ED closures spur worries of care crisis in L.A.

Backers of a tax initiative say it could ease the burden on hospitals.

By Katherine Vogt — Posted Sept. 20, 2004

Print  |   Email  |   Respond  |   Reprints  |   Like Facebook  |   Share Twitter  |   Tweet Linkedin

The loss of a sixth hospital emergency department in the Los Angeles area in less than 14 months is evidence that a crisis is brewing that ultimately could deny emergency care to thousands of patients in the region and statewide, some health care officials say.

Northridge Hospital Medical Center's Sherman Way Campus in Van Nuys, the oldest hospital in the Los Angeles Valley, announced Aug. 19 that it would close. The news came just days after Elastar Community Hospital in East Los Angeles shut its doors. They are among the growing number of hospitals in the area that have decided to close or curtail services, threatening to leave gaps in emergency coverage.

The trend is the result of several factors, including California's high number of uninsured residents, its low Medi-Cal reimbursement rates, and unfunded mandates requiring some hospitals to spend millions of dollars on nurse-to-patient staffing ratios and structural retrofitting to meet seismic standards, observers say. They worry that the Los Angeles shutdowns are a harbinger of what is to come in other communities in the state.

"We're hitting a convergence of forces that have been at work for several years. It is becoming impossible for more and more hospitals to keep their doors open," said Jan Emerson, spokeswoman for the California Healthcare Assn., a statewide hospital organization. "We are truly at a meltdown point."

In response, the California Medical Assn. and several other health care professional organizations are supporting a November ballot measure that they believe will provide immediate relief.

The initiative, Proposition 67, would increase the monthly 911 surcharge on phone bills from 0.72% to 3.72% on calls made within the state to raise nearly $600 million annually. The funds would be used to help emergency departments, trauma centers, emergency physicians, on-call specialists, paramedics and community clinics. Funds also would go toward an upgrade of the 911 system.

"Proposition 67 is an effort to deal with the hundreds of millions of dollars in losses at emergency rooms across California," said Peter Warren, spokesman for the California Medical Assn. "It is an effort to provide a fix. What happens in the emergency rooms is the great equalizer. If you have insurance or don't have insurance, you get treatment."

The recent closures represent the deepening of a trend that began years ago. The CMA said more than 60 emergency departments in California had closed in the last decade, including more than two dozen in the last five years. In Los Angeles County, the number of trauma centers has dwindled from 26 to 13 since 1985.

Proposition 67 could provide crucial funding for what has become a dire situation, Daniel Higgins, MD, an emergency physician and president of the Los Angeles County Medical Assn., said in a written statement.

"This initiative will provide critical funds to our beleaguered trauma care system so that emergency rooms remain open to provide the lifesaving services all Californians need and expect," Dr. Higgins said. "Lives could be lost if something isn't done, plain and simple."

But the initiative is vigorously opposed by some groups who argue that Californians shouldn't face another tax, particularly one that calls on phone users to fund health care. Critics also say that although the initiative would cap the surcharge at 50 cents per month for residential phone bills, it would not limit how much cell phone users or businesses could be charged.

Hospitals drop their support

Other detractors, including hospital officials, say Proposition 67 will provide only quick relief while failing to address long-term problems.

"It was only ever going to be a Band-Aid on one piece of the problem," said the California Healthcare Assn.'s Emerson. The measure fails to help hospitals address the financial burdens created by the growing uninsured population, the seismic standards law, the nurse-to-patient ratio requirements and low Medi-Cal reimbursements, she said.

Still, the hospital association was one of the original advocates of Proposition 67, Emerson said. The organization dropped its support after determining that it wasn't worthwhile to pursue because polling data suggested that the initiative likely would fail.

"We are neutral on the initiative from the standpoint that if we were to oppose it, we would be saying that there is not a problem. And there is a problem -- but we just don't think this is the solution," Emerson said.

Jim Lott, executive vice president of the Hospital Assn. of Southern California, said Proposition 67 won't provide the necessary comprehensive solution to help fix health care. "These stopgap measures have to stop," he said. "When these things pass, policy-makers feel that it's over, and they don't do anything else. We've got to get the appropriate solution in place."

Many observers agree that the most daunting challenge is the state's large uninsured population. Almost 20% of Californians lack health coverage, Warren said. This forces hospitals and physicians to provide hundreds of millions of dollars in uncompensated care.

In Los Angeles County, the problem is even more acute, with nearly 3 million uninsured patients, Lott said. "We've got more uninsured residents than most counties have people," he said. "That ends up meaning that about one out of every three patients that show up to a hospital emergency department is uninsured."

Emerson said hospitals also are suffering from low Medi-Cal spending, which she said is "dead last" in a poll of state programs. In 2000, she said, California's Medicaid program paid $2,068 per enrollee, compared with New York's top-rated program, which paid $7,609 per enrollee.

Also hurting California hospitals' budgets is a state law forcing many hospitals to conduct and pay for expensive structural retrofitting to meet seismic standards. The mandate is expected to cost hospitals $24 billion, Emerson said. And that's on top of the nurse-to-patient staffing ratio law, which took effect this year and is pinching their budgets.

The combination of all those conditions is forcing the Northridge Hospital Medical Center to close its 209-bed Sherman Way Campus, said spokeswoman Tracey Veal.

"If it was just one of those factors, perhaps we would have continued this noble cause of caring for the poor and indigent," she said. "I guess the stars were aligned, but in a negative way."

Back to top


Debating the solution

If passed, Proposition 67 would generate $500 million to $600 million annually for emergency services by raising the 911 telephone surcharge.

Proponents say:

  • The initiative would protect patients' access to care by helping to keep local hospital emergency departments and trauma centers open across California.
  • It would provide equipment and training to firefighters and paramedics who respond first to emergencies.
  • It would support local health clinics so EDs and trauma centers are reserved for true emergencies.
  • It would help upgrade the 911 emergency telephone system.

Opponents say:

  • Although the initiative would cap the surcharge for residential phone customers, there is no limit on how much cell phone and business customers could be charged, which could be a financial burden on them.
  • It would benefit for-profit hospitals with public tax dollars.
  • Less than 1% of the funding would go to 911 communications services.
  • The initiative might make it more difficult to increase future spending on 911 services.

Back to top



Read story

Confronting bias against obese patients

Medical educators are starting to raise awareness about how weight-related stigma can impair patient-physician communication and the treatment of obesity. Read story

Read story


American Medical News is ceasing publication after 55 years of serving physicians by keeping them informed of their rapidly changing profession. Read story

Read story

Policing medical practice employees after work

Doctors can try to regulate staff actions outside the office, but they must watch what they try to stamp out and how they do it. Read story

Read story

Diabetes prevention: Set on a course for lifestyle change

The YMCA's evidence-based program is helping prediabetic patients eat right, get active and lose weight. Read story

Read story

Medicaid's muddled preventive care picture

The health system reform law promises no-cost coverage of a lengthy list of screenings and other prevention services, but some beneficiaries still might miss out. Read story

Read story

How to get tax breaks for your medical practice

Federal, state and local governments offer doctors incentives because practices are recognized as economic engines. But physicians must know how and where to find them. Read story

Read story

Advance pay ACOs: A down payment on Medicare's future

Accountable care organizations that pay doctors up-front bring practice improvements, but it's unclear yet if program actuaries will see a return on investment. Read story

Read story

Physician liability: Your team, your legal risk

When health care team members drop the ball, it's often doctors who end up in court. How can physicians improve such care and avoid risks? Read story

  • Stay informed
  • Twitter
  • Facebook
  • RSS
  • LinkedIn