I can’t breathe…

by Tiny

But it is an emergen…” The last part of my sentence was cut off by the saliva draining into my throat at a rate of several quarts per second.

“No, Miss Garcia, I don’t think so…” The admitting clerk mistook my choking pause for uncertainty, and started 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-threatening emergency, and of course that is only if there is no other ‘county’ emergency room 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?”

She made a small snort of frustration and/or confusion and walked away.

I hadn’t had an asthma attack quite this bad in several months. After my last one I vowed never to go to an emergency room again. This was because of my experience of what I call “hellth care” – sitting in a county hospital emergency room for no fewer than 16 hours before receiving treatment.

Illness, unfortunately, is an untamable beast which strikes unexpectedly and when you are least prepared. 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. And then, all of sudden, a bit of fresh pollen and several hundred wayward dust mites entered my nose and mouth.

It began as just a difficulty breathing and turned into a monstrous cough/wheeze. At that point, logic and all other normal thoughts disappeared in adrenaline-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 how ill I really was.

The supervisor returned with the admitting clerk 20 minutes later. The clerk was still shaking he 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.”

“But I have no money to pay a bill…”

I attempted to spit out one last retort, but they had stopped listening. Eventually, I got care. I saw the doctor for four minutes, was hooked up to a breathing machine for 10 minutes and received a prescription for an inhaler. Two weeks later I received a bill for several hundred dollars.

Despite the growing numbers of medially uninsured San Franciscans, The City’s three largest private hospitals (Catholic Healthcare West’s St. Mary’s Medical Center and St. Francis Memorial Hospital and Sutter Health’s California Pacific Medical Center) reduced their charity care spending by almost 16 percent during the past four years.

Presented at a recent Board of Supervisors hearing were results of a study by the Service Employees International Union. In 1998, the three hospitals spent less than half of 1 percent of their revenues on charity care – approximately one-sixth the national average for tax-exempt hospitals. Together, these hospitals control more than half The City’s licensed hospital beds.

In exchange for receiving millions of dollars in tax breaks, tax-exempt hospitals are expected to provide charitable services to poor and uninsured patients.

Their 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.

To avoid the unjust treatment of thousands of indigent patients by these so-called “non-profit” institutions, 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.

>Use uniform charity-care applications, eligibility criteria, and appeals procedures.

>Publicly disclose charity-care policies and expenditures.

Then, perhaps, there will be a clear distinction between a medical emergency and a financial emergency.