March 11, 2005

Commentary:

UCSD and Our Fragile Safety Net

By Sandra Perez, MD and James Santiago Grisolía, MD

We never think about our own health until it’s in danger. But we and our families are only one car accident away from needing emergency hospitalization, and now our health care safety net is about to unravel.

UCSD has decided to close its downtown hospital, moving up to La Jolla, which already has enough hospital beds. The underlying reason is that decades of being underpaid are now catching up with all San Diego hospitals, including UCSD. About 25% of all hospitals have been forced to close in San Diego and across the state. UCSD wants to consolidate inpatient care in a single 500 bed hospital in La Jolla, citing cost and quality concerns.

While many San Diego hospitals take care of poor people, UCSD started its medical school by taking over the old County Hospital in the late 60’s, promising to provide care for the county indigent population. Currently, UCSD cares for 36% of all uninsured hospital patients in the county, drawing 35% of its hospital patients from south of Highway 8 and another 9% from outside the county, principally from Mexico.

UCSD intends to keep outpatient clinics and its emergency department open in Hillcrest, but currently it’s illegal to operate an ER without hospital beds, an operating room and an intensive care unit. UCSD leaders hope that the laws can be changed, and that poor people from south and central San Diego will be able to drive or take an ambulance up to La Jolla. But the reality is that many patients or their families will be unable to travel the extra distance and will go to other hospitals. This will place new burdens on hospitals and ERs throughout the county, especially in South County where many Latino families already cope with lack of health insurance along with other financial challenges.

This move will also leave only one trauma hospital south of Highway 8, covering 44% of the trauma patients for the entire county. The increased burden of unfunded patients will threaten many hospitals with economic collapse. University Community Medical Center has already decided to close its own small ER within the next few days. Meanwhile, when your daughter gets appendicitis or your brother-in-law has a heart attack, waiting times to be treated in the few remaining ERs will climb to many hours due to overcrowding.

We need to help UCSD stay open in downtown, protecting access to health care for the poor, for emergency and trauma patients. This means that county and state government must provide better funding for health care of the poor. While UCSD tries to cope with an aging infrastructure and many changes in health care, we need to keep the needs of the community as our first priority.

Dr Perez is a National City pediatrician and Chief of Staff-elect for Paradise Valley Hospital. Dr Grisolia is a Hillcrest neurologist and Chief of Staff-elect for Scripps-Mercy Hospital.

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