COMMENTARY ON HEALTH SERVICES : Patient Back From Dead, but County Care System Is Very Sick : It took $450,000 worth of care to save George, a newcomer from Texas. And there’s no one to take care of the bill.

It was hope, the sunshine and love for his wife that moved George to Orange County from San Antonio last November. George is a soft-spoken, hard-working, 46-year-old man who wanted to start a new career in sales--and make his wife, Laura, happy.

“She loves California,” George says affectionately. “She’s always wanted to live here.”

George and Laura drove in from San Antonio and set up housekeeping in a nice apartment in Costa Mesa. George found a new job quickly, working in subscription sales at a local newspaper. Life was going well, until the second morning at work, when George died. Literally.

The paramedics got to him quickly. He was lying on the floor in his office. Gray, ashen, his new co-workers kneeling frantic and powerless around him. George was about to become a classic illustration of the reasons Orange County’s health care system is failing fast.

At Western Medical Center-Anaheim, George hit the emergency room doors in extremis --near death. Laura got there as soon as she could, and remembers what she saw: “He was blue. No breath, no heartbeat. It was horrible.” George “coded”--the medical term for loss of vital signs--when a hidden ulcer in his stomach hemorrhaged, bursting an artery.

The emergency room team rallied and resuscitated him. Then George’s surgeon, Dr. Luis Rivera, refused to give up, in the next few days performing a marathon of four major and three minor operations, removing George’s stomach, spleen and gall bladder.

Laura lived in the hospital’s waiting room for seven days and nights, as the surgeries mounted and George stabilized. But in the administrative offices at Western Med, Director of Patient Services Sharon Gerdes was trying to find someone--anyone--to pay for George’s care.

Because he had only worked one day at his new job, he hadn’t yet received medical insurance. Middle-aged and middle class, he didn’t qualify for Medi-Cal. Orange County doesn’t have a county hospital, so he couldn’t be transferred anywhere. Not poverty-stricken or destitute, he couldn’t access the few state programs still left that serve the poor. Nowhere near 65, he didn’t qualify for Medicare.

In fact, Sharon found, George’s case fit in only one slot, Orange County’s Indigent Medical Services program. And that program, called IMS and administered by the county with state funding, had been cut to the bone. With recent massive county budget reductions of 30% and then 55%, IMS now reimburses hospitals somewhere between 6 and 11 cents on the dollar. Sharon threw up her hands.

The bill to date for saving George’s life: $450,000. Western Med CEO Tim Carda said: “Our doctors probably won’t even bill IMS; the paperwork’s not worth what little they get back. We will, but the hospital stands to lose $400,000, minimum. This one case put the entire hospital in the red this month. That really hurts.”

Both the IMS system and the network of Medi-Cal hospitals in Orange County are in extremis and hemorrhaging, too. IMS contracts are currently up for negotiation, with many hospitals expected to leave the system soon, and hospitals are preparing to sue the county to force it to hold hearings to justify such massive cuts to the public.

Medi-Cal is worse, with only nine hospitals out of an original 17 left in the network. Two more hospitals, La Palma and Martin Luther, have just quit their Medi-Cal contracts, simply unable to bear the volume of Medi-Cal patients any longer. UCI Medical Center, the sole big Medi-Cal provider left, loses millions of dollars a year in the program. Fed up with bailing out a county that refuses to adequately fund care for people who can’t afford it, the UC regents are considering pulling out of IMS too.

More people than ever need health services too. In 1988, there were 48,000 births in Orange County. Last year, there were 58,000.

Those sheer numbers, coupled with the financial woes of patients like George, who tax the system as it saves them, drive hospitals even further into debt, distress and disaffection.

When IMS and Medi-Cal contract hospitals are gone, forced out of business by state and county neglect, Orange County residents will increasingly be faced with emergency rooms and trauma centers that say “Closed” on their doors. And all people, not just the poor, will be at risk of having no access to life-saving care.

Meanwhile, George will soon be released from Western Med-Anaheim. He’s doing well. “They’re miracle workers here,” George says, a little weakness lingering in his voice. “You know, if I was still in Texas, I’d be dead. I’m really shocked that I’m in this beautiful hospital, alive. This IMS system saved my life.”

His wife is looking for work, unsuccessfully so far. An auto insurance price hike wiped out their savings. The loss of George’s income forced her to move out of their two-bedroom house in Costa Mesa into a tiny studio, and Laura was embarrassed when she had to apply for welfare and food stamps. They turned her down, saying she had no children and wasn’t yet truly destitute. “Your best bet,” a welfare worker actually told her, “is to become homeless.”

Welcome to California, George and Laura.