Adults with no health insurance face waits up to a year or longer for gallbladder or hernia surgery in Los Angeles County, a backlog that community clinic doctors say has worsened since the county downsized Martin Luther King Jr.-Harbor Hospital last year.
The elimination of most specialty care at King-Harbor, formerly known as King/Drew, has hit Harbor-UCLA Medical Center near Torrance the hardest, the doctors say. As the county-owned hospital closest to King-Harbor, it absorbed the bulk of that facility's displaced patients.
Community clinics rely on five county-owned hospitals to provide virtually all specialty care, including hernia and gallbladder surgery, for their uninsured patients.
With a quarter of the county's adult population lacking insurance, patients have always had to wait a long time. But delays are growing longer as the population ages and suffers complications from such chronic conditions as diabetes and obesity.
Still, clinic doctors were stunned earlier this month when Harbor-UCLA told them not to send any more nonemergency gallstone, hernia, orthopedic or neurosurgery patients until hospital physicians worked through the yearlong backlog for these surgeries.
After a Times reporter asked about the ban on referrals, the medical center sent another notice lifting it. But the backlog remains.
"The bottom line is there's still a year's wait," said Dr. Karen Lamp, medical director for the Venice Family Clinic.
Lamp said she now refers such patients to specialists at two other county hospitals, Olive View-UCLA Medical Center in the San Fernando Valley or Los Angeles County-USC Medical Center northeast of downtown. But both have waiting lists of their own, and Lamp fears that they too will become overwhelmed.
The other alternative is to send patients to hospital emergency rooms. That's what Dr. Rachna Gupta, chief medical officer for the South Bay Family Healthcare Center, did when a young man came to her Inglewood clinic doubled over in pain from an inflamed gallbladder.
"Emergency rooms should be saved for emergencies," she said. "But no one has a better answer."
More than a decade ago, the county partnered with nonprofit clinics to give the uninsured a place to go besides emergency rooms, which must see patients regardless of their ability to pay. Health officials also hoped that regular visits to primary care clinics would keep illnesses from getting worse and turning into real emergencies.
With funding help from the county, 43 nonprofit groups operate 117 community clinics throughout Los Angeles County. The clinics collectively see about 600,000 low-income patients a month for asthma and flu, diabetes and prenatal care, gynecological exams and immunizations.
But people without insurance also get hernias and gallstones, suffer failing hearts and ailing livers that, though not, technically emergencies, are beyond the skills of the clinics' primary care doctors, physician assistants and nurse practitioners.
Gallstones and hernias, for example, can be painful. But unless complications develop, their removal is considered elective surgery -- never mind that it's better for the patient and more cost-effective to remove or repair them before they become emergencies.
Gallstones are hardened bits of liquid bile stored in the gallbladder. Bile is used to aid digestion. The stones move around and can block ducts that lead to the small intestine, causing symptoms that range from belching to acute abdominal pain. If the ducts remain blocked, they can eventually cause severe infections of the gallbladder, liver or pancreas and require emergency surgery.
Hernias occur when part of an internal organ protrudes into muscle, often after a person strains to move a heavy object. A supportive belt or truss can help hold in the organ, but the belt can be painful and interfere with work, especially in jobs that involve manual labor or standing all day. Emergency surgery is need if a hernia becomes cut off from its blood supply.
Clinics faced with yearlong delays for specialists will sometimes send patients with inflamed gallbladders or painful hernias to an emergency room, only to have them examined and released because their conditions not a threat to life or limb.
At Valley Community Clinic in North Hollywood, referrals to Olive View-UCLA can take as little as two to three months for some specialists or as long as a year for an ultrasound to diagnose bowel or liver problems. For surgery, patients can wait three to six months to get a letter scheduling an appointment, then wait two more months for the appointment.
"If it's not life-threatening when we start, it certainly could be by the time we finish." said Judi Rose, the clinic's vice president of development and government affairs.