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Show j U hospital forced to turn awav Door By SCZAXXE DEAX Staff Writer Politicians dish up and hurl out rhetoric. Dark-suited lawyers argue ar-gue the nuances of state and federal fed-eral law. And at University Medical Medi-cal Center, a poor patient is told that sick or not he has to go home. Innocent citizens are often the unhappy victims of legal and political po-litical controversies, and right now, just such a controversy is forcing the University Medical Center to refuse treatment to patients pa-tients who are too poor to pay their hospital bills. At one time, bills of all poor patients were cheerfully paid by Salt Lake County. But now the County is contending that it is only responsible for some of the poor patients the ones who fit in certain legally-defined "categories", "cate-gories", and who, because they fit, qualify for state and federal welfare wel-fare money. The University wants to help all the poor. But it can't. The Beard of Regents has told University Univer-sity Hospital that unlers there is a life - and - death emergency, it must send away patients who went' be able to pay their bills. K?gents Instructions Dr. Franklin Ebaugh, dean of the College of Medicine, has passed the Regents' instructions on to the doctors and nurses who work at the hospital. In a memorandum to the hospital's hos-pital's house staff, Dr. Ebaugh discussed the indecency of "denying "de-nying care to a segment of outpatients out-patients who . . . are most in need of help", but pointed out bluntly that to treat them for free "would spell financial disaster for the medical center." Noting that during a single month, the hospital had given SIS, 000 in care for general assistance assist-ance patients, Dr. Ebaugh told the staff, "We have no choice but to cease seeing general assistance patients in as quickly and as orderly or-derly a fashion as we can other than those in emergency, life-preserving need." Difficult Problem He added, "I think it is very important at this trying period that we have the closest communication commun-ication between administration and staff and work as a team in coming to grips with this very difficult problem." The "why" of the whole problem prob-lem is almost unbelievably complex. com-plex. Perhaps the first time the problem prob-lem raised its ugly head was in the spring of 19G3 when then But it neglected to say who had to pay the bills for patients who couldn't get state help. The fact is that many of the patients who were being treated, even though they were definitely too poor to pay their bills, didn't fall into any of the federally-defined "categories." "categor-ies." No more money The county could receive state funds for "categorically-related" patients people on welfare, the disabled, the handicapped, etc. But who would pay for patients who didn't fall into any category, but who were still sick and still poor? Consequently, the Medical Center Cen-ter felt It had no choice but to stop admitting any new, non-cate-Rorieal patients. Current patients were retained. But Dean Ebaugh told Ills staff that the hospital could no longer incur bills "for which we have no certainty of being be-ing paid." Complaints from patients began flowing Into the Medical Center and county offices. Then Ally. Con. Phil L. Hansen charged that the county had misinterpreted his original opinion and Issued a second sec-ond one. Indigents who don't qualify for state welfare must be treated and (Cmillniiril on rng(. 8) County Auditor LaMar A. Raw-ings Raw-ings sent a routine letter to t h e Salt Lake County Commission. In the letter, Mr. Raw-lings said that the county was eligible for, but not taking advantage of, federal fed-eral and state funds for medical treatment of "indigent" patients. Opinion Requesti-d In response to Mr. Rawlings' letter, the Commission requested an opinion from the county attorney at-torney defining the county's responsibilities re-sponsibilities for poar patients. The county attorney replied that an act passed by the 17 legislature legisla-ture did indeed entitle Salt Lake County to state and federal funds for indigent medical costs. The act authorized Utah's participation par-ticipation In a federal medical-Insurance medical-Insurance program. The program was created as part of the MihII-care-Modicaid package passed by Congress in 15. The program made federal mon-ey mon-ey available to the state. The state could, in turn, make some of that money available to counties, coun-ties, the county attorney noted. All Salt Lake County needed to do to get Its share was to contribute con-tribute some "matching money" to the state. The legislature's 1907 act set down a formula describing describ-ing the amount of matching funds needed they equaled the amount collected by a one half mill tax levy. In Salt Lake County's case, a mere $.'!SO,000 would be required. $1 Million 1'iild The next development came In August, l!)(iS. A new county uudl-tor, uudl-tor, Glen F. Palmer, np'ured before the County Commission. Care for Indigent patients, h e told the commission, had cost the county $2,0IG,1S7 In 10117. Of that, $1,125,472 was paid to the University Uni-versity Medical Center. Mr. Palmer cited the sjx'clfie regulations of the program: patients pa-tients would meet eligibility standards stand-ards set down In federal law, nml state welfare officials would bo stationed at the University Medical Medi-cal Center to determine which patients could meet those? standards. stand-ards. The state would jmy one-third one-third and the federal government two-thirds of the bill for the first 20 days of hospital care given. After 20 days, the county would pay one third and the federal government gov-ernment the remaining two-thirds. The county, Mr. Palmer summarized, sum-marized, would save well over one million dollars. New Dimension Adilil Up to this point, the discussion had centered around whether or not the counly should participate In the federal-state medical payment pay-ment program. But In August, 19C8, a new dimension was added to the discussion. Jim P. Hansen, a Salt Luke County expert In Intergovernmental Intergovernment-al relations, appeared before the Commission an dchargod that during February, March and April of 1908, University Medical Center had overbllled the county $43,457 on care for general assistance assist-ance patienls. Mr. Hansen urged the Commissioners Commis-sioners to bring down the county's medical bill by modifying counly eligibility standards to conform with standards set down by t h e federal-state medical program. County Iti-HioiiHlblllt.y The commission reacted by requesting re-questing an opinion from the attorney at-torney general defining counly responsibility re-sponsibility for Indigents. The attorney general replied, In effect, that the counly had no responsibility re-sponsibility for medically Indigent patients provided they pay the equivalent of u half-mill levy to the Slate Welfare Department. What the opinion said was: Salt Lake County doesn't have to pay hospital bills for indigents if the state and federal government will agree to pay the bills. University loses image structed to make a list of names of patients who could be- removed from the hospital without their lives being threatened. A letter went out to the patients. pa-tients. "We have been informed that neither Salt Lake County Welfare nor Salt Lake Countv Commissioners will be responsible responsi-ble for providing payment for medical services for you," the letter said. Regretfully! the University Uni-versity Hospital dcx-s not have funds to provide free hospital care. Therefore, effective two weeks from today, the hospital will no longer bo able to accept you as a patient." So that's where things stand. The residue of the dispute has hurt the Univei-sity's image with patients who were refused treatment, treat-ment, and with the community. Solution could come through a legislative act. But that will likely take until 1971. The quickest solution would be for either the County or the State to declare themselves responsible. Neither are anxious to do that. So the complex problem still exists and its consequence is simple: sim-ple: until a solution is found, many indigent patients will not lie treated at the Unversity Medical Medi-cal Center. (lantiiuied from Paije 1) paid for by the county, Mr. Hansen Han-sen said. "The primary concern behind (the law that created the state-federal state-federal welfare program) was to provide a statutory vehicle which would enable the counties to do-fray do-fray the costs of caring for the indigident sick," Mr. Hansen's opinion said. "It did not relieve the counties of any of their present pres-ent responsibility." The County Commission stuck to its guns despite Mr. Hansen's second opinion. The County, t h e Commission said, would still refuse to pay for medically-indigent patients w h o did not fall in the eligibility categories cate-gories set down in state and federal fed-eral law. With this action the University's Board of Regents took a "get-tough" "get-tough" stand. In a terse announcement, announce-ment, Regents Chairman Donald B. Holbrook announced that no more patients would be admitted to the University Medical Center until Salt Lake County agrees to a satisfactory arrangement for admission and method for payment pay-ment of bills. Salt Lake County will also be held responsible for payment of professional services, including physician services," Mr. Holbrook said. A second memorandum went out from Dean Ebaugh's office. This time, clinical patients were in- |
