Medi-Cal Rejection in County Shameful : Doctors, State Need to Take a New Look at Program

It is a shameful fact that most doctors and hospitals in Orange County refuse to treat Medi-Cal patients. That rejection creates a bad situation that probably will get much worse if the Fountain Valley Regional Hospital and Medical Center, which dropped out of the county’s trauma network in December, goes through with its intent to drop its Medi-Cal contract too.

As it is, there are far too few Medi-Cal beds in the county, especially for maternity care. Fountain Valley’s abandonment of the already overtaxed system will make it even harder for the Medi-Cal patients--and for the other hospitals that will continue to honor their commitment--to treat them.

The Fountain Valley hospital is one of the county’s busiest Medi-Cal facilities. That fact, accented by the increasing number of Medi-Cal patients it has been treating, is one of the principal reasons that the for-profit, doctor-owned hospital decided to serve notice on the state that beginning Nov. 20 it will merely meet the letter of the law by treating emergency Medi-Cal patients only.

Hospital owners were concerned about the imbalance of treating too many indigents and not enough private patients. But the growing Medi-Cal caseloads demand more, not fewer hospitals. Without enough facilities, patients are left with no place to go, until their medical problem becomes a medical emergency that results in greater costs.

The full impact of Fountain Valley’s decision to drop out cannot yet be measured, but the prospect has raised several questions and fears in the medical community.

Some fear a domino reaction in which the few remaining hospitals left to treat Medi-Cal patients decide to drop out too, rather than be inundated with the poorer patients.

Some state officials are befuddled and annoyed by the attitude of Orange County doctors toward caring for the poor. Most of them refuse to treat poorer patients and some that do severely limit the number that they will see.

Many doctors criticize Medi-Cal for its low reimbursements and delays and red tape in collecting their fees.

While the Hospital Council of Southern California has been urging more Medi-Cal contracts, some officials in the medical community would like to see Orange County become an “open area” in which there are no contracts so people could go to any hospital that would take them. They argue that will improve access.

Some state officials, however, think the lack of legal commitment would result in less, not more treatment, and leave patients not knowing where to go for care.

County officials have urged the state to ease the shortage of maternity beds by allowing more single-service obstetrics-only Medi-Cal contracts. But the state, wisely, has been reluctant to do so lest the approach lead other contract hospitals to try to drop their full-service programs.

There are no miracle cures to the Medi-Cal problem, but Fountain Valley’s notice of withdrawal serves to focus attention on the need for the medical community and the state to find more areas of agreement.

The state must streamline its procedures to eliminate bureaucratic red tape and ease under-funding with more realistic reimbursements.

In the medical community, the answer is not for hospitals to drop out and refuse to treat the poorer patients. Rather, more doctors and hospitals should agree to treat them and finally accept their fair share of medical and social responsibility.