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

[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.