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California and the West

San Diego Doctors Protest Health System

Medicine: Demonstrators say professionals are abandoning the area, pushed to the 'bleeding edge' by HMOs.


SAN DIEGO — In what may be the harbinger of similar demonstrations throughout California, several hundred doctors and other medical personnel closed their offices for several hours Thursday to protest what they say is a dangerously deteriorating health care system.

"San Diego has been on the cutting edge of medical advances and managed care," Dr. Edward Singer, a gastroenterologist and president of the San Diego County Medical Society, told a protest rally. "Now we are on the bleeding edge."

With many wearing traditional white laboratory coats, and some with stethoscopes dangling around their necks, the doctors marched several blocks through the city's Old Town district.

Singer and others said doctors are leaving San Diego and patients are receiving reduced care because of burdensome paperwork and inadequate reimbursement from health maintenance organizations.

In recent months, five local hospitals have closed and one of the county's largest medical groups filed for bankruptcy.

The rally was dubbed a "code blue," hospital jargon for a life-threatening emergency.

"People do not understand the trouble their family doctors are in," said Dr. Dennis Wilcox, a general surgeon. "They don't understand that doctors are going broke and being forced to provide less care."

Peter Warren, a spokesman for the California Medical Assn., said that doctors in Long Beach, San Francisco and Los Angeles are considering similar protests in the belief that their usual style of low-key political lobbying is not working.

The association has estimated that up to 90% of the state's physician organizations are "poised for bankruptcy or closure" unless changes are made in HMO regulations and state support for health care.

"We could have gone to a bunch of Rotary meetings and shown our slides but we decided instead to try something more dramatic, a bit of shock therapy," said Dr. Robert Hertzka, a San Diego anesthesiologist and chairman of the California Medical Assn.'s political action committee.

Although health care and the conduct of profit-making HMOs are topics of national controversy, several factors make the issues particularly acute in San Diego County.

A higher percentage of people with medical insurance are covered by HMOs in San Diego County than in most other counties. The county's emergency medical system is burdened with costs associated with providing care to uninsured illegal immigrants. And for political reasons that are decades old, the county receives less money per capita from the state government for health programs than the more politically powerful counties of San Francisco and Los Angeles.

"Medicine is in crisis in this county," said Dr. John Berger, a general practitioner. "People are having to make decisions between paying for food and paying for very important drugs."

Among the protest declarations at the rally was one word-filled sign: "You Have Paid Money to Be Insured by a Big, Impersonal, Disorganized, Unfeeling and Money-Hungry Health Plan. Your Physician Assistant Is Taking Care of 3,000 Other Patients so . . . Please Wait!"

Another sign said simply: "I'd Rather Be a Plumber."

One protester arrived under a Morgan Stanley Dean Witter umbrella. Several stopped denouncing HMOs long enough to answer their pagers and make cellular telephone calls.

When a rain squall drenched the crowd and threatened to squelch the rally, the doctors mockingly suggested that a conspiracy was afoot.

"Look," Hertzka said, "Blue Cross even controls the weather."

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