Emergency Medical Care

Winding up in the emergency room is bad enough. But the California Supreme Court ruled Thursday that patients no longer have to worry about getting billed for emergency treatment charges that their HMOs fail to pay. Health maintenance organizations and patient advocates hailed the decision as an important protection against gouging by hospitals and physicians. But doctors said it would encourage greedy HMOs to underpay them and that that could put emergency rooms in jeopardy.

Frustrated emergency room doctors filed a class-action lawsuit against the state Tuesday, saying that California's overstretched emergency healthcare system -- which ranks last in the country for emergency care access -- is on the verge of collapse unless more funding is provided. Across the state, scores of hospitals and emergency rooms have shut their doors in the last decade, leading to long waits, diverted ambulances and, in the most extreme cases, patient deaths.

Patients are waiting longer for care in the nation's emergency rooms, a potentially deadly result of the shrinking number of emergency departments and rising demand for services, according to a new study by researchers at Harvard Medical School. Half of all emergency room patients waited 30 minutes or longer before being examined by a doctor in 2004, a 36% increase from a median wait time of 22 minutes in 1997, according to the study, published Monday in the journal Health Affairs.

Overcrowding in the emergency room at Harbor-UCLA Medical Center is placing patients in immediate jeopardy, according to state inspectors working on behalf of the federal government. The Los Angeles County Department of Health Services expects to receive a formal citation based on last week's inspection, another blow to the county's fragile emergency room system. In August, the county was forced to close most of Martin Luther King Jr.

The long waits that government inspectors say endanger emergency room patients at Harbor-UCLA Medical Center can also be found in backlogged hospitals across the country, according to emergency care experts who have been trying for years to draw attention to the nation's overloaded safety net. "Overcrowding in our emergency departments is a national crisis," said Dr. Linda Lawrence, president of the American College of Emergency Physicians, an advocacy group based in Washington D.C.

The honeymoon between the Los Angeles County Board of Supervisors and its health services director finally foundered Tuesday amid fears that a second county hospital could close. Dr. Bruce Chernof, who has headed the nation's second-largest public health system since December 2005, told the supervisors last week that the federal government would be citing Harbor-UCLA Medical Center for placing its emergency patients in "immediate jeopardy" because of overcrowding and long waits.

If you live in Los Angeles, Ventura, Orange or San Diego county and think you are having a heart attack, call 911 rather than have a friend or family member drive you to the hospital. It could mean the difference between life and death. That's the conclusion of a UCLA professor who reviewed data from counties around the nation -- including four in Southern California -- that have implemented a new approach to handling heart attack patients.

When Dr. Mark I. Langdorf began practicing emergency medicine more than 20 years ago, finding a specialist to help with a complicated case was easy. Newly minted surgeons and fledgling ear, nose and throat doctors would show up in the emergency room with boxes of doughnuts, hoping to pick up patients and build their practices. Today, specialists not only have dumped the doughnuts, they've abandoned emergency rooms in droves.

The ambulance entrance to the emergency room at St. Josephs Hospital in Orange was closed for nearly five hours Friday after a woman walked in with a bag containing an unknown material that was believed to have made her and a police officer sick. It turned out to be Alfredo sauce mix and an empty herbal vitamin package with some residue inside.

It made news around the world, hard evidence of an American public hospital's indifference to a dying patient. Edith Isabel Rodriguez writhed for 45 minutes on the floor of the emergency room lobby at Martin Luther King Jr.-Harbor Hospital as staffers walked past and a janitor mopped around her. Her boyfriend called 911 from a pay phone outside the hospital, pleading futilely for help.