Many Physicians Refuse to Provide Backup for Emergency Rooms : Doctors’ Reluctance Cited in Hospital Cutbacks

The pressure to curtail hospital emergency services is coming increasingly from doctors reluctant to care for the poor, health officials say.

More and more, doctors across the state are refusing to serve on hospital call panels that provide backup medical care to the sickest emergency room patients. Without this mandatory coverage from surgeons, internists and obstetricians, for example, a hospital’s emergency care program can be virtually crippled.

Doctors complain that they do not get paid for much of the care they provide and, furthermore, that this free care increases their malpractice premiums and disrupts service to their paying patients.

“They’re up all night, the risk of a lawsuit is high, and the compensation is less and less,” Dr. Philip Fagan Jr. said.

Fagan heads a medical group of about 50 emergency physicians working at several major Los Angeles hospitals, including the Hospital of the Good Samaritan, which along with California Medical Center has announced drastic cutbacks in emergency room care. “What’s happening is that fewer and fewer physicians will fill these positions on call panels,” he said.

Although recent attention has been focused on Los Angeles, the problem is statewide, according to David Langness, spokesman for the Hospital Council of Southern California.

The root cause of the problem, Langness and other health care advocates said Wednesday, is the growing numbers of patients without health insurance receiving emergency treatment from hospitals and physicians who do not get reimbursed.

In addition, they say that many doctors have been rankled by a new state law that assesses a $5,000 fine against any physician on a hospital call panel who refuses to treat an emergency patient.

In several areas of the state, especially Los Angeles and San Diego, the undercurrent of dissatisfaction among doctors has reached an acute level.

For example, physician discontent at the Palomar Medical Center--which operates a key trauma center serving Northern San Diego County--prompted hospital officials this week to relax hospital rules governing physician participation on hospital call panels, it was announced Wednesday.

In downtown Los Angeles, officials at the California Medical Center acknowledged this week that one of the key reasons for their upcoming emergency service cutbacks is the “growing difficulty” in maintaining adequate physician participation on call panels.

“For reasons that parallel the problems faced by hospitals,” said William F. Haug, the medical center’s president, “physicians are increasingly reluctant to provide coverage in the emergency department.”

Effective June 1, California Medical Center and Good Samaritan Hospital will no longer accept paramedic ambulances--a total of about 1,250 per month. Several other area hospitals are also considering moves to divert ambulances, which often bring hospitals their sickest and poorest patients.

Hospital officials say they are losing increasing sums of money on their emergency rooms--at a time when they can ill afford the loss--due to stringent new cost controls implemented by government health care programs and private health insurance carriers.

One hospital source said doctors are playing a key behind-the-scenes role in the pending emergency room cutbacks: “This is a doctor problem at the core. The doctors are saying, ‘We won’t sit on a call panel.’ That threatens hospital administrators more than anything else.”

Dr. Alan Heilpern, head of emergency physicians at California Medical Center, acknowledged that pressure has come--in some instances from “the entire medical staff”--and that it can be very powerful.

The problem for physicians, according to Dr. Gary Krieger, president of the Los Angeles County Medical Assn., is that some are being forced to give what amounts to between $25,000 to $50,000 a year of free care.

“They are spending more and more time taking care of individuals who enter the hospital as emergency cases . . . and who have no remuneration resources whatsoever.” He said the doctors have to interrupt their service to private patients by rushing to the hospital, sometimes in the middle of the night, to care for a patient who may never pay his bill and might well sue.

Furthermore, the influx of poor patients into the emergency room has at times clogged the rest of the system, saturating critical care units to the point where other physicians are unable to admit their private patients to the hospital for care, Haug said.

As Brian Johnston, an emergency physician at White Memorial Medical Center in East Los Angeles said, “It can be a double or triple whammy.”

Times staff writer Linda Roach Monroe in San Diego contributed to this story.