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by Rodessa Garcia
"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.
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.
PT 2 HEALTHCARE..!!!
On June 26, 2001 At the Board of Supervisors Health Committee Hearing, Sup. Sophie Maxwell who has been working with SEIU local 250 on this issue, introduced an ordinance that requires private hospitals to notify patients of their right to apply for charity care. The ordinance also requires hospitals to file an annual report with DPH describing how many people applied for charity care, received charity care and were rejected, as well as cost info, etc. The ordinance establishes financial penalties to be levied against hospitals for failing to comply.
This ordinance will help hold hospitals accountable and is a first step towards establishing greater public accountability.
The ordenance was passed by the full board on Monday, July 2, 2001
"Charity Care Policy Reporting and Notice Ordinance"(print this and keep it with you, poor folks!!)
I. Purpose: According to the ordinance, its principal purpose is to provide City agencies with adequate information to plan for the provision of health care to city residents and "to maximize the access to charity care within the community and to enhance the health of the public by informing individuals of the availability of charity care.
II. Provisions: This ordinance would add language to the San Francisco Health Code requiring San Francisco's private hospitals to:
Notify patients about their right to apply for charity care;
Submit annual reports to the San Francisco Department of Public Health describing each hospital's provision of charity care.
Patient Notification Requirements:
Hospitals would be required to verbally notify patients during the admissions process about the availability of charity care and any process necessary to apply for charity care.
Hospitals would be required to post multilingual notices about their charity care policies in several prominent locations within the hospital, such as the emergency department, billing office, and waiting rooms.
Public Reporting Requirements:
Hospitals would be required to file annual reports with the San Francisco Department of Public Health containing the following information:
The dollar amount of charity care provided during the year, as measured in terms of costs to the hospital;
The total number of applications for charity care received by the hospital, as well as the numbers of acceptances and denials, including visit code of each patient's residents;
The number of people applying for charity care who were referred to other facilities, including the name of the facilities to which they were referred;
The description of the type of services delivered to charity care patients (i.e., emergency, inpatient, outpatient or ancillary medical services);
All of the hospital's charity care policies, including but not limited to explanations regarding the availability of charity care and the time periods and procedures for application, determination, and appeal; any application forms used; and the hospital locations and hours at which the information may be obtained by the general public;
Other information that the Department of Public Health requires.
III. Enforcement: The ordinance would establish a penalty of up to $500 per day for hospitals that violate the ordinance.
IV. Applicability: The ordinance would cover all private acute-care hospitals in San Francisco. Kaiser Foundation Hospital San Francisco would be covered by the notification provisions of this ordinance, but would be exempt from the reporting provisions because Kaiser hospitals, which operate on a pre-paid basis, do not have billing systems capable of collecting the data required by the reporting portion of this ordinance. This mirrors a similar exemption for Kaiser hospitals under state law.
The ordinance was passed
by the full board on Monday,
July 2, 2001.
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