Judge Curbs County’s Ability to Refuse Uninsured Patients

A federal judge who has repeatedly stopped Los Angeles County from cutting hospital services has done so again, this time telling county officials they cannot limit the transfer of uninsured patients into two county hospitals, attorneys said Thursday.

U.S. District Judge Florence-Marie Cooper’s order complicates county plans -- approved this week by the Board of Supervisors -- to stop private hospitals from dumping their poorest patients into overcrowded county facilities, which bear the cost of treating them.

The county Department of Health Services has yet to flesh out the details of its plan, but the idea was to limit transfers when county hospitals were already full, which is much of the time, said department spokesman John Wallace. “It’s a way to decompress our emergency rooms so they won’t be quite so crowded,” he said.

Last year, private hospitals transferred 1,312 inpatients to county facilities and 6,751 patients to county emergency rooms, according to health department records. Many of those patients had no insurance, leaving the county to pick up the multimillion-dollar tab.

But in an order signed Tuesday, the judge enjoined the county from “taking any steps to limit the referral and transfer of patients from other clinics and hospitals in and outside the county system” to Rancho Los Amigos National Rehabilitation Center in Downey or County-USC Medical Center in Los Angeles. The ruling came as part of a preliminary injunction blocking the county’s plans to close Rancho or cut beds at County-USC until a trial could be held. It did not refer to transfers at the county’s other four hospitals.

Attorneys for the indigent patients who had sued the county praised Cooper’s latest ruling.

“The judge recognized that there are ways to close beds without [actually] closing beds,” said Barbara Frankel, an attorney with Neighborhood Legal Services. “You can take steps to limit the referrals, which in effect limits the number of patients you’re taking care of.”

Frankel said the issue arose several weeks ago when the county stopped admitting new patients at Rancho as health officials moved to close the hospital.

That prompted plaintiffs’ attorneys to specifically ask the judge to make sure patient transfers would be accepted at Rancho and County-USC.

Dr. Thomas Garthwaite, director of the Department of Health Services, said the county intends to comply with the order. But he also said he thought the judge’s ruling was meant simply to keep the county from blocking transfers until the patient load drops -- and then cutting beds because there were fewer patients.

“We don’t plan to cut the beds,” he said. “The point of the change was to improve our ability to control the flow [of patients] so as not to create a dangerous backup in our E.R.... I just find it hard to imagine that we are being ordered to take an unsafe transfer. That just defies logic.”

Donovan Main, the county’s chief deputy counsel, said his office will work with health officials to formulate a new patient transfer policy.