EMERGENCY CARE: Bill Would Prohibit Hospitals From Closing ERs
In a "revolutionary gambit rife with implications for emergency services around the state -- perhaps the nation," the state Legislature is considering a bill that would authorize California counties to prevent hospitals from shutting down their emergency rooms due to financial troubles. AB 421 would "prohibit approval by the state DHS of the downgrading or closing of an urban emergency department if a county or its emergency agency has concluded it is not in the community's best interest," and was drafted in response to what many view as an emergency care crisis, especially in the Bay Area and Los Angeles County. The growing ranks of the uninsured, combined with federal laws requiring emergency rooms to treat all visitors, have prompted many private hospitals throughout the state to close or downsize their emergency departments, the Los Angeles Times reports. Los Angeles County already has witnessed a 20% drop in the number of ERs over the past two decades, and a 1997 National Health Foundation report predicted that the area will face a "serious undersupply" of emergency rooms by 2005. Chair of the Assembly Health Committee Martin Gallegos (D-Baldwin Park) said, "We can't allow these emergency rooms to close willy-nilly like they are now. There are dangerous consequences to these closures. As always, the impact is always stronger on the low-income and minority communities." Two UC-Davis doctors agreed, writing in the January issue of the Annals of Emergency Medicine that "unless the problem is solved in the near future, the general public many no longer be able to rely on ERs for quality and timely emergency care."
The Los Angeles Times reports that while the bill already has cleared the Assembly, it will likely face "significant opposition" in the Senate from the hospital lobby, which has argued that the situation requires more than "knee-jerk solutions." Jim Lott of the Healthcare Association of Southern California said, "You are applying a Band-Aid to an open wound. You have mandated that hospitals treat all comers, and now you are trying to stop hospitals from closing facilities they cannot afford to keep any more." Hospital chains acknowledged that there is a problem, but said the law would "hamstring their ability to compete in a cutthroat health care market." Others questioned whether the bill is enough to curb the crisis, noting that the measure "does nothing to ensure that physicians remain on the job after a hospital has announced its intention of reducing or shutting down services," and it fails to deal with the law's financial impact on the private sector. The bill's sponsor, Assemblywoman Dion Aroner (D-Berkeley), and other supporters, such as the California Nurses Association, conceded that the "problems causing the ER shutdowns are much larger than the legislation would remedy," but maintained that the "public interest must be protected while bigger answers are sought, because the highly profitable hospital chains seem to have only their bottom lines in mind." Aroner said, "This is not Macy's. This is people's health we're talking about." She has indicated that she will amend her bill to include a "financial carrot" for hospitals. Several ideas under consideration include providing financially ailing hospitals subsidies or raising ER reimbursement rates, but those measures could be "extremely expensive." East Los Angeles emergency physician Brian Johnston, head of the Los Angeles County Medical Association board, said, "We can't do this on fairy dust. If there are dollars to cover the costs, this could work. But if people cannot receive compensation, the hospitals and doctors can't be expected to provide services" (Bustillo, 2/15).