LOS ANGELES COUNTY: Budget Would Curb ER Indigent Dumping
Los Angeles County inched toward financial stability yesterday with its proposed $14.3 billion budget that marks the second straight year the county has not had to slash services to offset a "mammoth deficit in its health department," the Los Angeles Times reports. Although the budget contains "no major cuts or increases," it does put a cap on the number of indigent patients that public hospitals can accept from others hospitals' emergency rooms. Even with a $300 million federal waiver to keep the health department afloat, county Chief Administrative Officer David Janssen "had to take unprecedented actions" to close the deficit expected to hit when the waiver expires. While private hospitals are required to accept indigent patients in their emergency rooms, they often quickly transfer the patients to public facilities. By putting an end to the "long-standing commitment to accept indigent patients" from other facilities, the county could save $5 million annually, according to Janssen. His proposal replaces his earlier plan to cut hospital beds by 10% to trim the deficit.
Not a Warm Welcome
Supervisor Gloria Molina blasted the latest proposal that she said was "dangerous" cost-cutting. Jim Lott, vice president of the Southern California Healthcare Association, echoed her concerns, saying, "This could have a branching domino effect that could really be damaging for Los Angeles. It could put the whole trauma system at risk." Lott predicted that private doctors would be wary of contracting with emergency departments that could saddle them with indigent patients. "The savings don't seem to be worth it," he said. The county's top medical officer, Dr. Donald Thomas, was less critical of the idea, but said "it has technical difficulties that still need to be resolved." Supervisor Zev Yaroslavsky praised the budget and the ER cap, arguing that "private hospitals can't use the county hospitals as a dumping ground for patients they don't want." The budget also calls for $3.8 million to expand public health services, $53 million in federal and state funds to hire outreach workers to boost Medi-Cal enrollment and $121 million in federal and state funds to expand mental health care for prisoners and children. The Board of Supervisors is expected to adopt the proposal today, and hearings should begin next month (Riccardi, 4/20).