Unemployed Patients Crowd Local Emergency Rooms

Orange County emergency rooms are feeling the brunt of caring for uninsured people who have been pushed out of jobs by the falling economy.

Federal law requires emergency rooms to treat patients under any circumstance, which has caused some overcrowding across the county. While none have seen patient levels reach the crisis point yet, some insiders are gearing up to prepare for that moment.

Saddleback Memorial Medical Center’s campuses in Laguna Hills and San Clemente saw their ER visits grow to 50,900 last year compared to 49,500 in 2007, said Marc Taub, a doctor and medical director of the hospital’s emergency department.

Saddleback’s Laguna Hills campus also is seeing between four and five more patients a day since Irvine Regional Hospital and Medical Center temporarily closed, Taub said.

Up the Santa Ana (I-5) Freeway at UCI Medical Center, Chief Executive Maureen Zehntner said her hospital hasn’t seen a huge increase in ER visits just yet.

“It’s really early in this kind of real economic meltdown for healthcare. I think as we continue to see people lose their jobs and health coverage,” emergency rooms could be stressed, said Zehntner, who is retiring from her position next month.

Even though emergency rooms may be pressured, by law they still have to treat all patients regardless of whether they have insurance or an ability to pay.

“There’s no relief for hospitals that I can see. I mean, people can’t pay (but), we still have an obligation and we will take care of them,” Zehntner said. “I hope we don’t reach pressure points in Orange County.”

Jim Lott, executive vice president of policy development for the Hospital Association of Southern California, suggested that emergency room pressure may be here sooner than expected.

He noted that the 25 local hospitals that have emergency rooms are losing money, but are offsetting that loss with other business lines, philanthropic contributions and reserves.

“That’s a non-sustainable policy over the long run,” Lott said.

As a whole, OC, whose 6.5% unemployment rate is well below California’s 9.3% jobless rate, has been relatively unscathed by emergency room and hospital closures in general.

The last local hospital that permanently shut its doors was Brea Community Hospital in 2005, according to data from the Hospital Association of Southern California.

(Irvine Regional, which also had an emergency room, is under temporary closure while Hoag Memorial Hospital Presbyterian renovates it and prepares it for reopening in about two years).

“Whenever you have more uninsured, more of them are going to use the emergency room as their primary means of accessing healthcare,” said Mitch Morris, a Costa Mesa-based partner at Deloitte Consulting LLP.

On the capacity question, Morris said he wasn’t aware of any news about decreased ER capacity in the county. He did note, however, that OC is one of only three counties in California that doesn’t have a county hospital (San Diego and Sacramento are the other two) and emergency rooms across the board would face more strain if the downturn continues.

Preparing for the Worst

Hoag Hospital Chief Executive Rick Afable is a bit more cautious about what could happen to emergency rooms if the recession deepens and more people lose health insurance because of layoffs.

“We are definitely on the edge as it relates to capacity and as it relates to emergency care in this community,especially in the areas that are underserved relative to the number of hospitals in the areas,” he said.

If one or two hospitals and emergency rooms were to close, Afable said, “that would put a major burden on existing hospitals, but more importantly, that would put the public at some risk if and when they do need access to emergency care, especially trauma care.”

UCI Medical Center, Western Medical Center-Santa Ana and Mission Hospital in Mission Viejo are OC’s trauma centers.

“If one or more of those trauma centers were to go away, this county would be in difficulty,” Afable said.

Capacity pressures on ERs could ease if hospitals find alternatives for treating patients who show up to the emergency room without emergency conditions, Afable said. Hoag has made efforts to find alternatives through community clinics, he added.

Lott called that strategy “finding medical homes for the frequent flyers. Hospitals throughout Southern California are working feverishly on that.”

He also said that hospitals in OC are developing what are called “fast-track systems,” in which patients are moved through emergency rooms and matched with primary care doctors.

Hoag is expanding its emergency department capacity through renovation and expansion in the meantime. It’s planning to go from about 38 beds to 53 beds within two years, Afable said. There will also be 11 emergency department beds at Hoag’s upcoming Irvine campus.