 2.6 million Californians buy insurance individually rather than through a group, and purchases are growing. Buyers included the self-employed, early retirees, part-timers and young adults who no longer have parental coverage.

One bill stops insurers from charging women more � so-called gender rating � for coverage they buy on the individual market. Ten states already prohibit it.

Another bill requires that all individual policies include maternity benefits. Right now, if a woman wants to add that coverage, it can cost hundreds of dollars a month extra.

The third bill requires insurers to prove to a review panel that individual-market customers "willfully" lied about health histories before policies can be revoked.

Such cancellations, or rescission, of thousands of policies in California for flimsy reasons prompted a class-action lawsuit. A 2007 settlement with state regulators requires insurers to offer some restitution to customers stuck with medical bills.

The insurance industry is urging the governor to veto the bills � and insiders are confident he's listening to them.

The rescission bill, the industry says, goes too far in its attempt to control insurers.

The gender-related bills, the industry also says, could push some people to drop coverage because they won't want to absorb higher premiums for maternity coverage.

Issue of cost vs. bias

Assemblyman Dave Jones, D-Sacramento, is author of the bill prohibiting gender rating, which for women can result in paying premiums 10 to 25 percent higher than men for identical coverage.

"I am very hopeful," Jones said, "the governor will not march in lock step with those who would discriminate against women."

Federal law prohibits gender rating in group policies. It also requires that maternity coverage be offered as a routine matter in employer plans with more than 15 people.

During the 1990s, 10 states, including New York and New Jersey, banned gender rating within the individual market. Two states limit it.

Anne Eowan, vice president of the Association of California Life and Health Insurance Companies, which opposes Jones' bill, said gender rating makes sense in the smaller universe of individual plans.

Younger women use more preventive care than younger men, she said, but older women use it less frequently than men.

"We don't feel it is discrimination," Eowan said.

In Minnesota and Montana, where gender rating in the individual market has also been banned, critics compared it to charging African Americans more than whites, according to a report by the National Women's Law Center.

Although it is hard to isolate the impact that banning gender rating has on insurance markets, none of the states that have prohibited it reported a surge in costs, said Richard Cauchi, who tracks state health-related proposals for the National Conference of State Legislatures.

A biological reality

Five states have also enacted laws that require the individual market to include maternity coverage, the other gender-related proposal now before Schwarzenegger.

In 1993, Montana's Supreme Court ruled it was gender discrimination not to include maternity coverage in individual health plans.

Schwarzenegger vetoed two previous bills requiring individual-market maternity coverage. He said that "a mandate, no matter how small, will only serve to increase the overall cost of health care."

Opponents, including the National Federation of Independent Business, agree, arguing that a mandate eliminates choices for customers who struggle to find affordable plans and don't need maternity benefits.

They said such bills only add to the affordability problem that the president and Congress are trying to solve.

Assemblyman Hector De la Torre, D-South Gate, the maternity bill's author, said opponents are exaggerating cost increases.

A state analysis estimates that the bill would extend maternity coverage to 207,000 women between the ages of 19 and 44, and that on average it would increase premium payments by about $7 a month.

Supporters of the bill, including the California Academy of Family Physicians, point out that while men will never need maternity coverage, women will never need treatment for prostate cancer.

Risk should be shared, they say, and women should not suffer for the biological reality that they bear children.

De la Torre said California also has a fiscal interest in resolving this matter.

The state enrolls privately insured pregnant women in subsidized public coverage if the women can't afford to pay for extra maternity benefits to tack onto their policy.

"The taxpayers have to pick up where the insurance companies don't," De la Torre said.

Seeking clarity of law

De la Torre is also the author of the rescission bill, a proposal Schwarzenegger already vetoed last year.

The governor called rescission "deplorable" in his veto message, but he said the bill was written to benefit lawyers and encourage lawsuits.

De la Torre said his new bill addresses the governor's concerns. But opponents are urging a veto, saying that proving a person deliberately lied on an insurance application is a burden that would encourage fraud and lead to more lawsuits.

"It would penalize those who are honest," Eowan said.

Other states, such as Texas, are also debating how to regulate policy cancellations.

Without clear standards, the law in California isn't strong enough to halt the practice, said Jamie Court, president of Consumer Watchdog.

Court said fines that state officials ordered companies to pay for rescissions were paltry � $1 million for Blue Cross � and that insurers are offering skimpy reimbursement.

Consumer Watchdog tracked the case of Fort Bragg resident Lee Rider, for example, who was saddled with $92,000 in medical bills when his policy was canceled after his insurer said he failed to disclose that a doctor had diagnosed him with neck strain.

The insurer offered him $5,000 to close his case. He turned it down, and the matter is in arbitration.

Court said consumers need clarity and protections. "It's all about the balance of power," he said. Read More...

Recession eases nursing shortage

Confident that she could walk into her dream job as a pediatric nurse immediately after getting her nursing degree, Christy Paris left a job she loved to start nursing school two years ago.

Now, she's kicking herself.

"I have applied at most all pediatric positions that I can find online," said Ms. Paris, 38, a Rock Spring, Ga., resident who had been a day-care center director for 20 years. "That's what I wanted to roll into, but that's impossible. ... If I had known that before I'd started nursing school, I probably wouldn't have started right now."

Still, the single mother of two boys said she considers herself lucky. Thanks to a pre-graduation internship at Hutcheson Medical Center, she was able to slip into a general nursing position at the hospital after her June graduation from Georgia Northwestern Technical College.

But many of her fellow students still are struggling to find work, she said.

"They go to interview after interview, and they don't get any call back. There's just so many of us," she said. "You hear everybody talk about the nursing shortage, the nursing shortage. I don't see one at all."

In the midst of an economic recession, the shortage of nurses in the United States has eased somewhat, experts said.

Current nurses are delaying retirement, putting off a career move or switching from part-time shifts to full-time employment, local hospital nursing executives said. Many experienced nurses are returning to the work force after a spouse has lost a job.

With fewer openings, recent nursing school grads are finding it harder to land a job in a profession often seen as recession-proof.

But hospital nursing executives in Tennessee and Georgia emphasized that a nationwide nursing shortage is still very much real, especially in rural regions, and they worry that a perceived surplus of nurses will lead to an even more severe shortfall years down the road.

"One of my major fears is that people will feel that the nursing shortage is ending," said Lynn Whisman, chief nursing officer at Erlanger hospital. "There is a lull right now, but it is going to be a short-term lull, and the nursing shortage is going to get even worse. ... It really is scary to me as a chief nursing officer what lies ahead."

At Erlanger, vacancies are lower than a year ago, with 4 percent of RN positions open, compared to 5.8 percent in July 2008, she said.

Memorial Hospital's current nurse vacancy rate is 2.3 percent, compared to 7 percent in 2007, said Diona Brown, chief nurse executive at Memorial.

FEWER SPOTS, MORE GRADUATES

Turnover at local hospitals is even more stable than usual, with employed nurses delaying career moves in an uncertain job market, hospital nursing executives said.

"I think (nurses) have got their feet firmly planted where they are kind of riding out the tides to see what's going to happen with the recession," said Debbie Reeves, chief nursing officer at Hutcheson Medical Center.

Last year's graduates from the nursing program at Dalton State College had an unusually hard time finding jobs and couldn't be as choosy as in the past, said Dr. Cordia Starling, dean of the school of nursing at the college.

"That's pretty unusual. Most of the time they're able to get what they want, where they want, when they want," she said. "I think all of them will eventually find a job. They may not be able to be (as) picky about it, but I think it's just taking a little longer."

GROWING INTEREST

After a nationwide nursing shortage peaked in 2001, when hospital nurse vacancy rates averaged 13 percent, an influx of new nurses hit the industry, according to a July article published in the journal Health Affairs.

"Nursing is a cycle. We see periods of time when there is a huge shortage, and following that, you usually do have an influx" because of perceived job security in the nursing field, said Deborah Deal, associate chief nursing officer at Parkridge Medical Center. "There still is a need for people that really truly want to be nurses ... because it will cycle back around."

Nursing school administrators say interest in the nursing profession has exploded over the past few years, thanks to promotion of the field as a career option and, more recently, from students seeking jobs seen as secure in a recession.

In 2007 and 2008, the number of nurses employed in hospitals nationwide grew by 243,000, the article said. The number of younger nurses, between the ages of 23 and 25, reached 130,000 in 2008, the highest level in 20 years.

That's brought even more qualified graduates to the job market, especially in Chattanooga, which is surrounded by a number of nursing schools in Tennessee and North Georgia.

The University of Tennessee at Chattanooga's School of Nursing received 501 applications this year, compared to 400 last year, said Dr. Kay Lindgren, director of the school of nursing at UTC. She is applying for a federal grant to increase the school's enrollment from 60 to 78 students.

To ward off a future shortage, school officials must persist in efforts to expand enrollment and add faculty members to train new nurses, despite the perception that there are plenty of nurses today, Dr. Lindgren said.

Nursing school enrollment is limited by nursing faculty, and many nursing school teachers are nearing retirement age, nursing school administrators said.

Across the country nursing schools have had to turn away 30,000 qualified nursing applicants each year since 2002 because of limited size of classes, according to the Health Affairs article.

"If we try to artificially slow down what we're doing, it will be a worse catastrophe than has been predicted," Dr. Lindgren said.

The most growth in nursing employment since 2001 has been in nurses older than 50 who accounted for 77 percent of the increase in RN employment, the Health Affairs article stated.

As those older nurses retire and aging baby boomers demand more nursing care, experts are projecting a serious shortfall of nurses starting in 2018 and peaking at a shortage of 260,000 nurses in 2025, according to the Health Affairs report. Read More...