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HELLTH CARE

Low-income patient chronicles her experiences with private non-profit hospitals in San Francisco

By PNN Staff

"But it is an emer.....gen.............." the last part of my sentence was cut off by my own saliva which was draining into my throat at a rate of three gallons per second.

"No Miss Garcia, I don't think so"..... the admitting clerk mistook my choking pause for uncertainty, and proceeded to start shaking her head from side to side while she filled the silence with her persistent rant, " We can only see you if it is a life threatning emergency, and of course that is only if there is no other county facilities available."

"I'm.....tell...ing.....you....I can't..... breathe.....It is an emer....." She was still shaking her head. I managed to spit out one last sentence. "Can you ask your sup...ervis..or..?!"

At this point she made a small snort of frustration/confusion and walked away.

It had been several months since I had had an asthma attack quite this bad and when I had the last one I vowed to never go to an emergency room due to an example of what I call "Hellth-care" which included sitting in a County funded emergency room for no less than 16 hours before I recieved any treatment. Unfortunately illness is an untameable beast which strikes unexpectantly when you are least prepared....and for poor people that is always.

But this day started simply. The sun was cool and flat....Mountain and ocean breezes from opposite ends of the sky collided in the San Francisco atmosphere refreshing my pores. And then......all of sudden....... a slice of fresh pollen coupled with several hundred wayward dust mites entered my nose and mouth.

It began as just a difficulty breathing and proceeded into a monstrous cough/ wheeze, at that point, logic and all other normal thoughts disappeared in place of adrenalin fueled terror and extreme states of anxiety. I walked into the emergency room of a hospital owned by Catholic Healthcare West, a private non-profit corporation, and began an odd sort of battle to prove the emergent nature of my illness.

The supervisor returned with the admitting clerk who was still shaking her head, in a permanent state of no...... "Miss Garcia...we will admit you this time but....." The supervisor's voice was loud and smashed through the glass window between us " because you have no insurance we will have to bill you...." I thought this was a strange comment from the admitting nurse's supervisor but somehow it meant I could be considered "an emergency"

After this 45 minute financial diagnosis I was able to recieve care. I saw the doctor for four minutes, hooked up to breathing machine for ten minutes, and recieved a prescription for an inhaler. Two weeks later I recieved a bill. It was for several hundred dollars.

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I called the hospital billing office after recieving the bill, " After a full minute of annoyance laced pleasantries between me and the billing clerk, I began my tirade, " I told the admitting clerk I was unemployed and homeless, I told her I had no money to pay for services...I told her I wanted to recieve services under the Hill- Burton act......why am I recieving this bill? "

Many non-profit hospitals have an obligation to provide charity care because of their use of low interest rate financing from the federal government through the Hill-Burton program.Approved by congress in 1946, the program extends to hospitals and other health facilities money for construction and modernization. In return, recipients of Hill-Burton funds are required to provide a reasonable volume of services to persons unable to pay and also make their services available to all persons residing in the facilities area.

"Well Ms. Garcia, we know someday you will be able to work and until that day we will continue to bill you"

"You are not hearing me...! ...I said I am very low income and I asked to be treated under the Hill-Burton Program."

"I told you what we will do......click

After that phone call....I began recieving bill after bill, until the blue and green colored envelopes turned into hues of pink and red. Billing turned into collection....and eventually collection locked in my cycle of poverty culminating with a landlord refusing to rent to me because I they thought I was a "bad credit risk"

Despite the growing numbers of medically uninsured San Franciscans, the city's three largest private hospitals (St Mary's Medical Center and St Francis Memorial Hospital of Catholic Healthcare West and California Pacific Medical Center of Sutter Health reduced their rate of charity care spending by 15.7 percent during the past four years. In 1998, the three hospitals spent less than half of one percent of their revenues on charity care- approximately one-sixth the national average for tax exempt hospitals. Together these hospitals control more than half of the city's licensed hospital beds.

All hospitals --for profit and non-profit alike-- have an obligation to serve the sick and uninsured. Tax-exempt hospitals are further bound by a basic social contract with the general public due to their tax-exempt status. In exchange for receiving millions of dollars in tax breaks, tax-exempt hospitals are expected to provide charitable services to poor and uninsured patients. Tax-exempt hospitals' tax breaks include exemptions from property and income taxes, access to tax-free bonds issued through government agencies, and access to tax-deductible donations from the public.

The City and County of San Francisco should require that hospitals:

*Meet minimum charity-care spending standards of at least 3 percent of net patient revenues or contribute any shortfall to pay for the cost of charity-care services at county and other major providers of free care.

*Provide patients with adequate notice that charity care is available;

*Utilize uniform charity-care applications, eligibility criteria, and appeals procedures;

*Publicly disclose charity-care policies and expenditures.

And finally to recognize the difference between medical emergencies and financial emergencies.

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THERAPY COSTS TOO MUCH!!!!
Dee Gray, M.S.W., M.F.C.   Licensed Therapist specializing in advocacy and crisis counseling. Mother, daughter and family counseling. Adoption and juvenile dependency. Literary and creative art counseling. Individual and group therapy. Sliding scale fee. (415) 541-5629.