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Paul Kiesel
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AP: Californians' Access to Emergency Healthcare in Jeopardy

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From the Associated Press:

A coalition of emergency doctors took the state to court Tuesday over low reimbursement rates for Medi-Cal patients.

In a lawsuit filed against the California Department of Health Care Services, doctors said Medi-Cal payments have remained low during the past 17 years while the cost of providing care has nearly doubled.

The physicians also complained that the number of uninsured and underinsured patients has become untenable due to the closure of 85 hospitals and 55 emergency rooms in the past decade.

In 2007 alone, they provided $100 million in unpaid services, according to the lawsuit.

"The entire emergency room system in the state of California is on its last breath," said Raymond Boucher, a lawyer for the doctors. "If somebody doesn’t immediately come in and provide a lifeline to these emergency rooms, too many of them will continue to close."

The Department of Health Care Services declined comment on the lawsuit, but in a statement said it supports health care reform in California that would benefit patients and physicians.

The suit seeking class action status was filed in Superior Court on behalf of five groups that Boucher said are top providers of emergency care in the state: Centinela Freeman Emergency Medical Associates, Valley Presbyterian Emergency Medical Associates, Valley Emergency Medical Associates, Sutter Emergency Medical Associates and Valley Emergency Physicians Medical Group.

Under state law, emergency care must be provided to all patients regardless of ability to pay. Doctors have long complained that the state has required them to provide care without providing necessary financial support.

The lawsuit calls for restitution, unspecified damages and an order protecting the right of emergency room doctors to be "justly compensated."

A doctor involved in the lawsuit, Dr. Irv Edwards, works as an emergency room physician in five hospitals, including Centinela Freeman Regional Medical Center. Patients have flooded the emergency room there since the closure of three nearby hospitals, he said.

"Most of us went into this specialty with the positive feeling that we’d like to take good care of our patients, and we’ve seen a steady erosion of our ability to take good care of patients," said Edwards.

In a national study published last month, the American College of Emergency Physicians ranked California last in access to emergency care, taking into account the number of emergency physicians in the state, percentage of doctors who accept public health insurance and the number of hospital closures.

The study also found that California has 7.1 emergency departments for every one million residents, compared to a national average of 19.9.

Dr. Dev GnanaDev, president of the California Medical Association, praised the lawsuit, saying doctors "can’t continue to subsidize the state of California forever."

The trade association was able to secure an injunction last year against a proposed 10 percent cut to Medi-Cal rates.

"I think the emergency room is just the tip of the iceberg," GnanaDev said. "They are on the front line but every on-call doctor has the same problem."