Sick Way to Treat Desperately Ill : Demise of County Medical Services program must be averted to save lives

The state says it is the county’s responsibility, and the county says it is the state’s responsibility to pay for medical care for thousands of seriously ill San Diegans who have no insurance and who are not quite poor enough to qualify for Medi-Cal.

But how the responsibility is divided up is not the most important issue right now. Saving lives is.

Unless Superior Court Judge Harrison Hollywood issues a preliminary injunction Monday, the county on Tuesday is going to discontinue the County Medical Services program. There is little doubt that that could cause deaths. Many of the people who use the service are desperately ill.

The county makes a strong case that the state should accept more financial responsibility for health care for the poor. For years, the state has been cutting back on its allocations for this increasingly expensive necessity and for other programs, forcing the counties to absorb greater proportions of the cost.

But San Diego County, already low on the state funding list, had less cushion to absorb the shock than many other large counties.

The state offered to ask the Legislature to loan San Diego County $9 million. But the county refused the loan unless it was guaranteed by the state, because paying it back depends on being able to collect new fees from school districts and other local agencies, a very controversial plan that the school districts are fighting in court.

The Board of Supervisors said it had no choice but to stop paying for the medical services. So the county sued the state, and the Legal Aid Society, representing the poor, sued the county.

But the poor cannot wait for the outcome of a court case.

The county should accept the loan from the state while the case is being decided.

If it does not, and the court orders the county to keep the program going--as it should--then the county would have no other option but to pay for the medical care by cutting other vital services.

The regional health-care system also cannot await the outcome of a court case. The clinics and hospitals cannot long afford to continue care without reimbursement. And, if patients cannot get the care they need to stay out of hospitals, many will end up in hospital emergency rooms.

In the wake of the closing of San Diego General Hospital, this could be the straw that breaks the back of the emergency health-care system.

Judge Hollywood must not let this happen. The financial costs will ultimately be higher, and the harm to human lives will be irreparable. For some people, his court may truly be the court of last resort.