Jaime Gutierrez recently broke his ankle. Because he is
uninsured, he had to drive 40 miles to Harbor-UCLA Medical Center.
But he said after waiting for 10 hours, he left without seeing a
doctor.
“The wait is unbelievable. It definitely makes you not
want to get medical help,” he said.
Gutierrez’s story is not unusual, and county health
officials fear that expected state health care cuts and a legal
injunction are tightening the belt around L.A. County hospitals,
including Harbor-UCLA and Olive View-UCLA, leaving emergency
departments little room to breathe.
Though Assembly Budget Health Consultant Michael Dimmitt said
the legislature does not want to limit access to Medi-Cal ““
the primary form of health insurance for 6.3 million Californians
““ some L.A. County government and medical officials said cuts
to Medi-Cal will likely be part of an approved budget.
These cuts have included decreasing patient eligibility, cutting
services eligible patients can receive, and reducing the
provider-reimbursement rate.
Since the federal government matches every state dollar
dedicated to Medi-Cal, any state cuts would be twice as damaging to
county hospitals.
While there is no immediate plan to downsize Harbor or Olive
View, city and medical officials said if a state budget includes
reductions to Medi-Cal, already underfunded and understaffed county
hospitals could get stuck with the rising cost of uninsured
patients.
Harbor Medical Director Gail Anderson Jr. said any reductions to
Medi-Cal could cause an influx of uninsured patients, as well as
Medi-Cal patients since “other hospitals and doctors will not
take those patients because (Medi-Cal) will not cover their
costs.”
This would cause overcrowding of county emergency rooms, which
are required to admit any patient in need of treatment, insured or
not.
“We are operating at full capacity, like a glass of water
filled to the rim ““ you simply can’t add more
water,” said John Hockberger, chair of Harbor’s
department of emergency medicine and president of its faculty
society.
Reductions in Medi-Cal services would also affect UCLA and
UCLA-Santa Monica Medical Centers, but those effects would be less
dramatic because they generally serve fewer Medi-Cal patients.
Despite the relatively nominal funding UCLA’s two
hospitals receive from the state ““ less than $2 million per
month ““ they have an advantage over their counterparts.
“When the state has problems, we don’t get the
headaches that a hospital like county gets,” Chief Financial
Officer Sergio Melgar said.
L.A. County’s problems are compounded by a recent legal
injunction that prevents them from closing one of their six
hospitals, Rancho Los Amigos, and removing 100 beds from
County-University of Southern California.
If the injunction stands, it will cost the county $75 million in
immediate savings, and by fiscal year 2007-2008, county hospitals
could face a $1.1 billion deficit, said John Wallace, director of
public policy for the L.A. Department of Health Services.
Tough times are nothing new to L.A. health care. Over the past
year, a lack of funding has caused the county to take a knife to
public health services, shutting down 16 medical clinics.
“The biggest issue the county has in health care is we
continue to have rising costs and decreasing revenue,” said
Sharon Harper, chief deputy for the L.A. chief administrative
officer who prepares the county’s budget.
Last year, county hospitals saw 800,000 patients; 75 percent
were uninsured.
With a lack of funding, county hospitals are often unable to
provide for acute medical needs. At Harbor, the emergency
department’s 51 beds and the waiting room are perpetually
occupied, which discourages people from seeing a physician until
they are seriously ill, Hockberger said.
“Ultimately, society spends even more money taking care of
diseases that went unchecked,” he added.
The issue is a lack of money. Both the L.A. Department of Health
and county doctors said the state and federal governments should
provide additional funding because of a “vested
interest” in maintaining the health of citizens.
A significant part of county health care, Harbor and Olive View
are also a vital part of the UCLA family. Predominantly staffed by
UCLA doctors, Olive View is the only county hospital in the
northern part of the county, and Harbor ““ the only Level 1
trauma center in the South Bay ““ is one of the top teaching
and research institutions in the country.
“(Harbor’s) a great place to learn. I get excited to
go in everyday,” said third-year UCLA medical student Wei
Tang.
But this praise means little to the numerous uninsured patients
who depend on county hospitals.
“(Harbor) has well-educated doctors. It’s just that
the doctors lack the resources to provide for everyone who needs to
be helped,” Gutierrez said.