The Hospital Crisis

Profound differences on emergency health care continue between Gov. George Deukmejian and the Legislature, and between the state and the counties. While the controversy continues, the state trauma system grows weaker.

Queen of the Valley Hospital in West Covina is the third hospital in the Los Angeles County trauma network to announce withdrawal this year. The reasons are the same: enormous financial losses because of the high levels of uncompensated care generated by a trauma center. The Assembly Office of Research calculates that 55 trauma centers in 13 counties lost $130.8 million last year.

The roots of the problem lie in the 1982 decision, during the Administration of former Gov. Edmund G. Brown Jr., to shift the care of medically indigent adults from state responsibility under Medi-Cal to the counties, with the state paying a portion of the cost. State support has not kept pace with growing costs, forcing heavily affected counties like Los Angeles to curtail health services--including paying only limited compensation to hospitals for medically indigent patients.

Deukmejian is now trying to carry this a step further, shifting all state responsibility for this and some other health programs to the counties in exchange for increased funding. Initially he proposed giving the counties a fixed portion of the sales tax. This was rejected by the Legislature, and many counties were uneasy because of indications that in the long-term they would face serious financial problems. So the governor froze payments this year to the counties and vetoed a $69-million trauma-center special fund, but signed a $110-million block grant to the counties that each board of supervisors may use at its discretion.

We think that the governor is moving in the wrong direction. The decision to dump medically indigent patients onto counties was voted in the face of a fiscal crisis in Sacramento, and was a mistake. It should be corrected by restoring the medically indigent population to Medi-Cal. At the same time, the state must accept responsibility for adequately funding Medi-Cal, now grossly handicapped by its ridiculously low fees to physicians and dentists--so low that basic services are not available to many impoverished Californians.

The governor has defended his vetoing of the special trauma-center funding on the grounds that the trauma centers are a county responsibility and that direct state funding should be limited to programs that help duly qualified individuals. That would be a more persuasive argument if the state were meeting the financial obligations implicit in the decision to push the medically indigent off the Medi-Cal rolls.