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San Diego County sued over indigent medical services

Five area residents have accused San Diego County of violating state law by failing to provide urgent medical services to themselves and other indigent residents.

They filed a class-action lawsuit Monday in San Diego Superior Court claiming that state law requires the county to consider an applicant's ability to pay for care and not just their monthly income. Four of the plaintiffs' incomes exceed the county's eligibility requirements by less than $400 while the fifth exceeds the requirement by more than $1,000. Each says they have had to forego life-saving treatment because of the county's refusal to cover their expenses after exhausting administrative hearings.

The Western Center on Law & Poverty and the San Diego office of Fish & Richardson are co-counsel for the plaintiffs in the lawsuit.

State law requires counties to provide subsistence medical services to indigent adults between the ages of 18 and 64 who do not qualify for Medi-Cal or other public health programs. However, counties are given discretion to define how they meet their obligation, including who qualifies and what services are provided. San Diego County's income limit for medical services is $802 for an individual or $1,084 for a household of two.

County Counsel John Sansone said the limit is adjusted annually according to the federal poverty guidelines. The U.S. Department of Health and Human Services raises the guidelines each February. In 2004, the department's guidelines set the poverty level at $776 per month for an individual and $1,040 for a family of two.

Sansone said the plaintiff's legal arguments are a "gross oversimplification of a very complicated statute."

The plaintiff's attorneys rely in part on a 1999 state Supreme Court opinion that concluded counties may not implement any eligibility standard that does not consider the financial ability of residents to pay actual medical subsistence costs.

Sansone said the plaintiff's use of the Supreme Court opinion in Hunt v. Superior Court of Sacramento County is "misplaced" and "misleading" because that case centered on whether the county could deduct money it spent providing health care from cash general relief payments to indigent residents. The court also did not define standards by which counties must abide in providing indigent medical services because of cost of living disparities from county to county, Sansone said.

He said the plaintiff's demands would force the county to provide "universal health care," and lead to a flood of applications for services.

Attorney Juanita Brooks, a principal with Fish & Richardson, said most counties offer some sort of graduated scale that allows indigent residents that exceed the income guidelines to pay for a portion of their care.

For example, if an individual earns $902 monthly, they might pay $100 while the county covers the rest.

Brooks said the income cut off is so low and San Diego's cost of living so high that it's hard to imagine there aren't thousands of people who haven't received services because they can't afford private medical insurance and don't qualify for other public programs. She is confident the class will be certified with thousands of plaintiffs.

Brooks' clients would like to see the litigation disappear, said Katie Murphy, a staff attorney with the Western Center on Law & Poverty. Murphy said she and her clients tried to work with the county to change the policy but were unsuccessful. They filed the lawsuit as a last resort because of a 90-day statute of limitations was running out for some of the clients.

The plaintiffs are not seeking monetary damages. They are asking the court to strike down the county's income policy and to cover their medical expenses, which are extensive.

The plaintiffs include a church camp maintenance worker with cancer, a dump-truck driver who needs a heart transplant, a paintball company worker who suffered a collapsed lung, an unemployed man who was hospitalized with a staph infection and a woodworker who suffered a stroke.

Murphy said creating a sliding scale for residents who exceed income requirements is not the same as universal health care, because the program is one of last resort designed to cover "life and limb protection" in emergencies not basic health care.

Sansone will meet in closed session with the Board of Supervisors Feb. 1 to discuss the case.

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