Emergency Visits Up at Private Hospitals : Health: Officials say the county’s decision to stop accepting new patients at its public clinics led to 11% increase.

Patient traffic in private hospital emergency rooms across Los Angeles County rose 11% during the week ending Sept. 2, an increase that hospital officials say is due to a decision by the county to stop accepting new patients at its public clinics.

The increase in emergency room visits was reported Friday by the Healthcare Assn. of Southern California, which tracked patients arriving at 36 emergency rooms in all sections of the county.

Private hospitals fear their emergency rooms will be inundated with low-income patients as the result of the county’s plan to close six comprehensive health centers, 28 neighborhood clinics and most hospital outpatient units Oct. 1 to help bridge a $1.2-billion budget shortfall.

The Healthcare Assn. survey compared emergency room visits between Aug. 27 and Sept. 2 and those recorded during the same period in 1994.

“The problems in emergency rooms haven’t gotten overwhelming yet, but this is a bigger change than we expected in one week,” said David Langness, a spokesman for the association. “We were frankly surprised at how much a difference a week makes.”

The survey showed that the number of patients who arrived at emergency rooms and then left without treatment rose 38% during the week, a statistic that Langness said hospitals kept as “a frustration meter.”

“That is a measure of lines,” he said. “If you go to an emergency room and get in right away, you don’t leave. If you sit an hour, a few patients will leave; if you sit there four hours, a whole bunch will leave.”

The survey also showed that the number of patients on the Medi-Cal program, a state-run health-insurance program for the needy, rose 9.7% over 1994, while the number of patients paying cash rose 8%.

The emergency rooms saw 16,045 patients during the week, contrasted with 14,233 in 1994. There were 595 patients who left without being seen, contrasted with 368 in 1994.

Toby Staheli, a spokeswoman for the Department of Health Services, said it may be too early to assess the long-term impact.

“We expected that we would see an increase in emergency rooms in both public and private hospitals, so this is not unexpected,” she said. “But we think it is a little early to draw too many conclusions. It’s only a week, and it’s the week before the policy took effect. I think we will find a better measure of the impact of the policy later on.”

Although officials began rejecting new patients at county clinics Sept. 1, they had previously posted notices telling patients they would have to seek medical care elsewhere.

The findings of the survey also are supported by the experience of several hospitals this week. The California Hospital Medical Center in Downtown Los Angeles, a private facility, cited an increase of about 10% in its emergency room visits since the policy took effect.

Meanwhile, county officials said Friday they will accept more transfers of seriously ill patients from private hospitals, averting allegations that the county was “dumping” patients.

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County hospitals last week began refusing transfers of most non-emergency patients, with officials saying they needed time to reorganize medical staffs that would be decimated by the scheduled layoff of 5,000 workers due to the county’s budget crisis.

But private hospitals, facing higher costs, charged that patients needing specialized care available at county facilities were also being turned away and threatened to file a complaint with federal regulators.

In a memo Tuesday to private hospitals, county Health Services Director Robert C. Gates said that besides accepting transfers of patients with traumatic injuries, burns and neurological problems, the county will take those needing “highly specialized services,” such as newborn infants requiring intensive care.

County officials said the move was not a policy change, but private hospital executives proclaimed a victory.

“This new policy certainly opens the door to more transfers than the county originally wanted to take, and it helps stabilize some of the chaos in both the private and public sectors,” said Langness of the Healthcare Assn.

Langness’ group had threatened to complain to the federal Health Care Financing Administration, which investigates possible violations of federal laws that prohibit hospitals from denying care to seriously ill people. Hospitals that dump patients face loss of their certification to receive Medicaid and Medicare reimbursements, a major funding source, as well as $50,000-per-violation fines.

Virginia Hastings, director of the county’s Emergency Medical Services agency, said Gates’ memo was intended only to clarify the county’s position. She said Gates’ Aug. 14 notice announcing the limits was not “real clear” on what patients the county would still take.

Hastings denied the county policy violates anti-dumping laws, adding that it was ironic for private hospitals--which last year shipped more than 16,000 patients to the county as soon as they were stable--to be attacking the county for rejecting them. The dumping laws, she said, were passed as a result of widespread dumping by private hospitals in the 1970s.

Hastings said the category of specialized services would include newborn babies needing transfer to county neonatal ICU facilities, or people who had limbs severed and require county microsurgery expertise.

In a Sept. 1 letter to the Healthcare Assn., Gates said private hospitals usually transfer uninsured patients for financial, not medical, reasons.

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He said the county will continue to reject “transfers of patients for non-specialized services simply because such patients are uninsured.” The county’s acceptance of patients requiring specialized services will depend on whether an appropriate bed is available.

Gates reiterated that the transfer limits may be lifted Nov. 1, when the county hospitals are restaffed and workers retrained in new jobs following employee layoffs scheduled to take effect Oct. 1.

Beth Abbott, acting regional administrator of the Health Care Financing Administration, said her agency is closely monitoring the transfer policy. But she said the county is unlikely to run afoul of anti-dumping laws as long as it treats people with serious illnesses or injuries.

Hastings said she had compiled figures on how many patients the county rejected since the new policy began eight days ago, but she refused Friday to release the figures, saying they are to be presented to the Board of Supervisors next week.