Specialists refusing to be on call for hospital emergency rooms

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Specialists refusing to be on call for hospital emergency rooms

December 29, 2001 Posted: 12:35:04 PM PST

LOS ANGELES (AP) - Specialist physicians are refusing to be on call

for hospital emergency rooms in a growing rebellion over money,

respect and managed health care.

A federal survey of emergency room doctors, nurses and other

personnel, published this year, found that refusals by specialists

are occurring in California and other states with high rates of

uninsured patients or managed care members, including Nevada,

Pennsylvania and Texas.

" I'm getting called at 3 o'clock in the morning, and the only people

I'm getting called for are people who are not going to pay? Why would

I do that? " asked Dr. Ross, president of the California

Orthopedic Association, who still takes emergency calls but

understands colleagues who don't.

In 1986, the federal government prohibited hospitals from " dumping " -

transferring emergency indigent patients to other hospitals for care.

If a hospital has specialist services during the day, federal law

says it must make the same care available at all hours in

emergencies, on penalty of losing Medicare funding. Fines of up to

$50,000 are authorized but seldom levied against doctors who agree to

take emergency calls but don't show up.

" I've definitely been involved in cases where the on-call

specialist's refusal to come in has not only jeopardized a patient

but has resulted in death, " Dr. Graham Billingham, chief medical

officer for EMSource, a Northern California firm that supplies

emergency room doctors to 30 hospitals, told the Los Angeles Times

for Saturday editions.

However, Billingham did not describe a specific case involving a

death.

At St. Rose Hospital in Hayward, where six of eight orthopedic

surgeons have refused to take calls, emergency room Dr. Elliot

Nipomnick said he recently could not find an orthopedic surgeon to

come in and operate on a patient whose leg had been shattered in a

forklift accident. The man's wife took him to another hospital.

The scope of the rebellion is unknown, but a survey of emergency room

personnel published this year by the U.S. Department of Health and

Human Services showed that 50 percent of the doctors and nurses

surveyed nationwide said emergency rooms were having difficulty

filling on-call rosters with certain types of specialists. Most

attributed that to shortages, but 12 percent of those surveyed said

specialists refused to take calls.

" Doctors have a professional obligation to provide charity care, "

said University of Pennsylvania bioethicist Arthur Caplan. However,

he added, " businessmen and women do not come out for free in the

middle of the night. "

To free themselves from taking emergency calls, some specialists have

stopped using hospitals, taking advantage of outpatient facilities

instead.

Others have campaigned to change hospital bylaws to make on-call

services voluntary or gain extra pay for being on standby.

" They're not bad guys. They're in a bind, " said Dr. Kaufman,

president of the California Urological Association and former chief

of staff at Western Medical Center-Santa Ana. " If you've got an

office full of patients and you're called to take care of an unfunded

patient in the emergency room and he's got a complicated problem

that's going to take a great deal of time, how motivated are you to

do that? "

Information from: Los Angeles Times