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Doctor: Illegal immigrants not key reason for ER problems

January 29, 2009 |  2:57 pm

Marguerita, an undocumented citizen from Mexico relaxes at the St.
Joseph Hospital Renal Center in Orange where she receives dialysis
three times a week.

A number of readers have written to suggest that illegal immigrants are the cause of problems detailed in a Times story Wednesday about a coalition of emergency physicians who sued the state for more funds and warned that California's emergency rooms are on the brink of collapse.

We asked Irv Edwards, an emergency room physician who is among the doctors who filed the suit, what role illegal immigrants play in the state's stressed emergency departments. Edwards, a former president of the American College of Emergency Physicians' California chapter, said that although California faces unique challenges because of its population, illegal immigrants are not the primary reason the state's emergency departments are overburdened.

"The population is increasing. The population is aging and becoming sicker, and the number of hospitals that are closing is increasing, leading to greater demand and decreased capacity," Edwards said.

Photo: Marguerita, an undocumented citizen from Mexico relaxes at the St. Joseph Hospital Renal Center in Orange where she receives dialysis three times a week. Credit: Mark Boster / Los Angeles

A study by the Rand Corp., published in the November 2006 issue of Health Affairs, found that undocumented immigrants in Los Angeles County use disproportionately fewer medical services. The study reported that undocumented immigrants make up 12% of the non-elderly adult population, but account for only 6% of the spending.

And those who are insured appear to be driving some of the increase in emergency room use. A survey released in 2006 by the California HealthCare Foundation found that Californians with insurance were overusing emergency services for medical problems "that often fail to meet the criteria for emergent or urgent care."

In California, 18.5% of the population is uninsured and 16% is on Medi-Cal, which helps cover healthcare costs for the poor. The state has one of the lowest reimbursement rates in the nation, a rate that has only been increased once in the last 17 years, Edwards said. Illegal immigrants are not eligible for Medi-Cal.

Edwards said a key issue facing emergency rooms has been a lack of in-patient beds for patients who come into the emergency room and then need to be admitted. He cited Mission Community Hospital in the San Fernando Valley -- where emergency room doctors held a news conference Wednesday -- as an example of a typical scenario. The hospital has 120 beds, but on Wednesday, 116 of them were full. As a result, Edwards said the emergency department had become a holding area for patients, further backing up treatment for those waiting.

"In a 20-bed ER at any given time, we sometimes have 10 or 12 beds holding admitted patients, three or four in the hallway and we're seeing volumes of patients in and out inefficiently," Edwards said.

-- Kimi Yoshino

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