L.A. May Start Imposing Fees for 911 Medical Care : Emergencies: But service would not be denied to those unable to pay, city officials say.

A proposal is moving through City Hall that, for the first time, would impose fees on city residents who call 911 and receive emergency medical care from the Los Angeles Fire Department.

The measure, designed to alleviate budget shortfalls, would impose a charge of $75 for first aid-type treatment and $173 for more sophisticated life-saving care. But officials stressed that help would be dispatched first and that bills would be mailed later. Care would not be denied anyone unable to pay, they said.

“We’re doing this reluctantly,” said Battalion Chief William Ward, commander of the Fire Department’s planning section. “Until now, the (emergency medical) system for the most part has been subsidized by our budget. But I think it’s obvious we’re in hard economic times, so we’re moving toward more fee-supported programs.”

The Fire Department suffered significant reductions for the first time this fiscal year, when nearly $23 million in cutbacks forced “rolling brownouts”--a temporary reduction in emergency crews at stations citywide.

The proposal is expected to be heard by the City Council’s Public Safety Committee within the next week. It has already garnered the support of Mayor Tom Bradley, the Fire Department, the Board of Fire Commissioners and Keith Comrie, the city’s chief administrative officer.

“It is with great reluctance that the city is looking at charging for these services,” said Bonnie Brody, deputy to Councilman Richard Alatorre, who heads the Public Safety Committee and supports the proposal. “But, as with every other fee in every department, we have to look at the bottom line.”

In fiscal 1990-91, according to the city administrative office, emergency medical care cost the city $46.5 million. Only $6.7 million of that was recovered by the city, which now charges residents only for ambulance transportation, mileage and oxygen. The current proposal, which could go into effect as early as September, is expected to generate an additional $4.3 million in “revenue enhancement” this fiscal year and $13.5 million in each subsequent year.

If the proposal is implemented, more than two-thirds of the money is expected to come from insurance companies, as well as from Medicare and Medi-Cal, according to a CAO analysis.

“We’re not recommending any fees that insurance companies don’t pay for,” said George Wolfberg, chief administrative analyst. “Basically, people will wind up getting charged in accordance with how banged up they are. That’s pretty traditional when it comes to doctors’ bills.”

Fire officials said they hoped that money raised by the fees would go back into the department’s budget to return to service some of the emergency crews that have been “browned out” of service since July 8. Because such fees go directly to the city’s general fund, the City Council would have to earmark the money for Fire Department use.

Several cities around Southern California have already begun charging for emergency medical service. Among them are Pasadena, Beverly Hills and Anaheim.

“No one wants to increase taxes if you’re a politician, or increase fees if you’re a service provider,” said James E. Blancarte, president of the Board of Fire Commissioners. “Unfortunately, it may be necessary.”

But, he added, no one calling 911 for emergency help will hear a dispatcher asking for a credit card number. “The Fire Department won’t look to the user’s ability to pay as a criterion for dispatch.”

Under the proposal, residents also will be charged for certain supplies, including $12.75 for oxygen masks and $23 for obstetrical kits for delivering babies. All the proposed fees are based on an average of the actual costs to the Fire Department.

“Other cities throughout the Southland have imposed similar fees,” said Bradley’s spokesman, Bill Chandler. “Residents should know that service is provided first, and the city would then contact insurance companies later.”

In recommending the user fees, the city administrative office also examined other possibilities.

One, which was rejected, would have imposed fees on anyone who calls 911 and does not need emergency treatment or transport to a hospital. Los Angeles has long opposed such a charge because it could deter poor people from calling for help. Moreover, officials say, it is sometimes difficult to tell who placed the call.

Another alternative recommended by the Board of Fire Commissioners but not yet formulated into a proposal is a residential subscription fee that could add perhaps $3 a month to utility bills.

Charging for Emergency Calls?

The following is a list of fees proposed to be charged residents who call 911 and receive emergency medical care from the Los Angeles Fire Department. The city does not currently charge for either supplies or treatment, but only for ambulance transportation when needed: Basic Life Support Treatment* :$75 Basic Life Support Treatment and Transport :$147 Advanced Life Support Treatment** :$173 Advanced Life Support Treatment and Transport: $338 Bandages/Dressing: $12.75 Oxygen Tube or Mask: $12.75 Backboard and Splint: $23.75 Obstetrical Kit: $23 Traction Splint: $42.25 * Treatment of such problems as burns and common household injuries. ** Services rendered by paramedics that can include life-saving care.

SOURCE: Chief Administrative Office