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California's Overstressed Emergency Healthcare System on the Verge of Collapse

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Raymond Boucher of Kiesel Boucher Larson filed a lawsuit today, on behalf of emergency room doctors, against the State of California.

The complaint says that California’s emergency healthcare system is in near shambles, and unless additional funding is received soon, the state should expect to see severe financial-related consequences throughout this sector of California’s healthcare system, such as fewer available doctors, quality of care, and more people dying due to long waits in emergency rooms all across the state.

California’s hospital closure rate and poor reimbursement rates to ER doctors places the state of California last in the country in access to emergency care and emergency room availability per capita, with only seven rooms per one million people. The reimbursement rate for California ER doctors ranks 43rd in the country.

From the Los Angeles Times’ L.A. Now Blog:

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

From the O.C. Register:


A group of emergency room doctors sued the state Tuesday, saying rates paid by Medi-Cal are too low and ultimately mean longer waits and diminished care for everyone.

The class action lawsuit, filed in Los Angeles Superior Court, names the California Department of Health Care Services, which oversees Medi-Cal, the insurance program for low-income families. It alleges that ER doctors subsidized state Medi-Cal with more than $100 million in care in 2007.

State officials declined to comment, saying they had not yet been served.

"We treat the uninsured and collect nothing and we treat Medi-Cal patients and collect what little we can, which doesn’t cover the cost of services," said Dr. Irv Edwards, founder of Emergent Medical Associates, which staffs emergency departments at Huntington Beach Hospital and La Palma Intercommunity. "We are truly struggling or sinking in our efforts to provide quality emergency services to our patients."

Edwards said those shortfalls in payment mean longer waits and fewer specialists who are willing to be on call for insured and uninsured patients.

"You could be traveling through a nice community and be in a freeway accident and taken to the ER and there’s no on-call orthopedist," Edwards said.

According to the latest report from the Orange County Health Needs Assessment, Orange County residents made 566,311 visits to local emergency rooms in 2007. Among them, nearly 16 percent were covered by Medi-Cal. Another 12 percent lacked any health insurance. Hospitals reported the data to the Office of Statewide Health and Planning Department

According to the report, uncompensated emergency care in the county totaled $240 million for the year. That figure does not include low reimbursements from Medi-Cal or Medicare. Federal law requires emergency rooms to treat anyone, regardless of ability to pay.

The suit says while California’s population has grown in the past decade, 55 emergency departments have closed, straining those still open. The most recent Orange County ER closure was at Tustin Hospital in 2007.

The suit comes at a time when doctors are facing fewer options for reimbursement and California has a massive budget deficit.

Late last year, the California Medical Association unsuccessfully challenged new state regulations forbidding out-of-network hospitals and doctors from going after HMO patients for bills not covered by their health plan. They argued that so-called "balance billing" was necessary because insurers don’t pay a fair rate.

Recently, the American College of Emergency Physicians issued a statement saying emergency rooms become more crucial during times of economic difficulty.

"When people lose their jobs or their health insurance, they go without preventive care and necessary medications, and depend on emergency physicians to treat them when their illnesses turn critical. Your stockbroker may not see you, but emergency physicians are always there when you need them, 24 hours a day, 7 days a week, every single day of the year," the statement reads.