Surgeries for Poor Delayed at UCI Hospital, State Says

Investigating a charge of discrimination against the poor, state health officials have confirmed that Medi-Cal patients at UCI Medical Center must wait two to six months for orthopedic surgery that private patients get in a few weeks.

“We can’t tolerate that kind of treatment,” Sally Lee, chief of the Medi-Cal operations division for the state Department of Health Services, said Tuesday.

Lee said she will be meeting with UCI Medical Center officials next week to seek an explanation and demand that the situation be corrected.

All state contracts “require no discrimination,” Lee noted. Although her division has no power to levy fines, Lee said that health officials could terminate UCI Medical Center’s Medi-Cal contract. However, she called the latter action unlikely.

“We don’t want that to happen. We want them as a player,” Lee said.

A former county hospital, the medical center in Orange handles about 60% of the county’s Medi-Cal patients.

Mary A. Piccione, the medical center’s executive director, did not respond directly to Lee’s findings Tuesday. In a prepared statement issued by an aide, she said only, “We plan to continue to address the problems of access in Orange County with CMAC (the California Medical Assistance Commission, which negotiates Medi-Cal contracts with hospitals).”

Lee said one of her doctors recently inspected medical center files of 21 Medi-Cal cases from last November through January and discovered there were delays of from two to six months.

Calling the situation highly unusual, Lee said, “We’ve never encountered this before--not in the university system, not in any hospital.” Delays in surgery are appropriate for medical reasons but not because of administrative decisions, she said.

The investigation followed a complaint by Dr. Sanford Anzel, a clinical professor of orthopedics who is also chief of orthopedics at the Veterans Administration Hospital in Long Beach.

“We have experienced a carefully planned program of delaying appropriate surgeries to keep unfunded patients to a minimum in the hospital,” Anzel said.

He complained that private patients with arthritis who need artificial hips or knees can have their operation “within a couple of weeks” but that similar surgeries for Medi-Cal patients or those covered by Orange County’s Indigent Medical Services program typically wait five or six months.

“I don’t think it’s right to be on a two-level medical care system,” Anzel said. “It’s very difficult to tell a patient who’s 75 years old and having pain that keeps him awake at night that he has to wait” six months for his surgery.

According to Anzel, once a patient receives Medi-Cal authorization for surgery, the hospital admitting office will not schedule the surgery until it receives a date from “a gray book” in the deputy executive director’s office that is just for Medi-Cal or IMS patients.

Because so many cases have been delayed, Anzel said that since last fall orthopedic surgeries have dropped from 130 cases a month to 70.

Not only does the lowered volume mean Medi-Cal patients are spending months in pain, but also, Anzel said, doctors finishing their training in orthopedic surgery are getting inadequate preparation.

“Residents (doctors) are not having the opportunity in having elective surgeries, planned reconstructive surgeries, available to them,” Anzel said. “They’re busy with multiple trauma cases. But, unfortunately, that’s not all that orthopedic training requires.”