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Segment | Economy

Critical Care

Downey Regional Medical Center is a stand-alone community facility, medium-sized, non-profit. What’s happening to Downey is typical of health care facilities throughout our region: ten years ago they were one of seven hospitals on what’s called “the 105 Freeway axis.” Today, that number is down to three. That means that more and more patients are streaming in their doors needing medical care; brought in by ambulance or walking in the ER. Correspondent Vince Gonzales reports that’s not the worst of it.

Since more and more people are without insurance, without a primary care physician, by the time they arrive at Downey they are sicker than ever; often suffering from multi-organ system failures.

Who’s going to pay for this? By law, Downey Medical has to take in everybody who shows up at their doorstep. After stabilizing patients, they used to be able to transfer many of the indigent cases to a Los Angeles County facility … but no longer. Even if a patient has insurance, if it’s Medi-Cal, those reimbursement rates are the worst in the nation.

Hospital CEO Rob Fuller estimates that he loses 1,000 dollars a night on each Medi-Cal patient … for a total of one million dollars a month.

Private insurance plans now have high deductibles,. In these harsh economic times many patients can’t or won’t pay. Their reimbursement rates go down, even as the hospital’s costs go up. Downey says that, just to stay alive, they have to play hardball figuring out who’s going to pay for what each and every time a patient is admitted.

It’s not like we don’t need Downey Medical Center. One recent study showed that the number of hospital beds per resident in Southern California is lower than in Louisiana after Katrina. That leads to Rob Fuller’s other big fear: As crowded and stretched to the limits as his hospital is, this current period has been relatively calm. What will happen if a flu pandemic hits? Or the next big earthquake?

This is what makes Downey Medical Center such an instructive case. It's neither a high-end facility like Cedars-Sinai and Ronald Reagan/UCLA, nor a low-income hospital like County/USC and St. Francis. Until very recently, they were able to keep their head above water (and even make a profit on some departments) … while scoring high marks from the hospital ratings agencies. Now they see themselves slipping downward, treating more and more uninsured and under-insured patients rates that might force them into bankruptcy … Emergency room ‘pass-through’ times mushrooming from an average of two to four hours … The next show to drop?: the disillusion and desertion of their paying patients (ie, those with good private insurance plans) to other, more ‘upscale’ hospitals. And one more step towards making health care a bifurcated system - divided between rich and poor, with little in-between.

Hospital Association of Southern California
UCLA School of Public Health
Consumer Watchdog

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It's time to take off the rose colored glasses, put down the Prozac, and talk about the elephant in the room. One of the biggest reasons there are so many uninsured using the emergency rooms is because this state is overrun with illegal aliens and their anchor babies.I have been to three different emergency rooms in the past year and each one was full of illegal aliens. Estimated costs due to illegals in this State (CA) are $10 billion a year. That is why hospitals are closing and the State can never obtain a balanced budget without passing costs on to its' citizens.

You are right on target. California's population has been growing at about 1.2% per year in recent years, mostly due to illegal immigration and the increased fertility of illegal immigrants. In order for average living standards to remain constant, all resources (water, food, oil and oil substitutes, and so forth) must grow at 1.2% per year. Over the long run, that is clearly impossible.

Although closing the borders is most likely necessary, other steps need to be taken as well. One of the most important is making certain that poor women have free access to the full spectrum of family planning services, so that they do not need to bear children they do not want and cannot support. That includes making abortion available, which is a controversial issue.

Then there is the issue of getting the message out that large family size is irresponsible in a world which is out of resources, subject to global warming, with many in the third world dying of starvation.

But most important is the fact that we start taking overpopulation seriously. See for example.

Mr. Wiz - You are 100% right! When are we going to address the illegal alien issue. I too have been to the emergency room, this time in Las Vegas, and it was filled with illegal aliens.

It is really time to talk about that elephant in the room. Bravo Mr. Wiz, bravo!

Would I be able to purchase a copy of this episode? (Critical Care Episode 120)

Needed to comment Any new hospial build recentley seem to have greatly reduced in size it's inpatient beds ie lac\usc and RR ucla

I see someone beat me to it.

Interesting story, but not ONE WORD about all the millions of illegals causing this problem. I have watched as the standard of living in LA has declined, declined, declined. Many hospitals have closed over the years. Look at the schools? We're tied with Mississippi for the quality of our schools.

Yet in this story, as also with the CA budget, not ONE WORD about illegal aliens and what they cost all citizens, even Hispanic citizens who are legally here!

Wake up!

(and I'm not saying ALL the CA budget problems are with illegals, but it is a big part. The rest is not taxing the super rich, Arnold's friends who get fancy jobs meeting on committees that do nothing, and state employee unions who do such things as make sure employees get full medical care FOR LIFE, and FOR THEIR SPOUSES, after 5 years of work? Plus pensions? Totally insane.)

I would appreciate knowing why my comment was removed?

I took time to write it, but it echoed what comment #1 said, which apparently is not only the elephant in the room, but something you can't post under comments at kcet.

Out of courtesy, I expect a response. I subscribe to KCET and if I'm to be censored, I'd like to know why.



Hi Clem,
Unfortunately we never received a previous comment from you. Would you please re-submit? We'd be happy to post your thoughts.

KCET New Media Manager

Fully agree with Mr. Wiz. Frankly, I just don't get the motivation of Val Zavala and KCET anymore. I know they are a left leaning organization, but do they not really care that this state is steadily declining into third world status?

I kind of disagree with Mr. Wiz. It's not the illegal immigrants that's being overruned in the hospital; it's people who are irresponsible in caring for these children. The parents are separated, each person tries to blame for the child's mistake, but they don't want to admit at fault. Younger moms are having children as young as 14. Younger dads can't change a simple diaper on their kids.
The problem is that some patients who do have private insurance are going to hospitals that doesn't have much people with Medi - Cal insurance or self pay. People that do come into Downey are sicker and don't take care of themselves. They sometimes come with uncanny attitudes into the hospital. After they are taken care of; they find themselves with no ability to pay for the services. So they sometimes lie, or leave without payment. This doesn't have anything to do with illegal immigration. It's people who take the easy road of not having to pay more for health insurance. There are some honest people who do pay for the hospital care.
I've seen more single mothers on Medi - Cal. It's very saddening to see them in that position. Will people listen to the hospital's crisis? Not really. Until the hospital closes, then they realize what happened. The politicians don't understand the concept of healthcare. Until a hospital that closes, and a politician needs hospital care - he or she will fianlly realize - it's been too late to save the hospital.
I am hispanic. There are hispanics that do work, like myself, has private insurance, and our hispanic elderly people do have private insurance with Medi - Care.

We shouldn't black ball the illegal aliens or the hispanic community for this. Hispanic families who have the potential to advance their careers in something seem to find the easy road, to apply for WIC - SSI - or Food Stamps. I remember working on an ambulance when I responded to a 911 call in Inglewood. There was man who flipped his newly Yukon with license plates from Nevada. In his wallet, he popped out his Medi - Cal insurance card. Now let me point something here.
No one should point fingers at each other. Each hospital(s) that closed since 1997 and onward, there were people who were Caucasians; African Americans; Hispanics; Middle - Descendants; Asians, etc. You have people who decide to be on the free end. You can benefit by having a free insurance card in your wallet or purse. But these people don't think about the cost these hospitals are losing money in.
Let me ask you this question before any of you point fingers to illegal immigration. How many of you visited the hospital for: abdominal pain, nausea & vomitting, chest pain, shortness of breath, anxiety, sexaul problems, or suicidal ideations? I bet each of your parents have these medical problems with the heart, lungs, ulcers, or joints. These elderly parents lived their lives. They have the right to have these ailments. Some of us who haven't reach 50 years old have these ailments. How many of us are guilty? Times are changing. People are being taught of eating the right foods, but they return for the same problems. People are obese. More ailments for the rest of us.
The hospitals should be left to be treated with necessities that a doctor's office can't handle. Not a hospital as a medical clinic. Our behavior has to change. HIPPA is going to drive the hospital(s) down to the ground. Mr. Wiz, Mike, or Ray may not have health insurance. Why bash at another ethnic group? We're all guilty of something. Now can you dig that?

I have a story for yo, a few weeks ago my husband was burning up with a 102 degree fever in the middle of the night. I took him to the closest hospital to our house, yes in downey, he does not have any Insurance and I thought to myself if we go there it might be some what expensive I came to grips with myself and decided to take him there any way, I thought maybe 200.00 the most 300.00 I can barrow some how and pay that. When the nurse took his blood pressure and temperature gave him an Iboprofin and ask us to wait in the waiting room. One Doctor came in ask him a couple of questions by that time he was feeling better and we ask if we could leave and go to our own doctor the next morning, the temperature was normal. The nurse came back and said no we could not leave the Doctor had order several test for him like ex-rays and blood test, a second Doctor came in and we explain he was feeling better, he then said don't have the blood test but have the ex-rays. To make a long story short, when we went to check out we paid $450.00 wish include $17.00 for the ex-raids and that is the only thing I understand about the bill, now we received several different bills in the mail and I don't understand them they are over 2,000.00 and I called they said it was the decoding amount. HEEELP PLEASEEE!!!!!!! I have not been able to stop crying, I have called several times to the phone on the bills and I do not understand the billing is so complicated. I do not understand why is so much money, and I do not believe for one minute that they are going broke they way they charge is the Insurance companies that are paying all this money the ones that are going broke. And this is only one case of some one that does not what medi-cal, no wonder our state is broke, how much money from us the taxpayers is really going to these overpriced Hopitals how or what do we really know of how they do their billing.

It's a combination of problems that nobody (politicians, or otherwise) wants to deal with. One of the problems is that to them, these problems arent "profitable" and dont benefit them. So what if it saves the state of california $10 billion every year; its not their $10 billion. The main issue here isnt about money or citizen status, its about nobody having the backbone to say whats really wrong and to make the tough choices. Nobody wants to stand up and tell that spanish speaking grandmother with lung CA and nowhere to go to get out of the hospital because she's bleeding us dry staying there for a month. Or to sterilize a mother of 7 from having anymore children when she cant even support herself (octomom). Our healthcare system is completely reactive to problems instead of preventive. Who's got the guts to stand in front of the state and say "you can go but you have to leave". So of course we're stuck at a moral deadlock. In my opinion the state needs to make some hard choices, choices that will probably be political suicide for politicians but will benefit the state on a whole. Someone has to stand up to the liberals and the conservatives and tell them that the system is screwed up and this is enough, no more. that someone needs to say this is what has to be done and why and if we dont take care of it, not only are we going to suffer with lousy healthcare and state services but this problem will snowball and will be passed on to our children and grandchildren.

After reading the comments on this blog, I'm reminded of Winston Churchill's observation that fans of democracy should spend 5 minutes talking with the average voter.

WOW - I feel for you all at good old "DCH" - I see that things have not gotten any better. Congrats to all of my former co-workers for hanging in there and trying to carry on. I worked in that ER for over 27 yrs. The staff really cares and tries their best. The problem in So Cal is that there are WAY too many people without insurance - and that was even BEFORE this latest economic recession. No one can be turned away, so they all come in with minor ailments and need to be triaged and evaluated. Somewhere, someone has to listen or the waits will be more like 10 hours! Britt- 'ya looked great! as did Deb and Ezzy and Marty :-)

As a physician, I am going to state the other "elephants" in the room: greed, waste and high costs at each stage of the health care and insurance process. Due to greed on the part of insurance companies, many patients aren't covered for current conditions. Also many patients get their insurance through their job. Ant then there are the cots. So what happens to a patient who needs have care but that care is denied by their insurance company. they go to the ER. The doctors and nurses who work on these patients command high salaries, the cost of supplies/drugs/procedures is high. So the cost to their insurance plans is high. And, of course, the high cost of medical malpractice insurance and the costs associated with law suits is high. Lawyers are also greedy. Insurance execs are greedy. Doctors and nurses are greedy (yes, I am a doctor and I am saying this!).

Watching this program, I was both incensed and thinking, "yeah, so what else is new?' But what really got me is the fact that I have used emergency rooms on three occasions --- the cost being $4,000, $7,000 and $8,000. Am I uninsured and this is my only option? NO. I HAVE INSURANCe. An HMO. And every time I need care and call my doctor --- during normal business hours --- he says/the office says "we can't see you. Go to the emergency room." This is one of the main reasons I believe emergency rooms are over-run and suffering. For my particular care, which was timely and necessary, I surmise that the cost if a doctor, my doctor, had seen me would have been the cost of a doctor visit and an MRI or some similar procedure, which certainly wouldn't have cost as much as my emergency room care. Doctors not seeing patients because they can't afford to, driven by HMO quotas seem to be the culprit.


I guess we can't just blame this problem on one group of people. It's actually the system, granting medicare to people that found loophole on how to have one, Misinformation of people who don't really don't understand the word Emergency room, i've seen a lot of people illegal or not that goes to ER for nothing and end not paying for they don't have insurance. I'll set an example, a female mother who came to ER at inland empire brought her daugther coz of fever when ask if she given any tylenol she said she could not afford it ,and wants prescription for tylenol so it could be free, when time to go home the nurse saw her suv a brand new Yukon that eats up a lot of gas but the irony was she could not afford a tylenol, or a drug seeker that goes to ER that know what drug they want, throws a fit to medical personel if they don't get what they want. These simple things that crowd ER everyday, were they can really go to urgent care or clinic for these eats up a lot of resources.I say triage them well and let them put money down first if they are not life threatening condition, so next time they go to ER thay will think twice. We need to educate people on how to use ER responsively.

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