Countywide : Health Care Changes Urged by Doctors

A medical task force has proposed a series of measures to provide adequate health care to the poor in what emergency doctors and nurses have described as an endangered system of local emergency care.

“We think the situation is becoming so dire that it has become necessary to trample on some toes,” said Dr. Robert Hook after releasing a report Wednesday by the Society of Orange County Emergency Physicians and the Orange County Emergency Nurses Assn.

Hook, who wrote the report and its 16 recommendations, said the increased number of indigents seeking care at local hospitals combined with state and local budget cuts have brought emergency medical care in Orange County to the verge of collapse.

Among the proposals to revive the local system, Hook and the task force have recommended changing state law so that physicians’ assistants and nurse practitioners can dispense inexpensive health care to the poor.

Assistants and practitioners now work under the supervision of physicians, Hook said. The task force proposal would allow those practitioners to perform “general evaluations” involving “minor sicknesses” and let them work more independently of their physician supervisors.

“Perhaps it may be a slightly lower level of care, but it is better than none at all,” Hook said.

Among other things, the proposals call for a decrease in the amount of public funds spent on extraordinary efforts to prolong the lives of the terminally ill. Another would establish priorities for those who need medical care.

The report stated that more than 50% of Medicare funds are spent on people with terminal illnesses in the final six months of life.

“We need to make a humane and positive effort to decrease the massive expenditure of public funds spent on the heroic and futile attempts to prolong the lives and suffering of the terminally ill,” the report stated.

To make up for state and local budget cuts, the task force is pressing for passage of Proposition 134, the alcohol tax initiative. The report stated that the ballot measure would funnel about $700 million a year to medical and social services in California.

The task force said more revenue should be raised with taxes or user fees on products that contribute to the demand for medical services, such as cigarettes and motorcycles.

Although supportive of most of the task force’s recommendations, the Orange County Medical Assn. said the medical community must be careful about how the changes are implemented.

Of the task force’s proposal to allow more independence for physician assistants and nurse practitioners, John Rette, the medical association’s executive director, said doctors would be “amenable” to considering changes in those functions.

“The doctors recognize there needs to be change, but it has to be closely monitored,” Rette said.

Rette, Hook and other local medical authorities believe Orange County suffered a major blow last August, when the County Board of Supervisors refused to cover a $13.6-million cut in state funds for indigent medical care. The program, which lost 55% of its funding, pays medical bills for about 20,000 people in Orange County. Also, five trauma units have been closed.