Financial Losses in California Emergency Rooms Call for State Action, Study Finds

"Swamped by patients and hemorrhaging money," California's emergency rooms will "flat-line and die" without financial help from the state, a study by the California Medical Association has found. While the problem of ER overcrowding is not new, the Los Angeles Times reports that the wait for treatment in California ERs "can stretch for hours," and paramedics routinely hold patients in ambulances until beds become available. According to the Times, 50 ERs closed in California between 1990 and 1999, while ER visits for that same period increased from 8.4 million to 9.4 million. The "epicenter" of the emergency care crisis is Los Angeles County, where 64 of 78 ERs lost money -- a total of $95 million -- in 1998-99, the year profiled in the report. Statewide, emergency departments reported losses of more than $416 million in 1998-99, for an average loss of $46 per patient. This "perpetual financial drain," coupled with a patient volume increase, ultimately will negatively impact the quality of care provided, the CMA report stated. According to the analysis, to save the system, Californians need a "philosophical shift" in the way they view and fund emergency care. Because the system is "vital" as a safety net for the uninsured and a necessity for the critically ill and injured, the state should provide "financial support to emergency rooms on an ongoing basis," treating ERs similar to police and fire departments, the report said. Steve Thompson, vice president of the CMA, said, "This is something that any civilized society should say is an obligation of government. The state needs to declare that these are essential services for the citizens and make a commitment to them just like we do for public safety."

The Times reports Gov. Gray Davis (D) is not likely to favor ongoing financial help to ERs, but several state lawmakers are proposing legislation that supports such a shift in policy. State Sen. Joe Dunn (D) is sponsoring a bill that would appropriate $200 million annually to "struggling hospitals" and declare trauma and emergency services "an essential public service." The legislation would require local emergency agencies to select certain hospitals as "essential" community facilities. These hospitals would then receive the funding from the state, based on the number of "911 patients" they see and the "range of specialty emergency care" they offer. Dunn said of his bill, "I know these are big price tags for any one proposal. But we're all at risk with this problem -- rich, poor, young and old -- and it's just getting worse and worse. We have to stop the bleeding now." Under a second proposal, sponsored by state Sen. Jackie Speier (D), insurers would be required to pay emergency room physicians directly, instead of through the patient's medical group, which can "delay reimbursement ... for months" (Warren, Los Angeles Times, 1/18).