LA County hospital services faces $204M deficit

Los Angeles County's financially strapped hospital system is projected to have a $204 million deficit by the end of the fiscal year in June, and the shortfall is expected to reach nearly $600 million in 2010-11, a
county official told the Board of Supervisors today.

The Department of Health Services hopes to close some of that gap with proposed hospital provider fees and federal funding, Interim Director John Schunhoff said, but those revenues remain uncertain.

"Clearly this year almost everything is focused on the hospital fee,'' Schunhoff said, adding that the ability to collect the fee "might require legislative fixes. So we are concerned about that.''

Supervisor Zev Yaroslavsky expressed even greater concern.

"The deficit problems facing DHS are compounded by major changes in health care delivery and the significant challenges and costs that the department faces in transforming itself into a managed care model,'' he said.

"We are dependent on the state to negotiate ... key initiatives. We are not at the table and not privy to critical information ... that would make or break the county's health care system.''

Carol Meyer, chief network officer for DHS, noted that county hospitals also receive 48 percent less in Medi-Cal reimbursements per patient than private hospitals.

"We carry out the same work. We are set up to have the same standards,'' Supervisor Gloria Molina said. "This is unacceptable. We cannot continue to shoulder all of this responsibility.''

Yaroslavsky proposed that the county's chief executive officer and DHS staffers return in 30 days with a report on specific steps they will take to close the budget deficit if federal revenue streams do not materialize.

During the financial discussion, DHS officials again refuted a complaint lodged last week by a woman who sought treatment for stomach pain at County-USC Medical Center. She claimed she waited eight hours, was told by a nurse that the average wait time was 35 hours and finally left to go to another hospital.

Meyer responded that the patient who complained had her vital signs taken within four minutes and "medically significant evaluation'' began within nine minutes. Four hours later, the woman was called by a nurse three times and did not respond to be treated, she said.

Meyer acknowledged that the average waiting time in the hospital's emergency room is nine hours. But she distinguished between wait times for patients with critical or minor injuries, both of which have short waits, and people with chronic pain, who take longer to assess and diagnose.

She also noted that wait time is calculated from the time the patient enters the hospital until they are either admitted to the hospital or discharged post-treatment, so it can include hours of MRIs, CAT scans and other tests.

"We know that our emergency rooms are extremely busy ... but I can tell you that those patients that are most emergent are going directly back (to be treated) ... that's what triage is all about, to determine which patients need the most immediate care,'' Meyer said.

"We are doing an excellent job and no patient is in danger,'' she added.

Molina also defended hospital staffers.

"I was shocked when I got the letter because I knew we had statistics that prove otherwise,'' said Molina. "I continue to be impressed with the work that is being done in a very overcrowded emergency room, as most of our emergency rooms in Los Angeles County are.''

Due to overcrowding, County-USC Medical Center is already transferring about 150 to 180 patients per month to other facilities for treatment, according to Molina.