Many Seriously Ill Indigents Can’t Find Care, Study Says

Despite medical programs for the indigent, many poor patients in Orange County with serious and life-threatening illnesses fail to receive care because they don’t qualify for aid and can’t find other doctors or clinics to treat them, according to a study by UCI Medical Center researchers.

The study “tells us there are a lot of people who need care but who aren’t getting it--people who genuinely need care,” said one of the researchers, Dr. Lloyd Rucker, a UCI assistant professor of internal medicine.

“There’s a gap between the people with insurance, or adequate insurance, and those who qualify for public programs,” he said in an interview Thursday. Those who fall into that gap, he added, “go without medical care for very serious illness because they don’t have the money.”

The study, prepared by four UC Irvine physicians and a research assistant, will be presented to the Board of Supervisors at a county budget hearing next week by the Orange County Task Force for Indigent Medical Services, a countywide advocacy group formed a year ago.

Members of the task force, of which Rucker is a member, will appeal to the county to pump more funds into indigent medical care and to ease restrictions which are keeping many needy patients from receiving treatment, he said.

The report gives several examples of chronically ill patients who are not receiving care, including:

- A 54-year-old man who had heart surgery in 1982. His income is $500 a month and he is required to pay $175 a month before public assistance will contribute funds for critical medications and ongoing care.

- A 24-year-old woman who gave birth by Caesarean section. Surgeons were not able to close her incision because of complications. Since she was admitted as an emergency case, her hospital stay was covered, but once she was sent home she no longer qualified for assistance. “She cannot afford follow-up care and sits at home with an open wound and no way to get to a physician,” the report states.

- A 25-year-old woman with cervical cancer who works as a waitress to support herself and her child after they were abandoned by her husband. She does not qualify for assistance because she cannot immediately dispose of property she jointly owns with her estranged husband.

The proposed county budget for 1986-87 appropriates $34.6 million for indigent medical services, essentially the same amount spent this current budget year. The money is provided by the state Medi-Cal program to the county, which in turn contracts with more than 30 hospitals to treat the indigent. UCI Medical Center is the dominant provider of care to the county’s indigent.

The UCI study tracked 200 patients who did not qualify for assistance from the state Medi-Cal or county indigent medical services programs--or those who qualified but could not afford their share of the bill.

Half of the group was referred to a UCI clinic so that physicians could diagnose their illnesses and determine the severity of the cases for use in the study.

The other 100 rejected patients, however, were handed a list of community or “free” clinics which might treat them, the usual procedure for patients turned away from UCI’s screening and referral center, Rucker said. A month later, the researchers contacted those patients to find out what happened. “The preliminary findings on their situations were dramatic,” the study states.

Only 32% had received care, while 45% went untreated, Rucker said. The remaining 23% could not be reached.

However, most of those who received care had only minor illnesses, the study points out. More than 86% of those patients thought to have a high risk of disability or even death were not able to obtain care, the study said.

Rucker said these patients had conditions such as severe heart disease, cancer or complicated diabetes. “These would be the people . . . (for whom) you’re going to break the piggy bank open to get treatment for them,” Rucker said.

The study disproves a public attitude that people who apply for government assistance are bilking the system and really can afford to pay their own way, Rucker contended.

There is also a misperception about who the medically indigent are, he said. While many people envision the typical indigent as an illegal alien, studies have shown that, nationwide, an estimated 35 million people do not have medical insurance or adequate insurance and the vast majority of these people hold jobs, he said. But as soon as these people fall ill, they become medically indigent, Rucker explained.

Rucker said the task force has not yet decided how much additional money it will ask the county to allocate for indigent medical services. Many counties add additional funds to the state-provided money, but Orange County does not, he said.

However, the medical-eligibility process is being streamlined in Orange County, according to a county report urging supervisors to approve a new indigent medical services contract with local hospitals next week.

Officials with the county Health Care Agency were unavailable for comment Thursday afternoon. UCI Medical Center director Leon Schwartz said he had not seen the study and declined to comment on it.