Community Memorial Sues County Hospital : Ventura: Facility claims public center is increasingly vying for privately insured clients. Action caps 18 months of acrimony.

Saying that Ventura County Medical Center has overstepped its legal role of treating the poor, rival Community Memorial Hospital filed suit Tuesday to stop the nearby public hospital’s alleged competition for privately insured patients.

The lawsuit caps 18 months of acrimony between the two hospitals, located just three blocks apart in central Ventura.

Community Memorial is seeking a Superior Court order that would keep the county hospital from accepting privately insured patients who could be served at private hospitals.

The suit also seeks to force the county hospital to treat more patients who are uninsured or unable to pay--its state mandate as a provider of last resort.

And Community Memorial demands that the county begin sending more patients insured under state Medi-Cal to private hospitals--a request prompted by insurance cutbacks that have led to a shrunken pool of patients.

For more than a year, Community Memorial has waged an increasingly public battle with the county hospital over its plans to add a new 105,000-square-foot wing. But attorneys for Community Memorial said Tuesday that their lawsuit is about more than the proposed renovation and expansion.

“The real focus of this lawsuit is about the county’s proper role in providing health care,” Los Angeles lawyer John E. McDermott said.

But county hospital officials said they have never sought private patients, do not treat many and have no plan to compete for them against private doctors and hospitals.

“We do not go after the private sector,” hospital Administrator Pierre Durand said. “Most of our private sector insurance comes through the emergency room or neonatal care. Our system targets the poor, the indigent and the Medi-Cal (patients). Our statistics show that.”

Only 10% of the patients served by the county hospital have private insurance, Durand said. That percentage has not changed much even with a new county plan that allows county employees to receive treatment at the public hospital and its numerous clinics.

Fully 70% of county hospital patients are insured by Medi-Cal, Durand said. Another 8% are covered by Medicare. The remaining 12% of patients are unwilling or unable to pay, and cost the county $20 million to $24 million each year, Durand said.

In contrast, the private nonprofit Community Memorial Hospital spends only about $300,000 a year on indigent patients, according to Durand.

Community Memorial spokesman Donald Benton said that only about 3% of his hospital’s patients are insured by Medi-Cal, although that number is expected to increase because the hospital recently signed a Medi-Cal contract with the state. Only 1% to 2% of the hospital’s patients are indigent, he said.

State figures show that only 0.2% of Community Memorial’s patients were indigent in the 12-month period ending last September.

According to McDermott, the county hospital system has increasingly competed for the fully insured private patients who are private hospitals’ lifeblood.

The lawyer pointed to a plan approved by the Board of Supervisors last fall that for the first time allows the county’s 6,000 employees to go to county facilities for hospitalization and basic treatment. About 1,000 employees have chosen that lower-cost option, and Community Memorial has lost patients as a direct result, officials have said.

McDermott noted that the county recently opened new clinics in Simi Valley and Thousand Oaks and is planning three more in Oxnard, Fillmore and Moopark. It already has clinics in Ventura, Oxnard and Santa Paula.

In the lawsuit, Community Memorial claims that the county hospital attracts private patients in other ways as well--and deliberately shirks its responsibility to treat the poor.

Physicians at the county’s clinics get extra pay for referring privately insured patients to Ventura County Medical Center, which is prohibited by state anti-kickback laws, the suit alleges.

And in Ventura, ambulances take patients from some of the city’s poorer neighborhoods to Community Memorial, while transporting some more affluent patients to the county hospital, the suit maintains.

County officials acknowledge that doctors at county clinics do get extra pay when they treat their patients--both rich and poor--at the county hospital. But they say that is the only logical way to compensate the clinic physicians for services.

“That’s the way our doctors get paid,” said Samuel Edwards, medical director at the county hospital. “How else do you pay a clinic doctor (whose patients are on Medi-Cal)?”

County Health Care Agency Director Phillipp K. Wessels has said that it is also true that some poor patients are routed to Community Memorial, but only to correct a past imbalance in the number of emergency patients sent to the private hospital.