County Sued on Health Fee : Accused of Charging Poor Eligible for Free Care

Los Angeles County’s controversial practice of charging health-care fees to the poor, even though they may qualify for free care, was challenged Wednesday in a class-action lawsuit filed by five public interest law groups.

The suit, filed in Los Angeles Superior Court, seeks a preliminary injunction that would require the county to “tell its patients the truth”--that no minimum charge is required for the poor and that the poor can get free or reduced-cost care under the county’s ability-to-pay program.

Attorneys for the American Civil Liberties Union, Legal Aid Foundation of Los Angeles, Western Center on Law and Poverty, the National Health Law Program and the San Fernando Valley Neighborhood Legal Services said they have documented nearly 100 cases in which county employees incorrectly told the poor that they had to pay $20 and $30 fees before receiving care.

In some cases, the suit says, patients in life-threatening situations were unable to get care because they were penniless. According to the suit, the cases included a woman suffering from leukemia who did not get chemotherapy for a month, even though a doctor at a county hospital told her that any delay in treatment could be fatal, and a 6-year-old boy who was twice refused emergency treatment at a county hospital for a critical blood problem.

In these cases, attorneys blamed “county financial screeners” who insisted that the patients pay $30 fees before seeing doctors.

County officials said they were unfamiliar with the specific cases cited in the lawsuit but denied that the county has turned away people because they could not pay.

“I have never heard of a single case of the county denying care to someone because of money,” said Irv Cohen, acting director of the county Department of Health Services.

Poverty rights attorneys say the county’s practice of insisting upon fees, first brought to light during heated legislative hearings last year, is causing the destitute to put off treatment and has forced many to dip into grocery money to pay for health care.

Under state law, counties must provide care to medically indigent adults--the so-called working poor--based on a sliding scale that offers free care to the poorest.

Those who would qualify for free care under the county’s ability-to-pay program would include a family of four, whose monthly income is $1,100 or less, or an individual with a monthly income of $700 or less.

However, the county is making millions of dollars off its poorest residents, because it is not attempting to determine who qualifies for the program, the lawyers said. Instead, they said, the county is charging nearly everyone the same $20 or $30 flat fee for a clinic or hospital visit.

According to county officials, $11 million in such fees was collected last year.

Signs required by state law and installed in county clinics and hospitals this year to explain the ability-to-pay program often do not mention the program or the possibility of free care, attorneys pointed out.

Most signs allude only to “reduced-cost health plans,” attorneys pointed out.

Moreover, a UCLA study released this week revealed that most county health-care workers are telling callers that a $20 or $30 fee is required to obtain care.

Cohen, the health department’s acting director, defended the county, saying word about free care is generally getting out to the poor.

He admitted that county employees inform patients about the ability-to-pay program on an erratic basis, but said, “We don’t think it’s a significant problem.”

However, according to the UCLA study, funded by the Western Center on Law and Poverty, ignorance about the ability-to-pay program is widespread among employees at the county’s 20 ambulatory-care clinics and hospitals.

Dr. Richard Brown, a UCLA associate professor of public health, and doctoral student Michael Cousineau said they found that more than 80% of the county employees handling phone lines wrongly told callers that a fee of $20 or $30 was required for everyone.

When the researchers, posing as patients, then explained that they were without money and asked what they should do, less than half of the employees revealed the existence of the ability-to-pay plan, Cousineau said. About a quarter of them continued to insist that the full fee must be paid, he said. The rest said they believed that there were alternatives to full payment but were unfamiliar with them.

Melinda Bird, an attorney for the Western Center, said at a press conference to announce the suit that some people are even turned away in life-threatening situations.

In the case of the 6-year-old boy, she said, the child had bruises over most of his body and was sent to County-USC Medical Center by a private physician, who detected a critical reduction in his blood platelet count.

“When the parents arrived at the emergency room with the child, they were flatly denied care because they had no money, no $30 fee,” Bird said.

The private physician, Dr. Deborah Satterfield, said she sent the family back to County-USC Medical Center again, and they were again denied care by financial screeners.

“I finally called the pediatric resident on-call at the emergency room, who agreed the child needed immediate hospitalization,” Satterfield said. “That physician told me that this happens all the time-- people are turned away in emergency situations.”

In another case, a teen-ager suffering from crippling arthritis was denied the injections he needed to “keep his hands from curling up,” Bird said. In desperation over his worsening deformity, he attempted suicide, she said.

The boy was hospitalized for nearly a month at the psychiatric ward at County-USC Medical Center as a result, Bird said.

In defense of the county, Cohen argued that attempting to process each of the county’s 85,000 working poor to find out whether they qualified for free care “would get very expensive and counterproductive.”

“We can’t sit down and explore the ability-to-pay plan with everyone,” he said.

Cohen also said that if a significant number of the poor qualified for free care, “we would lose $11 million a year in revenue and we would have to cut medical programs to make up for it.”

“More people would be impacted . . . if we cut back on programs than if we keep making them pay a $20 fee,” he said.