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Emergency Room Closings Possible, Official Says

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Times Staff Writer

Some San Diego County hospitals could close emergency rooms to cut losses from the care of indigent patients, according to a state official.

That threat has so far arisen only in Los Angeles, where three financially pressed inner-city hospitals have formally applied to end traditional emergency service and five others have indicated their intention to do so.

But the problem shows signs of spreading to San Diego, said Jim Lott, staff director for the California Senate Health and Human Services Committee, which oversees health-care legislation.

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Lott said the possibility was made clear during discussions he had with hospital officials during a recent fact-finding trip to San Diego on behalf of committee chairman Sen. Diane E. Watson (D-Los Angeles).

Watson has called a special hearing for today in San Diego to address the county’s problem of providing health care for the indigent.

Problem Called a Medical ‘Time Bomb’

“San Diego is not too far from where Los Angeles is right now,” Lott said. “We probably will see some emergency rooms either downgrade to standby status or close altogether so they can control the flow of indigent and unpaying patients into their hospitals.”

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Such a development would hamper medical care, not only for the poor but also for all the other patients those hospitals serve, leading to what the head of the San Diego County Medical Society calls a “time bomb.”

It also might worsen financial problems of the county’s six trauma hospitals, the special accident-treatment centers that lost $9 million last year to indigent care.

The special meeting, from 11 a.m. to 5 p.m. in the County Administration Center, will also hear testimony on how the uneasy balance on indigent health care would worsen if Physicians & Surgeons Hospital in Southeast San Diego is closed.

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The hospital’s operator, National Medical Enterprises, has taken several steps in recent months to sell the hospital, which has lost up to $2 million a year since 1984. Observers fear that its poor financial condition will cause a new owner to convert it to a more profitable use, such as a psychiatric or rehabilitation hospital.

Some of Physicians & Surgeons’ problems have been caused by the many non-paying patients and patients whose bills are paid by the state or county at about half the billed rate--all patients who use the facility’s emergency room for primary health care.

National Medical Enterprises is pressing the state to raise the reimbursement rate for Medi-Cal patients at Physicians & Surgeons. Representatives of the hospital and the California Medical Assistance Commission, which negotiates the rates, are meeting in San Diego today to discuss the daily rate for Medi-Cal patients and other funding issues, said Don Griffin, vice president for business development of National Medical Enterprises.

Many Babies Delivered Without Prenatal Care

Other hospitals are also complaining about the rising number of unfunded and under-funded patients caused by state and county cutbacks in funding of health-care programs.

For example, at Paradise Valley Hospital in National City, one-third of the babies delivered are to women who had no prenatal care and arrived in the emergency room to deliver. Tri-City Medical Center in Oceanside lost $43 million in the fiscal year that ended last week because of unpaid bills or underpaid bills.

Asked about the possibility of emergency-room closings in San Diego, Dr. Richard O. Butcher, president of the San Diego County Medical Society, said, “I think it’s very real . . . more so if the situation at Physicians & Surgeons doesn’t resolve itself.”

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He noted that, when Center City Hospital was in financial trouble in 1983, one solution was to downgrade the emergency room’s license so ambulances no longer could take patients there. As at Physicians & Surgeons, the hospital, now called Harbor View Medical Center, was in a prime location to receive large numbers of unfunded or under-funded patients. (Harbor View’s emergency room now only takes walk-in patients.)

Butcher plans to tell Watson’s hearing about “the medical time bomb we’re sitting on in San Diego. I think that it’s just a system waiting to go off unless it comes up with some kind of constructive restructuring.”

Wayne Wilson, marketing director at Tri-City, said that last week’s eleventh-hour securing of a county contractor to provide health services to the poor in North County narrowly avoided setting off the time bomb.

Stretched Beyond Ability

Wilson said emergency-room closures were probably closer last week than they had ever been.

As the closest hospital to Physicians & Surgeons, Paradise Valley fully expects to get a great many of its neighbor’s unpaying patients if the hospital closes. Already, 55% of its emergency patients are covered by low-reimbursement government programs such as Medi-Cal or are uninsured, said Paradise Valley President Fred Harder.

“We’re already stretched beyond our ability to meet the demands of indigent care, and, if Physicians & Surgeons closes, I don’t know what’s going to happen,” Harder said. “I don’t know how to say this delicately, but, if you’re going to survive, you can’t get buried under a wave of indigent care day after day. Somebody has to pay.”

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Although Paradise Valley hasn’t formally considered closing its emergency room, he said, “what we have to do is reduce the amount of indigent care that goes through there.” He had no other ideas on how to do that.

Hospitals in central Los Angeles found that the only way to control their “patient mix”--the ratio of non-paying or underpaying patients to insured ones--was to limit their access to the hospital through the emergency room, Lott said.

That is because emergency patients cannot be turned away. State and federal laws require that emergency rooms treat seriously ill or injured patients regardless of their ability to pay, and state law bars hospitals from diverting such patients to other hospitals.

Lott and others agreed that preventing the closure of Physicians & Surgeons won’t solve the overall San Diego indigent health care problem or eliminate the cloud over emergency care.

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