Hospitals Assail Bid to Kill Program for Poor : Health care: They say the county failed to inform them of plans to end care for 25,000 under program.

Angry hospital officials Tuesday challenged the proposal to kill San Diego county’s medical program for the uninsured and working poor Tuesday, charging that the county had neither considered alternatives nor collaborated with hospitals to try to find solutions.

“We are not able to fully embrace the explanations . . . as to how and why this crisis evolved,” wrote James Lott, executive director of the Hospitals Council of San Diego and Imperial Counties, in a letter delivered Tuesday to the Board of Supervisors.

The county precipitated the crisis by not setting aside in December the $9 million that school districts owed it under a new tax approved by the Legislature last year, Lott said. County officials have said they had no authority to do so until Jan. 1.

It also should have considered declaring a state of emergency--which might make state reserve funds available--and imposing a utility tax to help fund the medical program, Lott wrote.

But the biggest complaint was that the county ignored the implicit ground rules of the public-private partnership that has long been the backbone of the county’s medical care system for the poor, Lott said in an interview.

Hospitals first learned on Thursday and Friday that the system was on the verge of being killed, although county administrators had been discussing the problem intensely for a week.

Had they been consulted earlier, Lott said, hospital administrators would have pointed out what they see as serious countywide implications of the plan: That it could send some hospitals over the edge of financial solvency and threaten emergency room and trauma care for all county residents.

“We could have helped them think through what they obviously didn’t think through--and that is, what would happen if the entire system was brought down,” Lott said. “If you were a true partner with the private sector you would sit down and make those kind of assessments before you take this Draconian step.

“That’s not just for our particular benefit in this relationship. That’s what’s necessary for the people of San Diego,” he said.

Since the 1960s, when it turned over its Hillcrest hospital to UC San Diego, the county has operated a public medical care system that depends mainly on the private sector for its implementation. Hospitals, doctors and community clinics are reimbursed--at discount rates--for caring for people who are uninsured or who earn too much money to qualify for the state’s Medi-Cal program.

County administrators announced Friday that they were recommending that the board vote next week to shut down this system, called County Medical Services. The closure would take effect March 15.

An estimated 600,000 San Diego County residents have no medical insurance, and so in crisis might be covered by CMS. Its patient load is about 25,000.

David Janssen, assistant chief administrative officer for the county, said the shutdown was necessary because about half of the CMS program’s $41-million budget for this fiscal year had failed to materialize. He remains insistent that funding CMS is a state obligation.

Janssen noted that the county supervisors warned last September that a CMS closure was a possibility. But he acknowledged that hospitals were not consulted until the administrative deliberations about how to solve the problem were already complete.

“They may have a valid point on that,” he said.

Grossmont Hospital chief Michael Erne, who chairs the Hospital Council’s board, said his group is considering a lawsuit to stop the cuts.

But Lott is advising board members instead to support a class-action suit by patients.

“For a hospital to say it was aggrieved and it lost money is not as compelling as if a patient or consumers says that they were denied access to life-sustaining health care,” Lott said. “That’s where the grievance has to be.”

Rosemary Bishop, a Legal Aid of San Diego lawyer who handled a similar suit over mental health cuts three years ago, said potential plaintiffs are already being lined up.

Lott noted that the mental health suit three years ago ended in a settlement, with clients gaining very little. That was partly because Legal Aid didn’t have the money for expert witnesses and analysis, he said.

“This time they would have it,” Lott said. “We would do all that we could to support a consumer response with resources of the hospital industry.”

Janssen said the idea of a lawsuit is not unexpected.

“We have been sued every time we’ve ever tried to make a decision to reduce any programs. I would assume we will be sued,” Janssen said.

The issue still remains who is going to pay for programs that the state mandates, he said.

“Somebody somewhere has got to face the fact that you can’t continue to provide programs without resources. You just can’t do it,” he said.