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L.A. Sinks Into 'Chernobyl of Health Care'

Crisis: Financial woes, a nursing shortage and lack of insurance plague the system.


As the nation debates patients' rights and prescription drug benefits, Los Angeles County is struggling on a more basic level to keep its health care system from melting down.

The county's 13-hospital trauma network was just pulled back from the brink of collapse. Its Department of Health Services, solvent only because of two massive federal bailouts since 1995, is looking at a $506-million deficit in five years.

The private sector is suffering its own share of turmoil: Physician groups are merging and going under; community hospitals are fighting mightily to survive. Even a world-renowned medical center--UCLA's--this year found itself barely in the black.

Registered nurses are in critically low supply, labor strife is on the rise and--with vaccinations delayed--this year's flu could flood already brimming emergency rooms with patients.

"Los Angeles County is the Chernobyl of health care," said Dr. Brian Johnston, an emergency room physician and member of the Los Angeles County Medical Assn. board.

Many other parts of the nation face similar, although less serious problems, but "on a whole bunch of fronts, Los Angeles County represents the extremes of the problems that other places are facing" or will face later, said Larry Levitt of the Kaiser Family Foundation, a California-based health policy group.

The financial pressures on the medical system in this county are more fierce than almost anywhere else in the nation. That is largely because nearly a third of non-elderly residents here lack any sort of health insurance and nearly half receive treatment in an exceptionally competitive and volatile HMO marketplace.

The volatility was underscored this week, as Anaheim-based KPC Medical Management, a physician management group in charge of 252,000 patients across Southern California announced that it was closing for financial reasons.

The economic pressures on health care are compounded by the region's sheer size, its vast income gaps and its huge immigrant population facing cultural and linguistic barriers to care.

Although outrage is building among many physicians and nurses, patients often remain insulated from the problems of the local health care economy--that is, until they or their family members become seriously ill. Then, insured or not, many face painful experiences and daunting choices. Consider:

* A minimum-wage home-care aide, out of kindness, provides more hours of care to an 88-year-old diabetic patient than she is paid for. But she gets no health insurance through her job. When her young daughter developed pneumonia as a result of chickenpox, she steered clear of the emergency room against doctors' orders. Though terrified for her daughter, she was even more afraid to get a bill she couldn't pay.

"[Our clients] have somebody to care for them," said the aide, Amanda Figueroa, 40, of Huntington Park, who, with her husband, supports a family of five on $14,000 a year. "But nobody cares for us."

* A young mother of two, who has repeatedly gone to an emergency room suffering acute gallbladder pain, can't get the organ immediately removed because a rise in premiums forced her working husband to drop the family's HMO coverage. At the county hospital, doctors say, the South Gate woman could wait as long as a year for such surgery.

"It's worse than having a baby," said Katrina Pena, describing her pain from a gurney at St. Francis Medical Center in Lynwood.

* A 73-year-old Panorama City woman, diagnosed in 1998 with lung cancer, was told by her HMO doctor that she had six months to live and that nothing could be done. Desperate for treatment, she sought chemotherapy from a physician outside the plan and lived to fight another battle against the HMO--which is refusing to pay the $25,000 tab for outside care because it wasn't authorized.

* A La Canada Flintridge couple--he a former corporate vice president and she a proofreader--both have had cancer. Though each has insurance, the husband said it is a full-time job to press for the tests and attention they need.

"You find your primary care doctors are so overworked, they could care less who you are. [You're] another body," said the 57-year-old husband, Robert J. Ingram.

"It takes a while before you actually get to make a relationship with the doctor and look at him or her in the eye and say, 'For gosh sakes, this is my life.' "

Physicians say they are squeezed between employers and health plans that push to keep costs down and patients who demand or require expensive treatment.

Dr. Brian Greenberg, a Tarzana pediatrician and allergist, often resolves the conflict by providing costly but necessary services and tests for free.

"A lot of stuff that I will do, [health plans] will never, ever have to pay for," he said.

When he does get paid, it can be as little as $9 per child each month--compensation that he fears may discourage doctors from going the "extra yard" for patients.

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