State Says UC Hospital Delayed Care for Poor

UCI Medical Center has practiced an unwritten policy of discriminating against poor orthopedic patients by delaying elective surgeries for up to six months, state health officials charged in a report released Thursday on Medi-Cal patients.

Sally Lee, chief of Medi-Cal operations for the state Department of Health Services, said the practice is a clear violation of state guidelines and has ordered the hospital to stop treating Medi-Cal and uninsured patients differently than those covered by private insurance.

“We told them to cease the practice immediately,” said Lee. “They were ordered to implement corrective action and notify us within 30 days.”

Lee called the hospital’s pattern of discrimination “unprecedented.”

“We have never received any complaints like this in the years I’ve been here,” she added.

In a written statement released Thursday, Mary Piccione, executive director of UCI Medical Center, called the Medi-Cal charges “absurd.”

“UCI has not discriminated against indigent patients,” Piccione said. “As we have said before, this hospital takes care of more indigent patients than any hospital in Orange County, with only 6% of the beds in the county.

“In fact, our volume of Medi-Cal patients has increased, while our resources have remained limited. To accuse the most committed provider of indigent care in the county of discrimination is absurd.”

The state’s monthlong investigation of 10 medical center departments and clinics was initiated after a UCI professor of orthopedics complained about the “two-level” medical care system he alleged was operating at the Orange hospital.

In a review by Medi-Cal officials of orthopedic cases covering the period between January and June 7, only three of 45 insured patients had to wait 11 weeks or more for their surgeries, while 53 of 88 indigent patients had to wait at least that long before surgeries were scheduled. While none of the cases were considered to be emergencies, all had similar medical need.

“There has to be some logic as to how they are handling these cases,” Lee said. “What is the reason for the difference? Is the difference in the amount of pain? What are the circumstances? The only differences we found were between those who were insured and those who weren’t. We were given no other basis.”

Lee stressed that health officials found no problems with the quality of care that indigent patients were given.

In addition to the orthopedics department, delays in elective surgery for indigent patients were also found in the urology and gynecology-oncology departments, but the delays were of lesser duration and had eased somewhat by the end of the review, Lee said.

According to the report, investigators were told by hospital staff that “if an indigent patient and an insured patient have the same surgical need for elective surgery, the insured patient is given priority in scheduling.”

Also according to the report, “a surgical staff physician indicated . . . that the dean of the UCI Medical School (Dr. Walter Henry) stated that he wanted more insured cases to be admitted and that the insured should be given priority over the indigent cases.”

Lee said that although the information was secondhand and there was no written order to discriminate, “we assume the sources to be reliable and have no reason to doubt them.”

A UCI spokeswoman said that hospital officials would have more detailed comments on the report after further review.

The report did not attempt to assess specific blame for the hospital’s policies.

“Since it is not a written policy, we don’t have any evidence of who we can attribute it to,” Lee said. “But that is less of an issue than why the hospital, as a public institution, is accepting such a practice. Our object is to get it fixed, not to punish anyone.”

Lee said that state health officials may bring the issue before the UC Board of Regents or even ask a legislative committee to investigate if UCI officials do not adequately address the problems. Officials could also cancel the hospital’s Medi-Cal contract, but that action is unlikely, since UCI handles 60% of the county’s Medi-Cal patients.

“It is a very difficult situation,” Lee said. “We do not want to terminate our agreement with them. We think they can provide good care.”