fash Saco Bossible If Care Withheld

Hospitals Warned on Handicapped Babies

By Cristine Russell and Charles R. Babcock
‘Wastungton Pos Star! Wreers

The Reagan administration yesterday warned
the nation’s hospitals that they could lose govern-

ment funds if they deny food or treatment to. new- -

born infants with birth defects.

The warning from the Health and Human Ser-
vices Department—considered a nove! application
of a federal law prohibiting discrimination against
the handicapped—followed complaints by “right-
to-life” groups and a recent directive from Pres-
ident Reagan.

The department, in a notice to nearly 7,000
hospitals, cited “heightened public concern about
the adequacy of medical treatment of newborn
infants with birth defects.”

HHS Secretary Richard S. Schweiker noted the
recent national publicity surrounding the death of
a baby born with Down's syndrome in Blooming-
ton, Ind. The parents of *Baby Doe” asked that
food be withheld and refused to authorize treat-
Ment to correct a life-threatening defect associat.
ed with the disorder, which causes mental retar-
dation.

In addition, an HHS spokesman said that the
department this week sent an investigator. to
Crawtord Memorial Hospital in Robinson. ML, wo
check a complaint by national and local “right-to-
life” groups that surgical treatment is heing with-
held {tom a baby horn with a serious birth defect
known as spinal bifida

The breadth of yesterday's warning surprised
hospitals and medical groups, whose spokesmen
expressed concern about potential interference in
the practice of medicine and the legality of using
laws to protect the handicapped for this purpuse.

Groups representing the handicapped wel-
comed the administration's interest. but said it
didn’t jibe with Reagan's plans to cut federal fi-
nancial aid to the handicapped and to weaken the
regulations that already protect them.

In its two-page letter to hospitals that°receive
Medicaid of Medicare funds, HHS* Office tor
Civil Rights said that the government will apply
Section 504 of the Rehabilitation Act of 1973 to
cases involving the medical care of infants with
birth defects and will consider “termination of
federal assistance” to institutions that do not com-
ply.

It said that it is “unlawful” for hospitals to
withhold from handicapped infants food or med-
ical of surgical treatment required to correct a
life-threatening condition, if the handicap “does

“not render the treatment or nutritional sustenance
medically contraindicated.”

The notice also warned that hospitals should

 

Beart

re

Richard S. Schweiker poted recent case of “Baby Doe.”

not aid a decision. by the infant's parents... to
withhold treatment or nourishment discriminato-
vily by allowing the infant to remain in the insti-
tution” and said that hospitals will also be heid
responsible for the “conduct of physicians.”

Betty Lou Dotson. director of HHS’ Office for
Civil Rights. acknowledged yesterday that al-
though the rehabilitation law has heen on the
books since 1973, this apparently is the first time
it has been applied to the medical treatment of
handicapped children.

“To the best of our knowledge. it has not heen
used in this manner,” she said.

Justice Department spokesman John Wilson
said civil rights lawyers there “are researching the

 

law” but have not yet concluded what legal actions:
can be taken. “We've never been confronted with
this before. This is novel.”

Michael Bromberg, of the Federation of Amer-
ican Hospitals, questioned the legality of the new
HHS effort, saying he had never heard of apply-
ing the "S04" regulations to “patient care or med-
ical treatment.” He said that the hreadth of the:
HHS letter could “force a flood of court cases”
because of “tremendous legal conflict between
what this notice is trying to do and parental and
physician authority.” :

A statement by the American Hospital Asso--
ciation called the HHS letter a “simplistic solution
to complex situations involved in health care de-:
livery” and charged that it could “create an adver-.
sarial relationship between hospitals and parents
who elec. not to have complicated surgery per-
formed on these children.” :

Paul Marchand. director of governmental af-_
fairs for the Association for Retarded Citizens, -
said yesterday that gmups representing the dis-
abled have heen meeting regularly to try to devel- |
0p a practical solution for treating handicapped”

~ infants. But he said he viewed the government's:

action vesterday with some skepticism. “There is-
irony here and we're trying to use the president's:
Memo as a positive signal they're calling off the

dogs on 504.° :

Marchand noted that the president's action ‘ie~
the first and only positive action (Reagan has ta-
ken| for the disabled since he has set foot in the
White House.” He cited what he termed “astro-
nomical” budget cuts for pengrams for the hand-
icapped. and efforts by Justice and the Office and
Management and Budget to rewrite the Section
504 regulations, .

The extent to which HHS plans to entorce its:
warning is not vet clear. Dotson said t' at the let-:
“ter was intended as a “reminder” to hospitals and:
that the department will follow up 1 specific:
complaints, such as the [ilinois case. .

Gary Curran. a consultant to the American Life
Lobby, emphasized that “notification is not.
enough to make sure these babies’ lives are saved.
There is gning to have to be thorough surveillance.
for compliance with these laws and vigorous pros-
ecution if they are violated.”

But one outside medical source suggested that
the notice to hospitals was apparently regarded
within HHS as “more a public relations move than
anvthing else.”

In the [llinnis case, Carlton King, administrator
of Crawford Memorial Hospital. said he couldn't :
comment on the specifics. But he added. "Every
infant is getting maximum care. We would never
deny treatment to any patient.”