Emergency Room Closures Are At A Crisis
Los Angeles Wave Newspapers, News Report, Kevin Herrera, Posted: Oct 12, 2004
LOS ANGELES — Hospitals across the state — and particularly in Los Angeles County — are closing their emergency rooms at such an alarming rate that health experts are calling the phenomenon a “crisis of extreme proportions” that, if not treated soon, could lead to the meltdown of emergency networks in many municipalities, including Los Angeles.
As more hospitals shutter their emergency rooms because of increasing operating costs and demands by the uninsured, others will have to carry the load, potentially creating a domino effect where hospital after hospital closes as the burden of providing care becomes greater.
If that happens, both the insured and uninsured would have to travel farther and farther to receive care, which would most certainly lead to an increase in deaths and malpractice suits as the quality of care is diminished, health experts warn.
All have put the blame on rising health care costs, the increasing ranks of the uninsured who flock to ERs often for minor problems, the closure of community clinics used to treat and prevent ailments, and the decrease in reimbursement rates by insurance companies and the state.
“If I had to give a a diagnosis [of Los Angeles County’s network of emergency medicine] it would be critical; definitely a guarded prognosis,” said Dr. Thomas Garthwaite, chief medical officer and director of the county’s Department of Health Services who has been blasted by community activists and elected officials for recommending the closure of the trauma unit at King/Drew Medical Center. Garthwaite last month recommended the closure to protect the hospital from going under, which would further exacerbate the ER crisis.
“When you see middle-sized and larger hospitals struggling and major sell-offs of hospitals by private companies ... when you see people leaving hospitals because the wait to see a physician can take hours and even days ... you know that this system is not a healthy one, but one that is struggling.”
Over the last year alone, Los Angeles County has lost six emergency rooms — or the ability to treat 75,000 — and faces more closures.
Two days after the county Board of Supervisors announced last month they would seek to shutter King/Drew’s trauma center, officials at Robert F. Kennedy Medical Center in Hawthorne said that they would shut its doors — and its emergency room — by the end of the year, and on Monday, Northridge Hospital’s Sherman Way campus was ordered to close its emergency room, effective immediately.
Statewide, more than 65 emergency departments have closed over the last decade, 28 of them since Jan. 1, 2000, according to the state’s Department of Health Services.
“Where are families, children and the uninsured going to go to receive emergency attention?” asked Lesa Lessard, national communication director for the International Association of Emergency Medical Technicians and Paramedics, which has criticized elected officials for not dealing with the crisis sooner.
St. Francis Medical Center in Lynwood is one option. The private, nonprofit facility is preparing for an influx of patients in case nearby King/Drew Medical Center is forced to close. The center is already facing the closure of its trauma unit and federal regulators have warned that if drastic reforms are not made, the entire facility could be put out of business.
“We are continually being challenged and have seen significant increases in the number of patients we serve, especially the uninsured, after they head of King/Drew’s situation,” said Carol Lee Thorpe, vice president of community services at St. Francis. “It seems like there is always something threatening our long term viability, but we are going to remain vigilant and keep serving the community and raising awareness about this issue.”
Dr. Gail V. Anderson Jr. of Los Angeles County Harbor -UCLA Medical Center said he, too, has seen an increase in the number of patients visiting the ER, but the hospital has been fiscally conservative over the years, which has helped cover the increase. The hospital is in such “relatively good shape,” that officials are looking at expanding its facilities.
There are many complex factors contributing to the closure of emergency rooms, but the main one is cost. A federal law requires hospitals with ERs to treat all patients, regardless of their ability to pay. As the numbers of uninsured increase — estimates put the figure at nearly 7 million in California — and more uninsured and those enrolled in HMOs seek treatment at emergency rooms instead of with primary care physicians, the cost of treating them rises also.
According to a report by the California Institute for County Government at Cal State Sacramento, emergency room visits are soaring, totaling 10 million in 2001. Emergency room costs are an estimated six times more than treatment in a physician’s office.
That along with declining reimbursement rates from HMOs and state and federal programs like Medi-Cal — physicians face a proposed 5 percent reduction, which is being challenged in court — have contributed to more and more hospitals operating in the red.
According to a report released by the California Medical Association (CMA), which advocates on behalf of physicians and their patients, nearly 80 percent of ERs lost money in 2002, the most recent year in which data was available. Statewide the losses have reached more than $600 million.
Authors of the report estimate that the total loss statewide this year will reach well over $900 million for both hospitals and physicians.
UCLA Medical Center in Westwood lost more than $9 million in 2002 while County-USC Medical Center lost roughly $5.6 million during that time. On the average, hospitals lose $80 per visit to the ER, the CMA report showed.
“If you take some of the most highly skilled and trained people in society ... tell them they have to be open 24/7 and that they have to take care of anyone who walks into the door regardless of their inability to pay, this is not a viable model,” Peter Warren, vice president of communications for CMA, said. “It used to work when HMOs and Medi-Cal paid more, but now everyone is trying to undercut the price structure.”
William Brennan, the state’s manager of Medi-Cal’s rate development branch, said he has heard the criticism from hospitals and physicians regarding the decrease in reimbursement rates, but he has been ordered by the governor and legislators to cut further because of the state’s budget woes.
When the state had a budget surplus a few years ago, Brennan said he increased rates by 40 percent, but those days are long gone. Currently the state is ranked 45th in the nation when it comes to reimbursement rates.
Private hospitals are not immune to rate cuts or rising operating costs, either. They, too, are having trouble operating emergency rooms, especially after new laws went into effect requiring them to hire more nurses to meet more stringent staffing ratios and siesmic-retrofitting, which can lead to very expensive construction projects.
“It was a business decision to close those ERs and one of the reasons we made it certainly has to do with the difficult environment in California and particularly Los Angeles County with so many uninsured,” said David Langness, a spokesman for Tenet Healthcare. Tenet is in the process of selling 18 hospitals in California because of increasing operating costs.
However, Langness said ERs are not necessarily cancers killing hospitals over time. Emergency rooms bring in patients, which means money if they are insured. Some hospitals get 30 to 40 percent of their admissions through the emergency room, Langness said.
“Statistics showing hospitals losing money because of ERs are bogus,” Langness said. “People look at those and laugh because [the statistics] don’t count patients who go into acute care beds.”
Warren of the CMA said some hospitals, mainly those in affluent areas where people have good insurance, do make money because of ERs. However, “if you have a patient who comes into the ER and can’t pay or doesn’t pay, than it doesn’t make any sense that they will when they get upstairs,” he added.
There are no remedies in sight, experts say, but there are bandages that can stop the bleeding, including two propositions on the November ballot that are highly contested.
One is Proposition 67, which would increase the 911 surcharge on telephone bills and raise an estimated $500 million to keep ERs afloat. The money would go to hospitals, paramedics and physicians.
Opponents of the proposition, which includes telecommunication companies and groups representing California sheriffs and seniors, agree the financial burden on ERs and physicians must be relieved, but say it unfairly taxes consumers.
The proposition would increase the 911 surcharge to levy a 50-cent charge on most residential phone lines. Businesses and cellular phone customers would be charged 3 percent.
The other proposition is Proposition 72, which, if approved, would require companies with 50 or more employees to provide health insurance or pay into a state fund that would support a statewide health insurance plan.
Many businesses are against the proposition because they say it will increase their operating costs and force some out of the state.
Dr. Wesley A. Curry, president of the California Emergency Physicians Medical Group, said both propositions are a no brainer, regardless if you are opposed, because whether you are rich or poor, black or white, insured or uninsured, we all need ERs.
“What people need to be asking themselves is, if they become seriously injured or il l... will there be a system there to respond, and the answer now is no,” Curry said. “If you are on one side or the other, you have to cross that line because as an individual, we are all impacted.”
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