The man from Room 616 is in the corridor showing off his legs. Lifting his hospital pajamas, he reveals ankles the color of beets. He laughs. Those gams, stained and swollen by a life of drink, today will carry him back out onto the streets.
The character in Room 607 had been mixing heroin and cocaine. A five-bag-a-day man, he was shooting it into his left calf. He turned up in the emergency room shivering and sweating and unable to walk, his lymph system sick with infection.
In 509, the steel bed rail has been wrapped against the patient's seizures. In 618, a woman bloated with cirrhosis of the liver shifts painfully under the sheets. From 603 comes the voice of an 86-year-old man telling in Spanish what it is to be lonely and leukemic.
But the man of the hour lies folded under a bedspread the color of lemons. His hair is long, his eyes glitter, he breathes through a hole in his neck. At 42, he has neither voice nor teeth. His speech is a smiling, gurgling, flapping of gums.
Back From the Dead
He is back from the dead, the way hospital workers tell it--found by paramedics in February in an alcohol-induced coma. Encrusted in feces, he was brought to San Diego Physicians & Surgeons Hospital. There he lay in intensive care, for months.
His life is something of a mystery even now. Social workers who contacted his neighbors say the neighbors know nothing about the man. His hospital computer printout tersely declares under the heading Nearest Relative: "Patient says is none."
"It's a miracle that this guy's alive," says the hospital social worker.
San Diego Physicians & Surgeons Hospital is, for many, a place of last resort--a place you go, or end up, when life has gotten out of hand. It has become a hospital for the homeless, the undocumented, the transient, the broken, and the poor.
Crouched on a hillside in Logan Heights, where Southeast San Diego meets Barrio Logan and the two shoulder up to downtown, the 156-bed facility presides over a ramshackle neighborhood of sometimes-rundown bungalows cut off from the rest of the city by freeways.
Its bailiwick extends to the welfare hotels of downtown, the homeless shelters, the detoxification programs and some of the city's drug rehabilitation houses. Down the hill stands the city's most infamous welfare office, a former Safeway market at 25th and Imperial.
Few Are Insured
A mere 6% of the hospital's patients have private health insurance; 87% belong to federal, state and county programs for the elderly, poor and indigent. Seven percent have no funding at all, many of them Mexicans who have entered the country illegally.
Yet 70% of the acute patients come in the most expensive way--through the emergency room, in a state of advanced disease or decay. For reasons of economics, education and distribution of doctors, many seek medical care, or are forced into it, long after it's too late.
As a result, the hospital wrestles with chronic debt. For five years, annual losses have hovered around $1 million. To generate revenue, there are new programs for the elderly, the impotent, the incarcerated, but none has brought the hospital into the black.
So on Tuesday, hospital officials intend to make a pilgrimage to Sacramento for what they say is a last-ditch plea for more money under the Medi-Cal program. Without a large increase, officials say, they must seriously consider closing San Diego's only ghetto hospital.
"The fact that we've hung on with losses well in excess of $1 million a year indicates we're looking at this from more than a financial perspective," said Thomas Mackey of National Medical Enterprises, the nationwide health-care chain that has run Physicians & Surgeons since 1982.
"We do have a desire to serve the community," said Mackey, who is vice president of operations for the company's western division. "But you cannot do it forever. That's the reality. We've got to correct this situation over the next year if we're going to continue."
At the crux of the problem is the hospital's Medi-Cal contract, under which the state pays the hospital a negotiated daily rate to care for Medi-Cal patients. Under state regulations, that rate is confidential. But hospital officials say unanimously it falls terribly short.
Last year alone, the hospital lost $840,000 on Medi-Cal inpatients and $225,000 on Medi-Cal outpatients. Officials say the rate works out to 28% less than the hospital's costs for taking care of the average Medi-Cal patient.
The reasons behind the discrepancy are less clear-cut.
Some hospital staffers trace it back to initial Medi-Cal contract negotiations in the early 1980s, when San Diego was one of the first areas to enter talks. With few guidelines, and eager for a contract, some assert, the hospital settled for a rate that proved impossibly low.