Funds to Save Emergency Rooms Set : State, County Reach Accord on Financing to Avert Collapse

Heading off a drastic blow to Los Angeles County’s emergency medical care network, state and local health officials Tuesday announced an agreement that will pump millions of dollars in public funds into 11 key private hospital emergency rooms.

The centerpiece of the agreement is an infusion of state and county funds--totaling between $3 million and $4 million in the next year--to the busy nonprofit California Medical Center in downtown Los Angeles, hospital officials said.

Ten other hospitals will receive smaller amounts, ranging from $23,000 to $216,000 apiece, to keep their emergency rooms afloat through Oct. 1. After that, county heath services Director Robert Gates said that, depending upon the county’s cash flow, he expects county supervisors to appropriate additional funds, for a total year-long commitment of $7.5 million.

System Near Collapse

The county’s emergency services network has been nearing collapse since May, when California Medical Center officials announced plans to close their emergency room to public ambulances, which tend to bring the hospital its sickest and poorest patients. The emergency room had been responsible for hospital losses of $500,000 a month.

Other hospitals, fearing they would be swamped by the overflow of patients from California Medical Center, threatened to curtail their emergency room services also. Health care officials warned of a domino effect that would knock out emergency services.

The resolution announced Tuesday was hailed as “a win-win situation for everybody” by James Barber, administrator of Daniel Freeman Memorial Hospital in Inglewood, which had been considering emergency room cutbacks.

‘Positive’ Result

“We couldn’t be more pleased with the outcome,” Barber said. “People in government, in the county and the state, are really coming to grips with the issue. This is a very positive thing for emergency health care in Los Angeles county.”

John Westerman, president of the Hospital of the Good Samaritan in downtown Los Angeles, which had also threatened to shut off public ambulances, said the hospital is “very happy with the reasonable compromise that has been worked out.” He predicted that enough momentum has been generated to head off problems for quite a while.

Anthony Abbate, senior vice president of the Hospital Council of Southern California, said that a poll he took of the various affected hospitals shows that the pact is acceptable.

Increasingly, officials at inner-city hospitals are complaining about severe economic losses arising from their emergency rooms. More and more patients are arriving there sicker and poorer, doctors say. By law, they must be treated and stabilized.

But hospital officials are increasingly unwilling to absorb the cost of this so-called “uncompensated” care, due to tight budgets caused by stringent government cost controls, low occupancy rates and, in some cases, debts from overexpansion.

Caution Expressed

Dr. Kenneth Kizer, state health services director, personally helped negotiate the resolution that he announced Tuesday at the California Medical Center. Kizer said that he is pleased with the agreement, but cautioned that a long-range strategy addressing the problem of uncompensated care must be developed or there will be continuing problems and ultimately a breakdown in the health care delivery system.

“It’s going to take some time to work out the answers,” he said.

California Medical Center President Terry Belmont echoed, “Shoring up a crumbling health care financing system with piecemeal solutions, or propping up one strategically located institution is like putting a Band-Aid on a major hemorrhage.”

The center’s medical staff chief, Dr. Kenneth Senter, said that he believes that even with the newly reached solution, the emergency health care services rest on a “shabby . . . shaky” arrangement. “The system is ill-conceived, under funded and dependent upon a dwindling number of volunteer physicians.”

Funds to Doctors

A key negotiation point for California Medical Center has been to receive enough money to pass along some of it to emergency room doctors. The head emergency physician, Dr. Alan Heilpern, said that he collects only about 30% of what he bills for physician services.

Belmont, the medical center’s president, said the hospital will receive a total of “between $3 million and $4 million during the next year” from both the county and the state. Most of the money is coming from a rate increase in state funds paid to the medical center for treatment of Medi-Cal patients. The increase was approved recently by the California Medical Assistance Commission, which negotiates state Medi-Cal contracts with private hospitals.

The medical center is also scheduled to receive $285,000 from Los Angeles County through Oct. 1, and Belmont said he expects that pledge to be renewed at two-month intervals for a one-year period.

The other 10 hospitals in line for Los Angeles County funds through Oct. 1 are:

Brotman Medical Center, $88,875; Centinela Hospital Medical Center, $52,875; Daniel Freeman Memorial Hospital, $216,000; Dominguez Medical Center, $81,000; Hollywood Presbyterian Medical Center, $111,375; the Hospital of the Good Samaritan, $111,375; Queen of Angeles Medical Center, $52,875; Robert F. Kennedy Medical Center, $105,750; St. Francis Medical Center, $121,500, and White Memorial Medical Center, $23,625.

Gates said that continued funding of the hospital emergency rooms beyond Oct. 1 will partly depend upon passage of Proposition 99, a November ballot initiative that proposes to raise money for health care through additional taxes on cigarettes and tobacco.

Kizer said that in the event the county is unable to continue funding beyond Oct. 1, he will agree to allow California Medical Center to exercise its option to curtail emergency room services effective Jan. 1.