ORANGE COUNTY PERSPECTIVE : When the Diagnosis Is ‘Not Insured’

Few would argue if elective surgery for the needy and affluent alike at UCI Medical Center were scheduled based on how sick patients are. But the state says the system hasn’t been working that way.

According to a state Department of Health Services report, elective surgery has become hostage to another set of priorities--namely, who can pay and who cannot. If true, and the state data suggests it is true, that’s an unacceptable situation that should be remedied.

There’s no question that UCI Medical Center does its part to deliver health care to the indigent, in view of the fact that it handles 60% of Orange County’s Medi-Cal patients. But the danger for any hospital in taking care of the poor is that a two-tiered system of medical care will develop. In the area of elective surgery, this is what the state has in fact concluded.

The state followed up on a complaint from a UCI professor that such a dual delivery system was in place. It conducted its own monthlong investigation of 10 medical center departments and clinics.

In its review of orthopedic cases from January to early June, it found that only three of 45 insured patients had to wait 11 weeks or more for elective surgery, but that 53 of 88 indigent patients had to wait at least that long to be scheduled.

The inescapable conclusion--since none of the cases were emergencies and all involved similar medical need--was that the difference in scheduling had something to do with whether patients had insurance.

More disturbing is the state’s assertion that the numbers seemed to be backed by an unwritten policy.

Investigators reported that hospital staff members were operating under a common understanding that the admission of insured patients was preferred.

The hospital calls the accusation absurd and notes that it is the leading provider for indigent patients in Orange County. However, it still must give a more complete accounting than it has to date.

The report finds no problems in the overall quality of care given indigent patients, which is to the hospital’s credit. And the delays discovered in some departments, such as urology and gynecology-oncology, seemed to have eased up by the end of the review.

But the question remains: Why should poor patients have to wait so long for the same treatment?

The medical center has promised to have more to say on the report, but until it does, that’s an answer it has only begun to give.