The Doctor Isn’t In

California law requires that hospitals provide medically necessary care to patients who show up in their emergency rooms. But it’s a hollow obligation, no matter how willing the hospital, if the doctors don’t show up.

As a Times report showed Tuesday, medical specialists including plastic surgeons and orthopedists have increasingly rebelled against the failure of managed care companies to pay them by refusing to care for emergency room patients--even insured ones.

There is plenty of blame to go around. A state panel recently concluded that “in California, the problem of availability of backup [emergency] services is reaching crisis proportions in several hospitals.” Where is the state Department of Health Services, which is responsible for ensuring that emergency rooms have adequate, trained staffs? The state’s managed care regulator, the Department of Corporations, is also remiss for not disciplining managed care plans that don’t pay up when emergency rooms treat the plans’ patients, as required under a 1995 law. Federal regulators are lax in enforcement of a similar emergency care law that pertains to all hospitals that accept Medicare payments.

Finally, physicians--despite their well-founded complaints--should be held accountable if they enter a contract with a hospital to provide expert care in emergencies then cynically exploit contractual loopholes to escape their obligation.

The remedies could start with the Legislature. The Senate, for instance, is scheduled to vote today on a measure by Sen. Jackie Speier (D-Daly City) that would require managed care middlemen to set aside cash reserves to pay their doctors in case of insolvency--an increasing problem. The state’s fund for reimbursing the cost of emergency room care for the uninsured also needs bolstering: It currently pays only a fraction of those expenses.

In return, the California Medical Assn. should stop fighting efforts by the California Medical Board to beef up its admittedly lax discipline of physicians who shirk medical obligations. A bill by Assemblywoman Susan A. Davis (D-San Diego) would help, raising the annual fees doctors pay to the board to increase enforcement. Instead, the CMA supports an opposing bill by Sen. Kevin Murray (D-Culver City) that would actually weaken the board’s oversight by, among other things, making it harder to investigate and punish doctors who violate good medical practices.

Compromise is key, if serious frays in the state’s emergency room safety net are to be repaired. If emergency medical care is not important enough to transcend special-interest politics, then what is?