Majority of California ERs Posted Losses in 2000, More ‘Closures Expected,’ Report Says

Hospital emergency rooms in California lost $325 million in 2000, $8 million more than in the previous year, according to a study released yesterday by the California Medical Association, the Contra Costa Times reports. Sixty emergency rooms have closed in the last decade due to financial difficulties, including 10 since 1999. Using data derived from the Office of Statewide Health Planning and Development, the study found that 82% of emergency rooms in the state posted financial losses in 2000, "highlighting an underfunded system" that suggests more emergency room closures are "inevitabl[e]" (Silber, Contra Costa Times, 11/7). The report found the following FY 1999-2000 ER losses around the state:

• Hospital emergency rooms in the Bay Area were "hit particularly hard." Contra Costa County ERs lost approximately $14 million last year, while Alameda County ERs lost upward of $24 million. San Francisco hospitals lost more than $7 million and San Mateo County ERs lost $2.7 million (Colliver, San Francisco Chronicle, 11/7).
  
• Although UC Davis Medical Center, Sutter Memorial Hospital and Methodist Hospital did not report their ER financial information to the state, six other Sacramento County ERs lost a total of $6.4 million (Rapaport, Sacramento Bee, 11/7).
  
• In Los Angeles County, where ERs lost nearly $100 million, 25% of the ERs are "so strapped for resources" that they were closed to new patients more than 30% of the time last month (Bernstein, Los Angeles Times, 11/7).
  
• The 17 San Diego County ERs included in the report lost $21.6 million, up from $16.7 million in 1999 when 21 hospitals were included in the report (Fong, San Diego Union-Tribune, 11/7).

According to Gary Tamkin, an emergency room physician and president-elect of the California chapter of the American College of Emergency Physicians, seven million uninsured Californians, "as well as insurance payments that don't cover the cost of care," are "primary causes" behind the financial troubles emergency rooms are experiencing. Tamkin added that the "high numbers" of uninsured visiting the state's emergency rooms "contribute to the unwillingness of many specialists -- who don't get paid when patients don't have insurance -- to work" in emergency rooms. The CMA report also showed that emergency room doctors delivered $110 million in unpaid care, "over and above" the losses experienced by emergency rooms overall. "Emergency medicine is an essential public service with no funding source. Yet the fire department, the police department, no less essential services, have a clear funding source," Tamkin said.

Dr. Frank Staggers, president of the CMA, questioned "whether the emergency room system can survive," particularly if the "losses continue" and the "already stressed" health care system has to face the ongoing threat of bioterrorism and the flu. "[W]e are going to be on the front line for the flu and the war on bioterrorism. We dearly need to preserve our emergency system so it will be there when we need it," Staggers said. However, the seemingly "imminent threat" posed by bioterrorism could help "garner funds for emergency rooms." According to Staggers, the government, which plans to commit funding to public services important in responding to bioterror attacks, is "paying attention to the plight of hospitals and emergency rooms. ... We've been saying it for years, and nothing happened. But I think something is beginning to happen now" (Contra Costa Times, 11/7).