ER doctors sue state, say emergency room system near collapse

Emergency room doctors filed a lawsuit today against the state, saying that California’s overstressed emergency healthcare system is on the verge of collapse unless they receive additional funding.

California has seen 85 hospital closures in the last decade. An additional 55 facilities have shut down emergency rooms. The state now ranks last in the country in access to emergency care and is last in emergency rooms per capita with only seven per 1 million people. The national average is 20 emergency rooms per 1 million people.

 

“Patients are suffering every day,” said Irv Edwards, one of the doctors represented in the lawsuit and president of Emergent Medical Associates, which staffs 12 emergency rooms in Southern California. “There are emergency rooms throughout the state where people, we believe, have died. Some have died in the lobby before they were seen. Some have died shortly after being placed in a bed after having waited in the lobby for hours. Are people truly suffering consequences? Absolutely.”

Emergency room physicians say they have been particularly hard hit by the state’s fiscal problems. Unlike other doctors, who can choose not to accept Medi-Cal patients, emergency rooms cannot deny treatment. They provide care for these patients but are reimbursed at rates they say are half the cost of the treatment. California’s reimbursement rate ranks 43rd in the country, state officials said.

“As we go forward, these emergency room doctors, they can’t any longer take on the financial burden of the state’s obligation to its poor and to its elderly,” said attorney Raymond Boucher, who filed the lawsuit in Los Angeles County Superior Court today.  “This isn’t a joke. This isn’t just a power play. They are on life support.”

Emergency room doctors statewide believe they subsidized more than $100 million in services provided to Medi-Cal patients in 2007 alone, according to the lawsuit.

Tony Cava, a spokesman for the state Department of Health Care Services, declined to comment on the lawsuit until the state has been served with the papers. However, he acknowledged the low reimbursement rate and said more budget cuts may be on the horizon.

A budget proposal calls for cutting an additional $1.1 billion from Medi-Cal by decreasing eligibility and eliminating some optional benefits. Reimbursement rates for doctors also are scheduled to be reduced an additional 1% to 5% on March 1.

Besides overcrowding and threatened quality of care, Edwards said he was also seeing a flight of medical school graduates out of California and a graying of the ranks of emergency room doctors.
“Ever increasingly, I’m hearing the story, ‘I’d love to stay and I love California, but I can’t afford to live here any longer,’ ” Edwards said. “They say, ‘Reimbursement is not competitive with what I’d get in other states, not to mention I can buy a house there for a quarter of the price of a California home.’ ”
Most medical school graduates carry $250,000 to $300,000 in debt and they cannot afford to stay, he said.

“I’m seeing an exodus of providers of emergency medicine and ... a graying of our specialty,” he said. “Fewer and fewer young doctors are wishing to practice in California.”

-- Kimi Yoshino

Photo: Los Angeles Times

Comments

[larry darrell]

California = third world

[Mike]

It's the illegals in the ER that are overwhelming the system. There I said it. There is no reimbursement if you are not here legally. At least the poor and elderly have Medical / Medicaid and there is a 50% reimbursement rate.

[Dave]

To LA Times:

I would be interested in some in depth reporting on this issue. How much of this problem stems from the illegal immigrant problem? Most illegal immigrants have no health care, so when something goes wrong they go the the ER. The ER is required to provide care, but of course they never get paid. I am sure I am not the only one who would like to see some in depth journalism on this issue.

[kt]

I recently went to an emergency room with a friend who was in an emergency situation, and sat in a crowded waiting room filled with sniffles, coughs, and not one ailment that looked like an emergency. And not one person there spoke English to each other. Too bad I don't understand or speak Spanish or I would have been able to tell them to take 2 asprins or Nyquil and sleep it off. Our emergency rooms should not be used as a primary care Doctors office. But then again, when it's free to them, why should they care?We should do what Europe does when they treat an American without insurance -- bill the mother country. OR better yet, do what Mexico does to Americans - throw them in jail until they pay. That will stop the abuse.

[sbdsr]

When is California going to learn it's position on illegals is going to kill this state...didn't anyone learn or notice anything on the so called day without illegals...stop providing services of any kind to folks who are not citizens of this country and a lot of problems will go away...it'll also free up some jobs...if I was unemployed I.C.E. would be getting daily calls from me untill something opened up...if I needed E.R. service...I would call I.C.E. to clean out the waiting room...the solution the problem in this article and many others in this state are real simple to cure...

[m]

Stop giving welfare to illegal immigrants who treat emergency rooms as primary care physicians and I assure you the state will not have this problem anymore.

[Chrystal]

Yes, illegals are the main problem.

All we need now is a terrorist attack or a natural disaster, and we are all done for.

Everyone better learn first aid and be prepared to treat yourself and your loved ones, because no one is going to help you.

The government is doing nothing and could not care less.

[P J Evans]

When are people going to stop blaming the undocumented for problems they didn't cause? Emergency rooms have been overcrowded for years, and no one has done anything to fix it.

People use emergency rooms for routine care or minor rpoblems, because they don't have insurance, maybe can't even _get_ insurance, and can't find doctors who will take them. (Insurance companies won't always let you stay with a doctor when you do have one; trying to get one without insurance is difficult.)

[peter c]

The 2nd comment on this story is somewhat interesting to me. If is it true that there is a high utilization of ER services by illegals in California, why can't why charity care be given to those here legally first, and whatever funds leftover to pay for illegals. Otherwise, send a bill to the home country (#3's comment). If you use a service, pay for it. That goes double in the middle of the California budget mess. Our state tax refunds may not be issued, but nonsense like this still occurs?

[sbdsr]

"...When are people going to stop blaming the undocumented for problems they didn't cause? Emergency rooms have been overcrowded for years, and no one has done anything to fix it..."

P.J. Evans-

You are obviously not a California native...it has not always been this way nor has it been this way for years as you claim...

When are people going to quit being blind to the problem that sits right in front of their face...California's politics which sometimes borders on insanity is blowing up in the collective faces of all...

Budget crisis, ER's shutting down, Unemployment at an all time high in California and you make the argument that illegals are not part of the problem....

You can't continue to rob Peter to pay Paul so that you can maintain your status as a sanctuary state...at some time common sense and hard decisions have to be made...

The problem is sitting in an ER room or on a corner somewhere right now...California needs to wake up to that and retract services and assist these folks back home and reduce the drain on our resources...

[ScientistRCool]

Anti-immigration sentiments hear make this state sound like Nazi Germany.

What's wrong with you guys?

Legalize these immigrants get their employers (which pay them below minimum wage) to pay their health insurance. By the way if these employers had to hire American citizens they'd have to pay there insurance and higher wages, so it is not like the employers don't want them here.

[liz]

I worked in a local ER for two years and the situation has been increasingly worse over that time period. The majority of the people I saw were not "illegals" as the other posters are indicating. MANY were people who came to the ER for non-emergent problems. When I triaged them they would openly admit to not wanting to wait for the appointment they had with their doctor next week. Many others could have gone to a clinic, or would have if the clinic was open for late evening hours. Even then the clinic doesn't want to get sued and they would send patients to us that were not truly emergent. It is a systemic failure. Hospitals must treat you, no-one re-imburses them, Medi-Cal covers less than half, and more people now are out of work and have no other source for care. I respect the doctors I worked with every day. They had an enormous burden on their shoulders. In the end the level of stress was too high for me and I left the ER to continue nursing in a different discipline. I could no longer stand by while patients were 2 deep in hallways, 100 deep with a six+ hour wait in the lobby, and the ambulance gurneys 3 & 4 deep at the back door with nowhere for anyone to be treated. Someone was going to suffer a negative outcome and I couldn't sleep at night.

[Just facts]

Ironically, the tragic murder-suicide this morning in Wilmington was cmmitted by a man who along with his wife lost their jobs t Kaiser, the same facility which birthed these 8 babies at such huge expense.

Also ironically, KCAL-9, which is crassly openly annoyed not to be getting their vulture "interview" with the babies' mother yet after a mere 24 hours , reported a couple of days ago that Kaiser facilities are one of the best sources for new hires, upto 1500 people soon, and are opening a place in west L A area soon. (Like I said, she should NEVER feel obliged, this is a PRIVATE affair -- only fellow Kaiser patients have a right to get the broad details insofar as it affects WHO is and isn't covered and how for how much).

[Eric]

Coming from someone who has worked in an ER for five years, the problem is with people abusing the ER for primary care issues. Day after day we see people with Medi-Cal who flood the ER for non emergency issues. Why is it that I have to pay $100 copay to go to an ER, but yet anyone with Medi-Cal can come in for a hang nail and pay absolutely nothing. Medi-Cal patients should have to pay a co pay just like the rest of us, and maybe they would think twice before coming to the ER for non urgent issues.

And of course, it does not help that the burden of caring for the homeless lays solely on the remaining private hospital ER's in the county, cause god forbid you provide them free medical treatment, stabilize them and discharge them without magically curing society's problems which made them homeless. If the free medical care isn't enough, then on top of that the hospital is slammed with a $250,000 fine and a potential lawsuit. Then of course, it makes the top of the evening news which makes the doctors and nurses who work tirelessly caring for them look like villans.

[Just facts]

The 8 babies' births and 5-person murder-suicide all have to do with Kaiser and were meant for that thread.

As far as this issue, it's NOT racist or xenophobic to state the fact that California is 50th in Emergency Care availabiity and reimbursements because we have by far the most illegal immigrants of any country, and L A County is especially bad.

3/4 live births in L A County are to Latino immigrants, many illegals; same statistic as the school-age population. Meanwhile, there's a net exodus from California of middle class people, especially whites. Those who are moving in tend to be young people who also move out or at least out of L A when they start families and need areas with good schools, streets and hospitals.

However because this is a federal problem, Calif. should be reimbursed by the feds to the tune of many billions more. Maybe the local policies are also to blame as far as "welcoming" illegals, but Bush admin. until just this year did absolutely nothing to secure borders and arguably, NAFTA only made the situation south of the border worse, further inviting illegals to swarm here.

Now that their jobs are drying up, many are poorer than even and more dependent on welfare and free ER care for their basic heath care. This is the most expensive care their is -- there should be more free clinics staffed by nursing students and doctors, at a fraction of the cost, until a broader solution is reached on intragovernmental levels.

[anthony]

Scientist, you're a fool. If you legalize them then more will come. It's human nature. Once they see the door open for legalization, why wouldn't any desperate person come? Wake up, dude. Every amnesty more and more come. We have the right to say no more, as mean or callous as it sounds, it's our right.

[dave9]

The article doesn't say what percentage of ER visits are non-emergent and by people here illegally. Unless you have those numbers, making a blanket statement is pointless.

[Franl Talk]

Illegals? Are you serous? You must be Republicans fanatics who only get your news from AM radio ro Fox News!!!!! There are millions of Americans with NO health care, because your party thinks that health care for all is socialist! Is all those who have been kicked out of the line for health care by the free market who flood the ERs! Once Republicans begin to take ownership of the failures of the free-market system that you all put in place under Reagan, and how it has bankrupted this nation's moral and physical infrastructure than we can being to rebuild. Otherwise quit blaming people when you know it is your fault!

[Chuck Stewart]

Gosh, stop bashing illegals. I'm a white American born in Los Angeles with a Ph.D. from USC. Forty-three million Americans don't have health insurance. I'm one of those. I'm 57 years old and it scares me. I work five different contract jobs to make ends meet and not one of those employers pays for health insurance. I wish the people making these comments would experience poverty and abuse by employers who won't pay medical insurance. What we need is universal health coverage as all other western democracies provide. It would reduce the emergency room crush. I would think employers would relish the thought of getting out of the health insurance business. Don't forget, Republicans almost passed universal health care in 1974 and president Nixon supported the effort.

[strssinca]

Nazi Germany --- hardly... and in insult if you actually took the time to read history and understand Nazi Germany. REAL bad way to try and legitimize your "point."

People are coming to CA and taking advantage of services they are not entitled b/c they don't pay into the system. Hence, the part about being 'illegals.' Yes, the home country should be billed (not that we'd see a dime of that either.) If people didn't want to take advantage of America and CA - why would they be here in the first place. Illegals are bleeding CA dry and eventually the hardworking Americans who are barely propping up the state with their taxes won't have access to the services that they paid for because illegals bled the system dry with runny noses and simple headaches. No vested interest - so why should they care if that runny nose costs a hospital $450.00 to treat?? It's sickening.

Try and go to Wal-Mart and buy a lawn-mower and you've got to pony up the cash, they don't just hand out half their stock to illegals because they happened to be 'present and unaccounted for.'

At least some people here "get it" and know where the problem lies, and aren't making WAY off base references to history's worst slaughter ever, Nazi Germany, in an blatant attempt to deflect from the real issue. Read some history, learn some facts, and realize CA will be a bankrupt hulk unless they change their policies sooner than later.

[Roman]

I find the posts a bit over the top. The issues are quite diverse. Does charitable care cost? Yes. Does California have a problem with unemployment? Yes. The reality is that the state has a system that depends on private insurance to support it. Any state with 38 million people is going to have problems when 35% of the population is medicare/ medicaid. Further, another 5 million have no coverage at all. So when you analyse the cash flow 50% of the population is paying the bills for the half that are not. Unfortunately this is not a succesfull model as is clear from California. We can all blame undocumented workers but the reality is we're all to blame for allowing the system to devolve to this extent. Roman Urbanczyk MD

[Julian]

As a retiree who was born and raised in LA, this article is another good reason why I left California never to return. Hospital's are only a symptom of California society in decay. The exodus of professionals and retiree's is further proof.

[jojo]

"They provide care for these patients but are reimbursed at rates they say are half the cost of the treatment."

we need MORE mexicans here because they do the jobs american citizens WON'T do!
It's a fair trade.
you see, Mexicans work cheap for some Californians and the OTHER Californians, (the ones who won't work) pick up the tab!
Hey, it worked for me!
signed
a retired drywall contractor

[ScientistRCool]

I'm awake Anthony.

News flash, illegal immigrants will come here no matter what. Just like the illegal drugs. There is a California market for cheap labor and for narcotics.

If you want to spend countless millions of dollars to deport all illegal immigrants lets raise your taxes so we can pay for it. Then you can have their job picking avocados.

[ScientistRCool]

Let me simplify it for you ... strssinca.

It is "xenophobia" or possibly "racism".

I bring up Nazi Germany, because listen to the fervor, the hatred of illegal immigrants in many of these posts.

Having the home country pay for it sure, that is not hatred (and what kind of lame idea is that?). But, some of these comments are just pure hatred of immigrants.

[Rebecca]

My brother is an ER resident and is getting job offers in CA for $350-400K/year (as a brand new doctor). So I ask, how exactly how are these ER doctors hurting??? Compare this to a general internist who is lucky to make $180K/year. If Medi-Cal is decreasing reimbursements then good for them---ER docs are used to making far more than other physicians for comparable training and work. It's about time that things corrected.

[Iss]

At the expense of failure of the State, doctors are not only blamed and sued, but they also lose their sleep, honor, and license, which is far above money.

[Jonathan Richard]

People only go to an ER if they can't get decent health care elsewhere. It is pretty obvious that universal health insurance is the eventual solution. When the well off have to sit next to the not so lucky, then, maybe we will have the political will to raise taxes to pay for a single payer system. Right from the start a single payer system saves money because it gets rid of all that bureaucratic and HMO redundancy. Maybe taxes won't go up much then.

[Ann]

What's wrong with you guys?

Legalize these immigrants get their employers (which pay them below minimum wage) to pay their health insurance. By the way if these employers had to hire American citizens they'd have to pay there insurance and higher wages, so it is not like the employers don't want them here.

Posted by: ScientistRCool

____

You are the one with something WRONG with you.

Employers DO NOT HAVE TO provide health insurance (except in Hawaii & Massachusetts.)

Less than 40% of small and medium businesses (those with less than 500 employees) offer any kind of health insurance at all. 62% of companies over 500 employees offer health insurance.

Low wage jobs do NOT come with health insurance. Employers who pay $8, 9 or 10 and hour do NOT ante up $12,000 a year per employee for a family health insurance plan.

The low-skilled, uneducated illegals would be just as uninsured as they are now - except they could enroll in Medicaid and suck off the public teat.

[Joe Joe]

Uhh... yeah lets deport all of the illegal immigrants in this country starting with Christopher Columbus and the pilgrims. That way only indians and mexicans will once again rule the Americas. All white amaricans were once illigal immigrants in this land because nobody wanted them here in the first place.

[exnyed_doc]

I have had the privelge of working in the ED trenches for the past 25 years.

It is a mistake and a oversimplification to ascribe blame to the uninsured, illegal aliens or insurance challenged patients as the cause of ED overcrowding, the failure of Medi-cal or the crumbling of our healthcare infrastructure.
In an article published in the Journal of the American Medical Association (JAMA Vol 300 No. 6 Oct 22/29, 2008) commonly held myths regarding Emergency Care, ED overcrowding as well as inapprorpriate use of ED for primary care by uninsured patients, insurance challenged patients and or illegal aliens was definetively refuted and "debunked". It is categorically NOT TRUE!!!

The problem is not any one class of patients. The problem rest soley with the State of California. Guess what - when you watch 85 hospitals and 55 ED close is it any wonder that there is ED overcrowding and diminished access to care? When the State of CA balances it's fiduciary, governmental and moral resposibilities to provide indigent care - a federally mandated responsibility (EMTALA) by forcing ED physicians (who fall under EMTALA rules and regulations) to provide services at a level of reimbursements that no longer covers the cost of providing care - is it a surprise that the Emergency safety net is frayed, torn and broken nearly beyond repair.

There are those who read this that want to simplify this by ascribing the issues to greed among ED physicians, illegal aliens, the burden of the uninsured or other problems for which there is no solution except to shrug one's shoulders. Nothing could be farther from the truth. ED physicians provide care 24/7/365 - every second counts!!

Emergency Physicians must speak out on these issues as it is a moral and ethical responsibility for all of us on behalf of current and future patients seeking Emergency Care.

The public has been lulled into a false sense of security by shows like "ER". I am here to tell you, there is no romantic interlude or laugh track in California Emergency Departments. There is no shortage of seriously ill patients. Call panels are "dwindling". Resources are becoming more scarce. In the case of a catastrophe - natural or man made THERE IS NO SURGE CAPACITY.

This is not about the insured vs the uninsured. Dating to 1986, when EMTALA (Emergency Medical Treatment and Labor Act) was signed into US Federal law, access to healthcare through the ED became a federally guarenteed RIGHT. Yes another un or underfunded mandate. Access to timely, quality and compassionate Emergency Care is a vanishing resource - regardless of financial status or Countyr of origin.

Please - don't over simplify this issue - it affects all of us deeply and profoundly.

Now is the time to act. Now is the time to demand change. Now is the time that we must demand solutions from or elected officials. We have a narrow window to solve thiis crisis. I pray we act responsibly, and together, putting aside partisan differences to solve a GRAVE PUBLIC HEALTH CRISIS

[Mike Bridge]

Illegals are the problem! If you do not believe this, you must agree that at least they are not helping. If your a citizen with no insurance, the hospital will pursue you with collectors and ruin your credit until you pay. If your illegal, you give your "matricula" card, give a fake name/address and get free health care. They all know this. Let's no even discuss schools, welfare, health care, etc. Just a joke!

[domingo]

Isn't illegal immigration down in recent months? Also hearing that a lot of illegals have been moving back south of the border. These problems with state budgets and social spending and layoffs are happening all over the country. LA and southern Cal are just symptoms of these problems. The continued shedding of jobs will contribute to the strain on public health resources, unemployment resources and the like. California ain't the only state in a budget crisis. The blame on illegals is beyond pointless. The problem is bigger than even that... It's amazing what some people will see when they want to.

[Richard Ivey]

Yes, let's blame the foreigners, the poor folks, and everyone else for California's problems. But then Arnold Schwarzenegger vetoed a widely supported bill funding ER care. He didn't want hospitals to get repaid from auto accident insurance monies. Thank you, Arnie!!

[Blumen]

It's so easy to say mexicans, and people from all over the world who came to US are the reason of our problems, hey look at our Mayor!! he is not a native American! This a Federal Crisis!!!! a failure in our policies...

[daisymom]

Where is the $84 per year homeowner surcharge going that was designated to keep ER care available in Los Angeles County? Many ERs have closed down since the bill was passed, but we still are charged.

[ed md]

Rebecca

I'm an ED physician for 5 years. I have not heard of any jobs paying that much in Southern Cal, let alone to new docs. You can make those types of salaries after having partnered in a group, or if you run a group and make money off of everyone else, like Irv Edwards. Take your brother's numbers with a grain of salt.

-ed md

[Jack]

The anti-immigrant tone in this discussion board is eerily reminiscent of the time leading up to Kristallnacht in Nazi Germany (c. 1938.) I just dread the day when California nativist start pulling Hispanic-complexion individuals/ familiies from their homes and workplaces, and start beating them on the streets. I am a student of history, and this is not farfetched!

Now, for the record:

Approximately 60% of the federal budget (or some $1.6 trillion last year) is reserved for entitlements (social security, medicare, medicaid, etc.) -- not a single penny of which is reserved for illegal immigrants, even though many of them will have paid into this through payroll withholdings. If you are really concerned about what is breaking government budgets (and raising our national debt to catastrophic levels) your sick, hospital-ridden, native-born granny is more likely to be contributing to this problem than the typical illegal immigrant. If economics is the key motivation for your anger, then direct it to the appropriate demographic -- old, native-born retirees on social security and medicare. However, if your motivation is raw xenophobia, then I'm afraid nothing short of Kristallnacht, or heaven-forbid a Himmler-esque "final solution" will satisfy your anger.

[matt]

way to go dems! this is the legilature that has been running this state, they are incapable of managing our money yet we pay nealy the most in all taxes in the country. there is no justifing this in any way. yes, and part of it is illegals, but it is more than that too. its just a complete missmanagment. but looking at who people vote for, the problem will never go away, so basically we should just accept this as a change for the future and pay as much tax as we can untill we lose our jobs. people need to just accept this b/c they will never take a look at who they keep electing over and over and who makes up our legilature here in california. what gets me is so called, "educated people" are the most dumb when it comes to this, they are more interested in putting provoktive leftist bumper stickers on their suvs.

[Christine B]

ScientistRCool: "if these employers had to hire American citizens they'd have to pay there insurance and higher wages, so it is not like the employers don't want them here." // Guess again. There is no law that mandates employers provide healthcare or anything above minimum wage (which isn't enough to cover non-group healthcare premiums).

[Neal]

Illegal immigration is not the issue here. Sure, people without health insurance contribute to the problem of overcrowding. But, would you as a doctor refuse to treat any child with a entirely curable condition (take a 4 year old girl with an acute asthmatic attack) and potentially save her life because her parents cannot pay you for the simple treatment? I doubt many people would be so heartless.

The real problem in the emergency department is patients seeking non-emergency medical care. EMTALA essentially says that no one can be refused care, regardless of their illness. At the same time, it does nothing in the way of guaranteeing any sort of reimbursement, Furthermore, physicians are so afraid of being sued they will order a complete workup on anyone just to limit the possibility of being sued. Given past court cases I don't blame them.

Take it a step further to the 911 system. Paramedics/EMT's routinely take patients into the ER for non-emergent conditions ( See - "G-tube pulled" "I ran out of pain medication'). Unfortunately, ambulances often become glorified tax-cabs with a fast pass into the ER.

The system is a joke.

Re: Rebbecca - A quick Google, AMA or any other search will quickly reveal the starting salary is nowhere near the figures you have quoted. I'm not sure where you get your numbers but I've worked with Attending Physicians at Trauma I centers who aren't making that much in California.

But, I digress. Is salary really the issue here? Personally, the real issue is whether or not when my mother has a stroke she can be treated quickly and effectively. Whether she will receive the treatment to save her life , or die because of an unsupported, overcrowded, over regulated and ineffective system.

[TValley]

If all of America's illegal immigrants were granted citizenship, and every citizen in America had universal healthcare, this wouldn't be a problem.

You racist tools.

[Susan]

Wait a minute. First you guys say it can involve a wait of 6 hours or more to see a doctor at the ER, then you tell me there are hordes of people who are there just because it is more convenient. (More convenient than what? Than jumping off a bridge?)

Obviously no one in their senses goes to an ER unless (a) it really is an emergency, and/or (b) they really don't have any other alternatives.

Before we all conclude that the problem is all the "illegals" I'd like to see some numbers. It's easy to say all that, but it might not be true. Prove it.

Remember, there are lots of citizens here who don't speak English either, so you can't judge by what language people speak. I spend a month every year (legally) in the Netherlands and I don't speak Dutch. Does that mean they ought to take me out and shoot me?

[Eliminate the barriers to entry for health care businesses]

If we wish to take the burden off emergency rooms we will need (1) medical / medicare co-pay, and we should reduce the burden of competition by allowing any pharmacy to employee on-site licensed health-care providers. We should eliminate the need for doctor's prescriptions except for drugs which are likely to be abused. Of course, in order to achieve any of this, in the words of William Shakespeare, first we kill all the lawyers.

[kp]

My friend is an ER doc and agrees that the illegal aliens are a major problem.
Everyone is afraid to say it for fear of being called racist. The LA times will never write a good story on this.

People who aren't here legally should have to pay for what they get. period.

[tisofthee]

the immigrant bashing won't get you anywhere. having undocumented immigrants here (from all over) increases the bottom line for corporate america, always seeking to increase that dividend for shareholders. i'm a capitalist in many ways, and if i'm willing to pay someone measley wages in order to increase my profit in the short term, someone else will pay in the long term. look at wal-mart - training their employees on how to gain public assistance benefits - instead of taking money from the billions in profits to help pay for their health insurance. if undocumented immigrants, an esitmated 12 million in the u.s., spend an average of $10 per week on you name it, how much do you believe they (we) are contributing to this economy?

[bditman]

Doctors are not supposed to ask for visas or citizenship papers. They are there to help people and save lives. California's population has grown and ER's have closed leaving a huge service gap. Raymond Boucher is one of the finest, brightest lawyers and this is a public interest court case. We need to solve this problem collectively as a society. The California legislature has unfairly ignored and demoted this issue and shirked their obligation to keep public safety and health as a true core mission of government. We should all understand that this is not a court case about personal profit or greed, but a case of great social importance to all Californians.

[Gordon]

When you have Medical you think your medical care is "free" because you never pay aything and never get a bill. The ranks of those on medicaid are exploding because it is human nature that if something is "free" you are going to try to get some of it. Couple that with a society of winers who believes they should be taken care of and a governemnt/media complex unwilling to step up and say enough is enough...well, you see what we get. We are becoming a socialist country and there is no way to stop it. THose comments advocating universal coverage are advocating medicaid for all.....GREAT.

[Mike N]

The people commenting here, and calling those that bring up the logical point that, since there is a huge population that 1. pays absolutely NOTHING for the services provided by the state and hospitals because they are ILLEGAL, and 2. that those people, on average, take MORE advantage of those service than tax-paying, LAW-ABIDING citizens, are truly the racist ones.

You are trying to pretend their is not probelm with illegals, simply becuase of their race. That is racial differentiation (treating people different due simply to their race). THAT is racist.

Living on Modesto (farm country), when there are 10 hour waiting times in the ER's ONLY DURING PICKING SEASON, it is not too hard to see the problem. Also, when hospitals have to hire bilingual staff, simply because, during the picking season, once again, the large majority of the non-paying, mooching "customers" cannot even understand basic English, then the real problem is pretty difficult to ignore. So, don't try and pretend the BILLIONS billions being stolen from our tax-paying citizenry, simply to pay for illegals that do not pull their weight. It is both insults the intelligence of any thinking person that has done their homework and understands this issue, and makes you look like a fool, and probably someone that is making money off those illegals, one way or the other.

[John D]

I have worked as an emergency physician for 17 years. Here is the problem: EMTALA, a federal mandated law requiring all hospitals to provide an emergency medical screen to all patients, is not funded by the federal govt. What business in American is required to provide a service by law without being reimbursed for their services? Also, comparing the internist and emergency physician compensation is not comparing apples to apples. There jobs are not even close. The best way to compare compensation between these two professionals is reimbursement per patient. This would shed light on what is fair and not fair. The typical ER doc in this country performs half of their work at night, on weekends and holidays. The ER never sleeps.

[sketchy]

Rebecca: WHERE in CA is your brother getting those offers? I would be shocked if they were from hospitals in any of the the big three metro areas. And $350k-$400k is really unusual for emergency medicine, even in a high-need area. It's more like $200k-$300k.

[Mike N]

One last thing: Those arguing for "universal healthcare" are fools. There already is universal care...all you have to do is PAY FOR IT, like the rest of us!

And for Chuck Stewart, if you re truly a PhD, why is it you cannot get gainful employment? Did you receive your degree in a discipline that is completely without value? As a contractor, you have the ability, and freedom, to buy your own insurance. Stop trying to mooch off the rest of us that actually work and are providing marketable skills that employers, and people in general, find are worth paying for.

After all, is your degree in underwater basketweaving, or womyn's studies, or something? And, why did you waste all those years (AND MONEY!!) in school, only to study a discipline that is considered so worthless that you cannot make a livable wage? Productive, tax paying people should not have to pay for your shortsightedness or stupidity. This iis why a majority of US citizens have problems with single payer health care. We do not want to have to pay for losers that are not pulling their weight. And we have seen how the state and feds handle (squander) our money (social security - bankrupted by Congress, Medical - bankrupted by the Legislature, and the list goes on)

[Bart Anderson]

No, it's not just because of illegal immigrants that the ER's find themselves in this spot. This trend has been going on for years. Imagine, with all the wealth in this state,the wealthiest state in the most powerful nation in the world and these rotten politicians can't even keep the hospitals open. As for the governor, come on Mr. Terminator, you campaigned on the promise that you were going to "pump California up", well, why don't you supply some sorely lacking leadership and come up with a plan to solve this problem.

[Jim in Pasadena]

Let's see, illegals overwhelming the ER system, destroying the school system, illegals 1/3 of the prison population with associated huge costs and overcrowding, illegal alien gangs protected by sanctuary city Mayors Villaraigosa and Newsom, Cali run into the ground with every conceivable nanny state program the 'progressive' socialist legislators can imagine, like breakfast, lunch AND after school snacks, while high producers are ripped with the highest income and sales taxes in the US of A. Is anyone surprised that high earners and companies are leaving Cali in droves while the unskilled and uneducated continue to pour in?

[m]

Joe Joe-

You do realize that most Mexicans are a mixture of Spanish and indigenous peoples? You do realize that Spaniards are white?

If you aren't a fan of European style society, you are welcome to return to Mexico and countries south of there, they seem to have their act together!

[Ryan]

Americans treated overseas most likely show proper credentials and are documented, which is why they can reasonably show proof of citizenship. How do you suppose we "bill the mother country" in the case of illegals? Sorry, but "this person looks Mexican and speaks Spanish" would be laughed at on the receiving end of that bill of services. There is only one way to stop this... and it is at the border. Once someone is here, they are here. The battle is already lost at that point.

[One]

About the income - you are forgetting that much of income is based off reimbursements. If no one pays, the hospital doesn't get paid, therefore the hospital closes causing the physician not to get paid. In addition, the loans are a huge amount. Even trying to pay off the loans in 30 years, you are looking at around $4-5,000 per month just for that loan payment. Then there are licensing fees in order to practice, another to write prescriptions, and another to write for the narcotics everyone tries to get from the ER. Then there are classes you continually have to pay for to stay up to date on how to treat patients in order to get sued the least. Then there are conferences you have to pay for to get more training. These are just some of the costs a physician incurs that most people don't realize.

In addition, go to school until you are 30 without earning any money, then talk about getting paid too much. They spent at least 8 years in school learning to get where they are. Many of their families have suffered because of this. No social life for that period of time. It wears on a person. No one will ever be able to endure the pain of education for just the money. Trust me.

I agree with one of the posters above. Even if on medicaid, medicare, medi-Cal or whatever, force them to pay an upfront charge of $100. That will decrease the number of visits by a lot. They will definitely think twice before showing up. I think society has lost the concept of what "emergency" means. If non-emergent patients could be sent away it would help, but then because of the lawsuits, they would have to see a physician and be worked up just to be determined non-emergent.

[nick]

cost of healthcare related to managing and treating diabetes type 2 in the US:
174 BILLION dollars. That's not factoring in the 100's of billions spent treating coronary heart disease and atherosclerosis.

(type 2 diabetes is almost completely preventable and controllable through exercise and diet)

maybe instead of worrying about the taxing of the healthcare system by illegal immigrants, we should be worrying about the fat, unhealthy, alcoholics, and smokers and perhaps putting a bit more money into deitary education and disease prevention.

[Dr.C]

Rebecca (and any who wish to be enlightened):

As an EM resident (not in CA), I feel the need to provide some clarity on physician's salary.
$350-450K offers your brother is claiming to get are.... exagerrated. Unless you are in rural middle-of- nowhere and they pay you $400/hr to work there, highly unlikely he is receiving offers like this in CA. The work that emergency physicians do is hardly comparable to other primary care specialties. I'm not saying any of them are superior to the other whatsoever....just not comparable.

Anyhow, with regards to salaries. The article above is not exaggerating about medical school debt. Mine is $250,000, adding interest will likely go to at least $300,000. I make a little less than $10/hour. Work 80 hours a week. When I'm an attending, that $225,000 salary that sounds like I'm rolling in gold coins isn't as glamourous as you may think. That amount is BEFORE taxes...now subtract 40%= $135K My debt repayment right now would be $3100/mo. Another thing to note is that most Emergency physicians, if independently contracted, have to pay for their own health insurance (that's how it is in my neck of the woods). If you work with a physician group they will sometimes cover it, but usually you are footing the bill, and it's expensive (esp if you have a family). Don't forget to add disability insurance to the monthly tally, which is completely separate from health insurance, in case something happens to you and you can't work to make the $12,000/mo you have in bills. Add in the normal living expenses everyone else has, and now you know why doctors have to make the salary they do.

As for CA, I will definitely have to agree with one of the other doc's statements that immigrants and uninsured patients are NOT the problem. While a ton of uninsured people use the ER for non-emergent issues, the system enables them to do so. That is the source of the problem. The reimbursement rate is so crappy, I can see why hospitals go under... again problem of the system. Imagine shopping at Target, and your bill is $100 and you say to the cashier: "I'm only going to give you $60. See you later!" Or, imagine working 50 hours a week and only getting paid for 30. You'd be pretty unhappy, right? Now you know what medical reimbursement is like. . . . Again, the system's fault.

[er susan]

First off you are un-educated and should read up on some literature if you are talking about illegals. This has nothing to do with illegal immigrants. Secondly, these physicians miss out on a lot of luxuries to become doctors and earn a paycheck so that when they do finish school and pay off their loans, they can make a good living. That was their choice, and if they wanted to miss family vacations, birthdays, get thrown up on, save hundreds of lives, get home with bodily fluids covering their jackets, etc. then that was their choice and now they can reap the rewards. It was also your choice to not become a physician. I cannot stress enough how wrong it is to accuse Irv Edwards of being a thief. Shame on you. Grown up. Also, Sadly, with the recent laws that were passed due to balance billing, the state of California is going to be in a world of hurt when it comes to emergency care.

[novel idea]

How about taking the "paying customers" (those WITH insurance) first?

Then take those AMERICAN CITIZENS without insurance next.

Leave the uninsured illegal aliens (undocumented) for very last.

[steve]

Anyone who thinks the government covering everyone will reduce the number of people who go to the ED is crazy. If EVERYONE thinks they are insured they are much more likely to seek out care. The only way to stem the tide of humanity that is the ED is to make everyone pay a copay. Americans are so freaked out they are going to die at any moment (and many of them will) that they will continue to go to the ED.

I am a resident and recently rotated through the ED - I had a patient wait 4.5 hrs for me to see her for chapped lips. I kid you not. If she had to pay even $20 she would have gone to the store and tried some chap stick first. Instead the hospital has to eat the $300 bill or pass it on to paying customers.

[perspectoff]

Adding more children to the government dole is not going to help the health care system.

Physicians, hospitals, and clinics get reimbursed at rates lower than their expenses for Medicaid (30% below costs), Medicare (10% below costs), and other programs (like SCHIP). Several states don't pay Medicaid for several months at a time, if at all. (Just this week, a large number of California Emergency Physicians are suing to get paid).

Because of this, there are many areas where it is impossible to find a physician that will accept Medicaid, and the number of physicians that accept Medicare and other government programs is dwindling, as costs rise and reimbursements fall.

We need a two-tier health care system, as is the norm in most of the rest of the world:

1) a national network of state, county, and rural hospitals, clinics, and physicians subsidized by the government (financially and with free electronic medical records and bulk purchasing discounts) in exchange for accepting Medicare, Medicaid, and other government programs (such as SCHIP)

2) a private network of hospitals, clinics, and physicians free to set their own rates in order to recoup their costs, and free to negotiate with insurance companies for fair reimbursements for services, instead of the current system (as in California) where insurance companies can set their own arbitrary low rates and are protected by law in doing so

If we don't institute such a two-tiered system now, health care will continue to crumble. This year.

[thomas]

how do u spell illegal aliens?? the true cause of not enforcing the law. do honestly expect the liberalas in LA politics and sacramento politics to change this mess by enforcing the law ,,,,doubt it for now al americans sufffer from the influx of illlegals

[Frank W]

I heard it helps to get Emergency service if you wear a Border patrol hat into the waiting area . This usally clears out about 60% of the people that are in there. Come on people get realistic, start hauling the illegal aliens back to Mexico. The hospitals are here to furnish health care for US citizens, or those legal aliens who can pay.

[Brijette]

mexico?are you stupid...Not all immigrants are Mexican...By the way they do alot of work here what you americans be without them?so why not help them out in a emergency room.

[Ki]

I read all the posts here and all of you have good points and bd. I have worked in the ER for almost 9 years and I belive that all kinds of people are to blame for over crowding and loss of services, however it is true in what we see that medical and medicare pts abuse the system more so then others. I personal find that simple eduacation is the problem. things like if my child has a fever did you give tylenol or motrion and most people say no. If your child is vomiting all night all day then why are they eating chips while waiting? Did you know that you can get a pregncay test at the 99 cent store? A emergancy room is just that it needs to be used for things that can not wait an i am sorry but need a pregnancy test or my finger nail hurts is not something that should be there and these are the type of people who flood the er and cause extrem wait times and real emergaies to suffer since the staff is spread so thin. As far as what a doc makes really who cares, if you had to be able to save a life with the little amount of info given then you would deserve the pay to. Er docs and nurses are the top dogs of the medical profesion and you may not respect them now and pass all kinds of judgement but i can promise you this if it was you or oyr kid or your mom on that table you sure respet them at that moment. What I am trying t say is that there are many reasons why the er is over crowded and yes mediacal pts head that pack but if you refuse to educate your self for the simple things and first aid then sit down shut up and wait your turn.