County Plans to End Subsidies for Emergency Rooms

Los Angeles County officials disclosed Friday they are planning to suspend subsidies to key private hospital emergency rooms Oct. 1, raising the possibility once again of drastic cutbacks in emergency services.

Less than three weeks ago, state and local health officials averted threatened cutbacks in emergency care by announcing plans to pump more than $9 million into 11 hospitals. So far, more than $4 million has been awarded, and government officials were hopeful that the additional subsidies would be available through the rest of the year, or at least through November.

But county Health Services Director Robert Gates said Friday that a recent $78.6-million shortfall in state funding to the county has put the hospital subsidies in jeopardy.

“My hope was to continue funding this program. I regret very much that the county’s financial situation will prevent this,” Gates said in an interview.

Richard Dixon, the county’s chief administrative officer, said the shortfall in state funds poses a serious threat to all county health services. But he said the hospitals should not despair because his staff is studying several bills passed by the Legislature that may provide financial support for emergency services. The measures are awaiting the governor’s signature. Dixon’s top aide, Virginia Collins, said her analysis is incomplete but, she cautioned, “Quite frankly, it does not look good.” Dr. Kenneth Kizer, state health services director who helped negotiate the August agreement, said in an interview, “I’d be real disappointed if the county did not continue the supplemental funding. We were optimistic they would.”

“I’m tremendously disappointed,” said Stephen Gamble, president of the Hospital Council of Southern California, which has called a meeting next week of the 11 private hospitals affected by the funding cutbacks.

“Our expectations are, apparently, definitively shattered,” said James Barber, administrator of Daniel Freeman Memorial Hospital in Inglewood. “We got a reprieve, and now we’re right back into hot water again.”

The county’s entire emergency services network has faced a serious threat since May when California Medical Center in downtown Los Angeles announced plans to close its emergency room to public ambulances, which tend to bring the hospital its sickest and poorest patients. Officials said losses from the emergency room amounted to about $500,000 monthly.

Other hospitals, fearing that they would be swamped by the overflow of patients from California Medical Center, threatened to curtail their emergency services also.

On Aug. 23, the county distributed $1.2 million among the 11 private hospitals to prevent cutbacks through Oct. 1, and Gates said that depending upon the county’s cash flow, he expected a total $7.5 million in subsidies to be available over the course of the next year. In addition, the state provided about $3 million to the California Medical Center by raising the hospital’s Medi-Cal reimbursement rate.

Reacting to the county’s plan to suspend subsidies Oct. 1, Harvey Rudisaile, president of White Memorial Medical Center in East Los Angeles, said, “None of the hospitals want to pull out of the emergency services system. I hope this doesn’t cause that. I’m worried that it might. This just might cause the whole thing to come tumbling down.”

Dr. Brian Johnston, director of White’s emergency room, said he feared hospitals may pull out of the system. “They cannot commit suicide to fund a government obligation,” he said.

At Queen of Angels Medical Center, also in East Los Angeles, Richard Smith, chief executive officer, said, “I’m really disappointed because we had hoped this was something where there would be ongoing support.”

Health officials agreed Friday that California Medical Center remains the pivotal private hospital in the emergency care network, with curtailment of its emergency room services likely to trigger cutbacks elsewhere.

Hospital spokeswoman Michelle Barker said California Medical Center’s position remains unchanged from several weeks ago when its director, Terry Belmont, said, “Unless the county provides ongoing funding, California Medical Center will not be able to continue providing a basic emergency service.” He was unavailable for comment Friday.