Emergency Departments on Life Support

by David Gorn

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The backlash has begun. This week, the Assembly and Senate will debate the final package of budget reductions -- and some of those cuts have produced howls of protest, both outside the Capitol building and inside its hallways.

Among the $6 billion in health-related cuts is the elimination of the Maddy Fund, a $55 million attempt to reimburse emergency departments for indigent care.

The funding only came into existence in January, and now it's gone again. Emergency departments around the state may be in danger of disappearing, too, according to Peter Sokolove, president-elect of the California chapter of the American College of Emergency Physicians.

"Those funds are critical to keeping EDs open," Sokolove said. "Some EDs are hanging by a shoestring, and if they did close, we'd be looking at an increase in emergency wait times, more ambulance diversions and an inability to respond to emergency situations that might arise in California."

The Maddy Emergency Medical Services Fund was designed to be a sort of county-level medical savings plan for paying for indigent care. Each county, after establishing an emergency medical services fund, would administer the account.

Many of the health-related cuts have cumulative impact on emergency departments, Sokolove said. For instance, when Medi-Cal co-pays are increased, fewer patients will get preventative care, and end up in the emergency room.

"The caps on visits, the mental health cuts, declining reimbursement of providers," Sokolove said, "all arrows point toward the emergency room."

There has been hope among lawmakers in the Capitol that federal dollars for health care reform might absorb some of these cuts in 2014, if only the health care system -- and in this case, emergency services -- can hang on for two-and-a-half more years.

"What's important to keep in mind is, when an ED closes, it doesn't reopen," Sokolove said. "You have to ask yourself as a patient, when you're having your emergency, your heart attack, your stroke," he said, "if you can hang on for two more years."


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