Mauricio Hernandez's belly was swollen like a pregnant woman's.
Every month for four years, he'd been going to the emergency room at Los Angeles County-USC Medical Center to have his abdomen drained of fluid, the result of cirrhosis caused by years of heavy drinking.
It wasn't exactly an emergency, but the ER was his only medical care. An illegal Mexican immigrant, Hernandez had learned that emergency rooms legally cannot turn away patients without examining and stabilizing them. He had stopped drinking, he said. But his job unloading big rigs paid little and offered no health insurance.
At each ER visit, he waited from five to 10 hours, received immediate treatment and left with no long-term plan for follow-up care. So his condition worsened, making more ER visits necessary.
Hospital officials estimate that in the first four months of 2006 alone, Hernandez's ER visits and hospitalizations cost taxpayers $37,500.
Hernandez, 45, is among a relatively small -- but extremely costly -- group of patients known in the field as "frequent fliers." They are chronic users of the emergency room whose care would be far less expensive, and who would probably be less sick, if they were seen regularly in a primary-care clinic.
He is an extreme example of a wider problem: About 40,000 people each year -- about 22% of ER patients -- go to the emergency room at County-USC with health problems that do not qualify as true emergencies, according to county officials. Millions of people across the country do the same thing, but the problem is especially acute in Los Angeles County, where a quarter of non-elderly adults are uninsured.
Many of these patients are homeless or working poor people. And in Los Angeles County, many are immigrants, legal and illegal. Collectively, they have strained the more than 70 emergency rooms in the county to the breaking point, helping to boost uncompensated care costs to $1.6 billion annually.
Nine ERs have closed in the last five years in L.A. County alone.
Partly to ease this strain, Gov. Arnold Schwarzenegger proposed earlier this month to ensure coverage of all legal residents of the state and illegal immigrant children. But even if his proposal passes, undocumented adults such as Hernandez would still have to depend on the county system.
