Groups Planning Suit Say Poor Wait Months for Medical Specialist Care

Describing nightmarish conditions at county hospitals in which indigent patients must wait up to nine months for an appointment to see a specialist physician, legal groups announced Wednesday that they will file a lawsuit to force Los Angeles County to treat the sick in a timely manner.

The suit, which five legal groups said they will file today, is an effort to force the county Board of Supervisors to adopt minimum standards covering accessibility and waiting times at the county’s outpatient clinics and waiting rooms, attorneys said.

In documents released Wednesday, physicians said patients with untreated diabetes wait months for appointments as their condition worsens, women with lumps in their breasts are forced to put off treatment as they wait months for biopsy results, and patients with mild stroke symptoms must undergo risky delays that may ultimately result in major strokes.

Taxpayers ultimately foot the bill for the delays, since they must pay for much more expensive treatments when doctors are unable to intervene early enough to prevent more serious health problems, said representatives of the groups--the Western Center on Law and Poverty, the Legal Aid Foundation of Los Angeles, the American Civil Liberties Union, the National Health Law Program and the Legal Services Program for Pasadena and San Gabriel-Pomona Valley.

The suit will be supported by a study, prepared by lawyers and based on county reports, showing that indigent patients at County-USC Medical Center must wait 38 weeks to see a podiatrist, while those seeking specialists in neurology, diabetes, urology or gastroenterology cannot make appointments at all because the waiting lists are already too long. At Harbor-UCLA, patients must wait 16 weeks for a diabetic eye screen, 21 weeks to see an eye doctor and 24 weeks to see a brain specialist.

In the past, county health officials have attributed the long waits to budget reductions forced on the county by state funding cuts. On Wednesday, Sharon Wanglin, a spokeswoman for the county Department of Health Services, said the department would not comment immediately on the suit. “We haven’t seen it yet. We can’t say anything until we have time to go over it,” she said.

Wanglin said the county was doing its own study. As for the detailed report on waits at county hospitals released Wednesday, she said “it might be accurate or it might not be accurate.”

The lawyers for the groups presented various statements from physicians detailing the serious problems countywide as a result of treatment delays. Dr. Mark Goldberg, chairman of the department of neurology at the county’s Harbor-UCLA Medical Center, described the effect of waiting up to five months for an appointment at his clinic.

He said some patients arrive after suffering mild “warning” strokes with symptoms such as blurred vision, weakness in an arm or loss of feeling on one side.

“When they come in we look for treatable causes such as high blood pressure, heart problems, blockage of major vessels to the brain. We can completely prevent many of these strokes if we see these people in time,” Goldberg said.

But sometimes it is too late.

“Many of these people do not get in the system prior to the stroke,” he said. “They might come to (the emergency room) and after five hours of sitting and not being seen, they leave because they feel better and are tired of waiting. A private patient would be rushed to a neurologist.”

Goldberg said that “all but the most ill individuals are discouraged” from seeking an appointment at county specialty clinics. At Harbor-UCLA’s Neurology Clinic, new patients referred by county clinics “must wait five months for an appointment,” and then another six weeks for a follow-up appointment, the physician said.

In another written statement, Dr. Susan Fleischman, director of medical services at the Venice Family Clinic, said she is reluctant to send her patients to county clinics for specialty care because of the long waits.

“One of my patients is a woman in her mid-40s,” Fleischman said in another document given to the county Board of Supervisors after being uncovered by legal aid lawyers. She explained that a mammogram turned up a mass in that patient’s breast.

“I referred her to the breast clinic six months ago for further diagnosis and treatment,” she said. “She should have been tested promptly. Her appointments were canceled twice due to overbooking. It took five months for her to finally get an ultrasound,” Fleischman said. That patient, fortunately, was not cancerous, the physician said.

Another of her patients, faced with waiting months for a biopsy on a possibly cancerous condition exposed by a Pap smear, said one county physician “recommended that she have a hysterectomy instead because she could get that sooner than a biopsy,” Fleischman said.

Another physician, Dr. Ed Newton, who works at County-USC, wrote that last October the waiting time for operations to remove a gallbladder was six months. “That is six months that this person has to live in pain. It may impair her ability to work or simply to function on a day-to-day basis. If that patient is indigent, she has nowhere else to go and must wait the six months,” Newton said.

Dr. Matthew Budoff, an internist at Harbor-UCLA, said a patient with diabetic eye trouble might encounter the following scenario if he shows up at a county hospital with relatively minor problems such as seeing spots or having headaches.

“He probably will give up after 24 hours and go home,” Budoff said, drawing on his experience with patients in the county system.

“When his symptoms get worse in a few weeks he’ll come back to the emergency room. But he may not be seen and may leave again. He will probably come back two or three times before he is seen. Then he will be given an appointment with general medicine in three months. After that exam, he’ll have to wait another six months for the ophthalmology clinic. By the time someone is available to see him, he may have gone blind.”

Drawing on those and other documents, Robert Newman, an attorney for the Western Center on Law and Poverty, told reporters Wednesday: “The county has no standards for the timely delivery of care to the poor.”