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ER doctors sue state, say emergency room system near collapse

January 27, 2009 | 12:27 pm


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