COUNTYWIDE : Judge Gives County Contempt Deadline

A Superior Court judge on Monday gave county officials until August to show why they should not be cited for contempt for failing to set up an appeals process for indigent patients who are denied medical payments.

Judge Eileen C. Moore ruled in April, 1991, that the county was denying some patients due process and must grant them the right to an appeal when medical payments are denied.

The county has since turned in two plans to the court, but Moore has ruled both insufficient. The latest plan, submitted in February, provided for a written appeals process but no oral hearing. County officials appealed Moore’s February ruling to the state Court of Appeal but said it was unclear if the court had issued a stay until a hearing could be held.

Moore said Monday that because county officials believed a stay was in place, she would not cite them for contempt. She gave them until Aug. 3 to determine whether a stay was in effect.

The case stems from a lawsuit filed in October, 1990, alleging that some indigent patients were left with unpaid medical bills after the county refused to reimburse doctors and hospitals for treatment under the Indigent Medical Services program.

In its appeal, the county argued that an oral element in the hearing process was not a part of Moore’s original April, 1991, decision, said Thomas Morse, deputy county counsel. Because the county believed a stay was in effect, it did not implement any appeals process, although it did begin notifying patients that they have a right to appeal denied medical payments, Morse said.

Because the county did not implement an appeals process, the attorneys for the plaintiffs asked that Moore find the county in contempt.

One of the patients involved in the lawsuit, 65-year-old Pamela Arpin of Costa Mesa, was accepted into the Indigent Medical Services program after disabling back surgery. She was never told that the county program would not cover her medical bills, among them one for $16,000 at Western Medical Center-Santa Ana, and was stunned when a creditor began hounding her 18 months after the surgery, the lawsuit said.

“They told her the surgery . . . wasn’t necessary and denied (payment) on that basis,” said attorney William Wise of the Senior Citizens Legal Advocacy Program in Santa Ana. “The $16,000 bill from the hospital was just one of many bills she received. At the time, there was no procedure for challenging a denied payment.”

The county Indigent Medical Services program was started in 1983 to provide health care for adult patients who are no longer eligible for state Medi-Cal insurance.

Like a health insurance policy, the program reimburses doctors, hospitals and clinics that provide medical treatment for the poor. Unlike most insurers, however, the county will reimburse providers only for “services that are medically necessary to protect life or to prevent significant disability or to prevent serious deterioration of health.”

In court documents, the county argued that it has contracts with health-care providers spelling out which medical treatments will be covered by Indigent Medical Services. It is the provider, not the county, that is responsible for determining what treatments are medically necessary and eligible for reimbursement, and the doctor or hospital can appeal if benefits are denied, the county has contended.

In practice, however, doctors and hospitals simply bill the patient for what the county refuses to pay, the Legal Aid Society of Orange County has argued.