Complaint Filed on Emergency Care Cutbacks

A class-action complaint against the California Medical Center was filed Friday by public interest attorneys seeking to prevent drastic cutbacks in the hospital’s busy downtown emergency room.

Attorneys charged that the hospital’s plan to turn away ambulances beginning next month is illegal because it violates a pledge made by hospital officials when they accepted about $1 million in federal construction funds more than a decade ago.

At that time, the nonprofit hospital at 1414 S. Hope St. vowed, in return for the money, to “provide community service forever,” said Standley Dorn, an attorney with the National Health Law Program. This includes a reasonable volume of free care provided without discrimination to all people in the hospital’s service area, Dorn said.

Immediate Order Sought

The complaint, which was filed with the U.S. Department of Health and Human Services, seeks an immediate order requiring the medical center to maintain its emergency room “at full service capacity.”

In addition, attorneys have demanded that unless the hospital agrees by Wednesday to delay the cutbacks for 30 days, they will also file a lawsuit in state court challenging the cutbacks by the medical center and by two other hospitals that plan to follow suit.

Samuel Tibbitts, president of the Lutheran Hospital Society, which owns the medical center, said that he has been advised by his attorneys that the emergency room cuts do not violate the law.

The hospital operates the busiest private emergency room in the county, treating about 1,200 patients a month, including about 800 who arrive by ambulance. Officials say the hospital is suffering great financial loss--projected at $500,000 a month--from patients who cannot or will not pay their bills but who must, by law, be treated when they seek care in the emergency room. Many of the sickest and poorest patients arrive by paramedic ambulances.

County officials fear that diverting ambulances elsewhere will overload other hospitals, prompting a domino effect of others downgrading service.

Two other nonprofit hospitals--Good Samaritan and French--have already followed California’s lead in announcing plans to downgrade their emergency rooms to standby status, meaning that ambulances will be diverted and physicians are allowed to be “on call” rather than required on the premises. Two big medical centers--Hollywood Presbyterian and White Memorial--have given strong indications that they, too, may soon curtail emergency services.

“California Medical Center is a key right now. If they stay in, I think the others will too,” said Robert Gates, director of health services for Los Angeles County. “It’s important we do anything we possibly can to keep California operating. If that (complaint) will accomplish that, then that would be good.”

The complaint, filed jointly by the Legal Aid Foundation of Los Angeles and the National Health Law Program, rests on the argument that the hospital may not adopt any policy or practice that “has the effect of excluding a certain class of person.”

In this case, the excluded class is the poor, attorney Michael Dowell said.

“Cal Med has never pretended that its actions are motivated by anything but a desire to avoid serving indigent patients,” the complaint charges.

“Its refusal to permit public emergency ambulances to transport indigent emergency patients to the hospital that is most accessible to them is tantamount to a denial of emergency care on the basis of inability to pay.”

The lead plaintiff in the class-action complaint is Leonard Huddlestone, a 59-year-old disabled man living in a Skid Row hotel who suffers from emphysema and “will in the future need emergency medical care” from California Medical Center, according to the complaint.

The complaint cites two cases where federal health officials have ruled that emergency room closures violated the requirements of the 1948 Federal Hill-Burton Act, which authorized $6 billion in loans and construction funds to more than 7,000 medical facilities throughout the country, including 195 hospitals in California.

In one case, a Florida hospital closed its emergency room for two weeks because of a physician protest over the high volume of indigent patients. In the other, a California hospital in the San Joaquin Valley was found to have violated Hill-Burton requirements by implementing a policy that excluded from treatment those pregnant women who did not have a physician on the staff of the hospital.