CALIFORNIA PUBLIC MEDICINE FALLING APART

Thousands of doctors converged Tuesday on Capitol Hill calling for congressional help to keep emergency rooms open. California emergency room physicians, more than 260 of whom participated in Tuesday's mass rally, said the crisis in the state is worsening by the day, caused in large measure by the rising numbers of uninsured and skyrocketing costs of providing uncompensated service. "It's a perfect storm," said Napa physician Paul Kivela, immediate past president of the California chapter of the American College of Emergency Physicians. Kivela and others said that unless something is done to reverse the trend, California hospitals will not be able to respond to Hurricane Katrina-scale emergencies such as a major earthquake.

R. Myles Riner, an emergency room physician in upscale Mill Valley, said that even there, "we are seeing more and more uninsured and finding it harder and harder to find specialists for our patients." Jan Emerson, vice president of the California Hospital Association, concurred. "We have a huge crisis in emergency room care," she said. "Seventy hospitals have closed in the last decade, 10 in the last year," she said. Those closures also wiped out emergency room services, which is the only place the uninsured can go for basic medical treatment.

Under state law, hospitals are prohibited from hiring doctors and so must contract out for those services. But Emerson said that hospitals are finding it increasingly difficult - and expensive - to arrange for medical specialists to cover emergency rooms because of the high likelihood they will never be paid. "In some areas, emergency room specialists are demanding to be paid stipends of as much as $3,000 a night just to be on call," she said. "Hospitals are paying $600 million a year to ensure that on-call physicians are available - and still some communities are having problems finding specialists," Emerson said.

Kivela said that if a patient shows up at the emergency room with a broken jaw and has no insurance, the emergency room physician has a dreadful task of finding an oral surgeon willing to come in and take the case. "I'll have to call eight or 10 different doctors," he said. "I'll spend two hours making these calls while a bed is taken up in the emergency room while sick patients wait." Sometimes emergency rooms are so saturated with patients that ambulances are instructed not to bring any more, and the ambulance drivers have to drive around in search of an emergency room that will take the patient, the doctors said.

Often, when a patient has been seen in the emergency room and admitted to the hospital, that patient must wait for hours until a bed is found, adding to the crowding and delay for others, to say nothing of the misery level for the patient. "I saw a patient in the emergency room last week on the verge of a heart attack," Dr. John Bibb of Los Angeles said. "The hospital was full. So this person had to wait on a gurney in the emergency room, next to a patient who is throwing up and another who is screaming. It is not a place for anyone on the verge of a heart attack."

Federal law requires emergency rooms to treat and stabilize everyone with a serious illness, severe pain or who is in labor, and in California, patients can't be asked about their ability to pay until services have been provided. "It's a completely unfunded mandate," Bibb said.

The solution the doctors were advocating Tuesday would add incentives for emergency room service. It would limit their costs of malpractice insurance by providing them government-paid coverage for treating the uninsured, like Public Health Service doctors receive. It also would offer 10 percent bonuses to hospitals and doctors involved in emergency room services to Medicare recipients.

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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