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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 () | Archives (67)

California = third world

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.

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.

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.

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...

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.

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.

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.)

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?

"...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...

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.

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.

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).

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.

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.

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.

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.

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!

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.

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.

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

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.

"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!
a retired drywall contractor

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.

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.

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