UCI Medical Center Caps Indigent Care

UC Irvine Medical Center officials today will begin referring some poor patients to 24 other Orange County hospitals, saying the center can no longer provide the bulk of medical care for the indigent.

Under the new policy announced Wednesday by its chief executive officer, Dr. Ralph Cygen, the medical center in Orange will turn away poor patients who do not live within five miles of the hospital or two miles of its satellite clinics in Anaheim and Santa Ana.

Emergency care will still be provided, as will service to existing patients, Cygen said. But new patients living outside UCI Medical Center’s service areas whose conditions aren’t immediately life-threatening will be referred elsewhere.

“There is a looming health care crisis in Orange County,” said Cygen, the latest in a long line of directors of the financially troubled institution, which traditionally has been the main provider of care for the poor in the county.

No one knows how many people will be affected, or how soon. The medical center will refer patients to other contracting hospitals or to the county officials who administer indigent care funds.

Patient advocates said they understand UCI’s predicament and reserved their criticism for county supervisors, who decide how much money to spend on health care.

“No one who’s been a health advocate in Orange County for any period of time would hold it against the university because they’re taking this step. They’re doing more than their share,” said Nancy Rimsha, director of the Health Consumer Action Center at the Legal Aid Society of Orange County.

County Supervisor Cynthia P. Coad called UCI’s actions unwarranted.

“UCI was premature because we were making headway,” she said. “UCI thought we were at a stalemate, but we were not at a stalemate.... I thought it could be worked out a different way.”

But Cygen said the medical center, which must build a costly new facility to meet earthquake safety standards, is losing too much money and jammed with too many poor patients to serve anyone properly or meet the university hospital’s teaching and research missions.

“This has been going on now for almost 20 years; it has created a crisis in the medical center and a crisis in the county,” he said.

Cygen said the medical center was not reimbursed by the county for $10 million to $11 million in hospital services and $2.5 million in physician services in the fiscal year that ended June 30, and as much as $200 million over the past two decades.

A recent study of the county’s Medical Services for the Indigent program showed that with just 9% of the county’s hospital beds, UCI Medical Center provided 29% of all inpatient services among the 25 hospitals that contract with the county to provide MSI care in the fiscal year ending June 30, 2000. And it provided 63% of all outpatient services, several times more than the next-highest provider.

Medical center officials put the county Health Care Agency on notice last year that it would not continue to serve indigent patients unless more providers participated in the contract program.

Since January, a task force of hospitals, the Orange County Medical Assn. and the county Health Care Agency have met 20 times to seek a solution, said David Riley, the county’s MSI negotiator. One of the issues that came up was the number of patients going to UCI, Riley said.

The medical center’s action also is an emphatic statement that it will not serve as the de facto county hospital for one of the three urban counties in the state that do not have a county-run facility to provide medical care for the poor. (The others are San Diego and Sacramento.)

“I think it will result in enough pressure that it’ll work toward finding a solution,” Cygen said.

The MSI program provides medical care for people ages 21 through 64 who make too much money to qualify for Medi-Cal, are not old enough for Medicare. Often, that means working poor whose employers do not provide health insurance.

Cygen said his medical center was forced to take such a dramatic step because it can’t afford the financial burden. He said several specially recruited doctors had left the 215-bed teaching hospital because they were overwhelmed with care of poor patients and had little time to spend on research.

UCI also found that more than 52% of the outpatients travel more than 11 miles to the medical center or the clinics, bypassing one of the 24 other county hospitals that are part of the program.

“We’ve told the county it wasn’t our intention to pull the rug out from underneath the system or the patients,” Cygen said. “But we want everyone to do their fair share.”

Rimsha, of Legal Aid, said the MSI program is also fraught with baffling bureaucratic rules that in many cases impede proper care and keep many doctors from participating.

“Under MSI, if you have cataracts, they will operate on only one eye,” she said. “They won’t pay for the other one.”

Felix Schwarz, executive director of the Health Care Council of Orange County, a patient advocacy group in Orange, said that for every $1 Orange County spends per capita on health care, San Francisco spends $10.

“The Orange County Board of Supervisors are congratulating themselves on their fiscal acumen for not having a county hospital,” he said . “Unfortunately, the poor and the middle class are the people who are suffering.”

Riley countered that in the past two years the county has increased funding of the MSI program by a total of $5 million, to $47 million. This year, he said, the health agency’s budget has been cut $14 million because of state budget shortfalls.

He said the county has been negotiating with three or four hospitals near UCI to reserve beds for indigent patients, in anticipation of the medical center’s move. He would not name the hospitals.

He also said the county expects to install a new case-management program to approve care beforehand, on the model of a health maintenance organization. He said he expected the changes to be in place in the fall. UCI officials said they have provided services only to learn later that there would be no reimbursement.

UCI Medical Center’s contract with the county ends Oct. 1.

Los Angeles County also is struggling with how to pay for treating the uninsured. It has a network of public hospitals that care for patients from across the region, but, facing an $800-million overall health care deficit, is considering limiting services.

Seeking to limit the impact of what they say are inevitable medical care cuts, Los Angeles County supervisors this week placed on the November ballot a $168-million parcel tax measure to preserve the region’s emergency health system.

Of the roughly 800,000 patients treated in Los Angeles’ six public hospitals and dozens of clinics each year, roughly 75% have no insurance, though almost all of those patients work or are related to those who do.

As UCI Medical Center has tried to transform itself from a county hospital to a top-ranked teaching hospital, it has had several brushes with financial disaster, often because of the cost of indigent care.

As recently as 1997, UCI was having discussions with private companies about leasing the medical center.

The medical center was in such straits 11 years ago that the University of California threatened to close it. Orange County supervisors came through with $3 million to cover care for the poor. Two years before that, medical center officials said they were threatened with bankruptcy because they were treating so many indigents.

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Times staff writers Nicholas Riccardi in Los Angeles and Mike Anton in Orange County contributed to this report.