Curing What Ails Medi-Cal : Few Physicians Now Accept Such Patients; Those Who Do Work Harder but Earn Less

The doctor chuckled with delight as the brown-haired girl smiled, chanted and swung her arms playfully in the air above her crib.

Dr. Stephen Osburn said he felt gratified that Christina, a profoundly retarded 4-year-old, has a chance to develop, maybe even learn a few words, now that he has helped her overcome a debilitating series of illnesses.

“Christina’s goals are very small, but they are very important to her,” said Osburn, who spends two days each month examining and treating about 60 developmentally disabled children who like Christina live at Hy-Lond Home, a convalescent facility in Garden Grove.

Residents of facilities like Hy-Lond don’t always get such devoted physicians. Their stigma is not that they are handicapped but that they are part of the large and swelling ranks of people in Orange County and throughout California who must rely on the state to pay their medical bills through the Medi-Cal program.

By allowing Medi-Cal patients to become 40% of his practice, Osburn, a 47-year-old Santa Ana pediatrician, is an anomaly within the medical profession.

Medi-Cal’s low reimbursement--the state pays 24% to 40% of customary fees--has made the state’s health insurance for the poor unattractive to most physicians. Only about 100 physicians of the 2,850 members of the Orange County Medical Assn. have allowed their names to be put on a list that the group uses for Medi-Cal patient referrals. Medi-Cal physician lists at hospitals also are short, as most doctors take Medi-Cal patients only on a case-by-case basis.

The current state budget crisis, which has temporarily halted any Medi-Cal reimbursement to doctors and other health care providers, is only the latest problem that discourages physicians. They complain about Medi-Cal’s excessive paperwork, frequent billing changes and seemingly capricious payment denials and delays.

But there are still some doctors who, like Osburn, are committed to serving patients regardless of their ability to pay. And the need for such dedication is great: In Orange County the number of people on Medi-Cal has almost doubled since 1989 from 126,000 to 233,000.

The small cadre of doctors who see Medi-Cal patients say it is their ethical responsibility. Those who were interviewed also frequently had more personal motives: a Vietnamese refugee who is repaying society for her good fortune; a neurologist dedicated to helping the handicapped because of a boyhood friend who contracted polio.

Dr. Robert E. Cassidy, an orthopedic specialist in Mission Viejo, said he is following in the tradition of his profession and his family by treating Medi-Cal patients.

“I grew up in Washington, D.C., where my dad was a pediatrician, and all hospitals back there had clinics for people who couldn’t afford to go to private doctors,” said the 51-year-old graduate of Georgetown University Medical School. “Everyone seemed to be taken care of back then.”

Only with the entry of state and federal programs like Medicare and Medi-Cal, Cassidy said, did a new generation of doctors begin to believe that they deserved to be compensated for charitable work.

Cassidy is angered that he is frequently sent Medi-Cal patients from hospital emergency rooms in distant communities after orthopedic surgeons on staff at those hospitals turn them away. Whenever that happens, Cassidy treats the patient but sends a letter of protest to the Medical Board of California which licenses physicians in the state.

Cassidy, the father of nine children, works extra hours every week to compensate for the low reimbursement he gets from Medi-Cal. “If I wasn’t seeing Medi-Cal patients, I would be out playing golf,” he said.

Dr. Roger Huf, a pediatric neurologist who practices in the East Los Angeles community of Boyle Heights, said he noticed two years ago that the Medi-Cal portion of his business had burgeoned to 85%. Medi-Cal patients were coming to him from as far as Orange, Riverside and San Bernardino counties.

“First I thought I was becoming famous,” Huf recalled with a laugh. “Then I realized I was the only guy left in my field who was taking Medi-Cal.” So he began limiting his Medi-Cal practice to the geographical area surrounding his office, with some exceptions.

Because his best childhood friend contracted polio when they were growing up, Huf said, he made an early commitment to treating handicapped children.

So Huf travels from his Westwood home to tend to children with neurological problems at two Garden Grove facilities for the severely disabled, Hy-Lond and Meadow View.

“There are tremendous rewards for doing this,” Huf said. Previously, he said, Hy-Lond was unable to provide continuing neurological care for its young patients, many of whom suffer from frequent seizures, because of the difficulty of finding doctors who will accept Medi-Cal payment.

He takes pride that in the 18 months he has been visiting Hy-Lond, he has weaned many of his patients off all anti-seizure medications or reduced their drug reliance. But Huf said Hy-Lond sometimes can’t find doctors in other medical specialties.

He said that recently a boy who needed to have a feeding tube inserted into his stomach had to be transported to White Memorial Medical Center in Los Angeles for the surgery after Hy-Lond officials were unable to find an Orange County surgeon willing to take Medi-Cal.

An Anaheim internist who accepts Medi-Cal clients but did not want his name to be publicized for fear of being deluged with patients said he has sympathy for the handicapped and those temporarily down on their luck, the people for whom he believes Medi-Cal was intended.

But, the internist said, the Medi-Cal population also includes “a sub-sector of patients who are more of a problem. Many have a history of drug abuse or antisocial behavior or psychiatric problems that make them harder to deal with.”

Fears of having to cope with such patients is yet another reason why many doctors avoid the Medi-Cal program, he said.

Simon Zemel, an obstetrician/gynecologist in Santa Ana, said he discovered that his fears were unfounded when his medical group began to accept Medi-Cal patients a year ago. Zemel said he learned that most of the Medi-Cal families he sees are no different than private-paying families.

More obstetrician/gynecologist specialists have begun to accept Medi-Cal patients in response to the state’s decision to boost their reimbursement with the aim of improving prenatal and delivery room care for poor mothers.

However, Medi-Cal continues to provide much lower reimbursement to pediatricians. So after Medi-Cal babies are born, it is difficult to find doctors to care for them.

One of the exceptions is Osburn, who is considered something of a “hippie” by associates for the beard and sandals he wears, the beat-up van he drives and for his disinterest in becoming rich.

Osburn is among the very few pediatricians on staff at Western Medical Center-Santa Ana who will take on Medi-Cal babies born at the hospital and care for them through their childhood.

For his practice to survive, Osburn recently decided to stop seeing new Medi-Cal patients who call his office for appointments. He also economizes by doing without a nursing assistant, taking upon himself such tasks as weighing and measuring his young patients. And he works exceptionally long hours, from about 7:30 a.m. to as late as 11 p.m., in part because he is always on call at night.

Osburn said he is toying with the idea of sharing after-hour calls with another doctor. He observed that it would be much easier to find a physician willing to do this if he didn’t have so many Medi-Cal patients.

But Osburn said he is committed to continuing to take care of children who need a doctor, including those on Medi-Cal, as long as he can do it and stay in business.

“There are children on Medi-Cal who need care. It would be nice to make more money, but the job of a pediatrician is to take care of kids.”

Medi-Cal Rolls, Costs Increasing The Medi-Cal rolls in Orange County have nearly doubled since 1989; costs increased 40% between 1989 and 1991. If expenses for the second half of this year equal those in the first six months-$290.9 million-1992 costs will exceed last year’s by $100 million. Number of Patients 1992: 233,170 Note: Total changes on a monthly basis. Above figures are from June of each year. Costs In millions 1992: $465.6 Whom to Call Patients looking for physicians who will accept Medi-Cal reimbursement can call the Orange County Medical Assn. referal service at (714) 978-1770 from 9 a.m. to 4 p.m. Mondaythrough Friday. Also they can contact the referral services provided by many hospitals. Source: Orange County Health Care Agency Researched by JANICE L. JONES / Los Angeles Times