Lives at Stake

The California Legislature is moving to enforce regulations that bar the “dumping” of uninsured or indigent patients in critical condition from one hospital emergency room to another for economic reasons, and that is a good thing.

But once again the political leaders are tightening rules that impose a high cost on hospitals and doctors without offering adequate public compensation for that care, and that is irresponsible.

The California Medical Assn., speaking for the doctors, has criticized the absence in the bill of a guarantee that doctors will be paid for providing these emergency services. The California Hospital Assn., speaking for the hospitals, has also expressed reservations and raised the compensation issue. Their concerns are understandable.

But the fact remains: The pervasive dumping reported in testimony before the Legislature violates contractual agreements that licensed emergency rooms and attending physicians have entered into. Furthermore, it is obvious that those violations will continue and grow unless the tough sanctions now proposed in AB 3403 by Assemblyman Burt M. Margolin (D-North Hollywood) are imposed. Any delay in making those changes prolongs an intolerable health risk for the poor.

Legislators supporting the measure are obliged, however, to see that they themselves are not guilty of dumping. The cost of emergency care for indigents is a public obligation. The practice both in Washington and Sacramento of mandating public health care while providing woefully inadequate funding for the required services weakens the quality of the entire health-care system. This legislation must be followed by funding to make it work fairly.

Under the terms of Margolin’s bill, hospitals and emergency-room physicians would face sanctions if they failed to provide necessary emergency-room care, including the delivery of babies, without regard to the ability of the patient to pay. After the condition of a patient had been stabilized, a patient without health insurance or the ability to pay might then be transferred to a hospital designated for indigent care if that hospital agreed to accept the patient.

This is not a departure from existing regulations. It respects new federal legislation that sets the same general goals but has no mechanism for enforcement. Enforcement is the key. Now, without it, some hospitals, even in counties with compensation provisions for the indigent, continue to transfer patients when it is not safe to do so. Some hospitals have threatened to suspend obstetrical care in emergencies. But counties, like Los Angeles, with coherent transfer policies have shown that most abuses can be eliminated.

The Margolin legislation is a stopgap measure, because it falls short of the kind of health care that should be provided. The national goal should be the development of a funding base that will assure equal care for every person at every institution, the indigent with the affluent. But, in the meantime, at least the rights of equal emergency care can be assured by providing these measures to enforce existing agreements.