Doctors Refusing Calls to the ER in Dispute Over Pay, State Report Finds

Emergency room patients often must wait hours -- or sometimes days -- for treatment from specialists, largely because many doctors resist coming in unless they are assured adequate payment, according to a state report.

The report released Wednesday by the California Senate Office of Research concluded that the crisis affects patients with and without health insurance.

In some cases, patients are shuffled from hospital to hospital until an appropriate specialist is found, the report stated.

“The system is past broken. I think it’s on its last legs,” said state Sen. Deborah Ortiz (D-Sacramento), who heads the Senate’s Health and Human Services Committee.

Carol Gunter, acting director of emergency medical services for Los Angeles County, agreed.

“It’s a huge problem, and it’s probably worse in Los Angeles County than most places,” Gunter said. “The bottom line is that this is an essential public service that isn’t funded. The public expects emergency and trauma services to be there if they need it. But someone has to pay for it.”

The study cites a recent example in which a man with internal bleeding came into the emergency room of an unidentified California hospital. Over the next three hours, six gastrointestinal specialists refused to come to the hospital to treat the patient.

Finally, the director of the emergency room lured a specialist to the hospital with a promise of $500 cash. The specialist then performed the procedure and the bleeding was stemmed.

The report cites a number of reasons for the problem: Fewer doctors are willing to work for the rates offered by Medi-Cal and other health plans. Emergency rooms are also crowded with patients who are uninsured and many times are seeking the kind of care they should be receiving in a doctor’s office.

The report recommends that each county maintain an emergency medical services fund that can be tapped to pay for specialists.

Other recommendations include standardizing the way doctors are paid by insurance providers and having the state more closely monitor staffing shortages.

Ortiz said the best move legislators could make this year is to refrain from rolling back the rates Medi-Cal pays doctors. Gov. Gray Davis proposed a 15% cut to those rates earlier this year.