State Plans to Step Up UCI Medi-Cal Inquiry : Health care: Allegations that some patients must wait for months for elective surgery will be pursued over the next two weeks.


State health officials decided Wednesday to broaden an inquiry into claims that UCI Medical Center discriminates against Medi-Cal patients by delaying their elective surgeries for up to six months.

Sally Lee, chief of Medi-Cal operations, said the medical center’s executive director, Mary Piccione, pledged during a two-hour meeting in Sacramento that “they do not discriminate.”

But determined to resolve the question for good, Lee said that doctors and nurses on her staff will spend the next two weeks pulling records and studying a wide sample of cases from every clinic that sends private and Medi-Cal patients to UCI operating rooms.

Earlier this spring, one of Lee’s doctors inspected files of 21 Medi-Cal orthopedic surgery cases from last November to January and determined that those operations had been delayed from two to six months. Meanwhile, Lee and several UCI doctors have said, patients with private insurance who also needed hip replacements or similar surgeries were operated on within a few weeks.


Some UCI doctors also claim that Medi-Cal patients face long waits for any kind of surgery, not just orthopedic procedures.

Lee so far has only documented a problem in orthopedics. And, she conceded this week, her earlier study was not random but rather “a sample of only problem cases.” So now, she said, her staff will take a broader sample.

If a policy of discrimination is confirmed, Lee has threatened to take the issue before the UC Board of Regents, ask legislative committees to investigate, or cancel the hospital’s Medi-Cal contract. The latter action is unlikely, however, since the medical center in Orange handles 60% of the county’s Medi-Cal patients.

Piccione and UC attorney John Lundberg, who accompanied her to the meeting in Sacramento, could not be reached for comment late Wednesday.

Meanwhile, Assemblyman Burt Margolin (D-Los Angeles), chairman of the Special Committee on Medi-Cal Oversight, expressed concern about the claims of discrimination at UCI’s hospital.

“The practice of treating county indigent and Medi-Cal patients in a separate and less-accommodating manner than those who are insured is an outrageous and indefensible practice,” he said. “They shouldn’t tag people Medi-Cal at the front door and give them second-class care. . . . If you can’t get your procedures done and wait months with chronic pain, you’re being given substandard care.”

Margolin said he will be looking into the matter further and may hold a special hearing into the medical center’s conduct.

Despite the decision to broaden the inquiry at UCI, Lee described her meeting with Piccione as amicable.

She said they reached agreement on the Medi-Cal reimbursement rate for UCI’s proposed birthing center for low-risk deliveries. She added that she had expected to spend six months working out details but now expects a contract to be signed within a month.

Further, Lee said, she and Piccione discussed the Medi-Cal system in Orange County--how more doctors and hospitals are needed to care for the poor and how the county should provide “general primary care” clinics.

Throughout the meeting, Lee said, Piccione “was not confrontational. She looked kind of tired. She feels constantly badgered. Criticism is cheap. Ideas are not and everybody is first to criticize.”