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California regulators launch review of long, deadly delays in L.A. County specialty care

Los Angeles, CA, August 24, 2019 - Majid Vatandoust, a 49-year old heating and air conditioning technician from Canoga Park, who went to LAC clinic Mid-Valley for a check-up in early 2014. He had unintentionally lost about 20 pounds and routine tests found he was anemic and had blood in his stool, all early indicators of potentially deadly colon cancer. His doctor put in a request via eConsult for a colonoscopy but was denied, his medical records show. The gastroenterologist who turned down the request without ever seeing Vatandoust said the test used to detect blood in Vatandoust's stool was "not valid for patients under 50 years old." Thousands of patients in L.A. County's public hospital system who endure long, sometimes deadly delays to see medical specialists, a Times investigation has found. Doctors, nurses and patients describe chronic waits that leave the sick with intolerable pain, worsening illnesses and a growing sense of hopelessness. According to a Times data analysis of more than 860,000 requests for specialty care at the L.A. County Department of Health Services, a sprawling safety-net system that serves more than 2 million, primarily the region's poorest and most vulnerable residents. (Robert Gauthier / Los Angeles Times)
Majid Vatandoust died of colon cancer at age 52, three years after a request for a colonoscopy was denied by a specialist working for L.A. County despite tests that showed clear indicators of the disease. (Robert Gauthier / Los Angeles Times)

As current and former doctors in Los Angeles County’s public hospital system condemn delays in providing specialist care, California regulators have launched a review of the long, sometimes deadly waits faced by patients who need treatment from one of the nation’s largest public health systems.

The actions come in the wake of a Times investigation that found patients of the Los Angeles County Department of Health Services face agonizing delays to see specialists after referrals from primary care providers, leaving many with intolerable pain, worsening illnesses and a growing sense of hopelessness. The Times report included several patients who died of the conditions they waited to have treated.

The California Department of Health Care Services will review whether any managed care plan that offers Medi-Cal — the government-subsidized program that covers low-income Californians and most county patients — violated its contract with the state to provide adequate access to care, an agency spokeswoman said.

“Any untimely death is a tragedy, and our hearts go out to the families suffering the loss of a loved one. The wait times outlined by The Times are unacceptable,” Michelle Baass, undersecretary of the California Health and Human Services Agency, said in a statement. “Timely access to care is a fundamental patient right.”

The review is the second underway by the state. The California Department of Managed Health Care began an investigation of the county’s wait times this year in response to questions from The Times about delays in specialist appointments.

Baass is overseeing both inquiries after her boss, state Health Secretary Dr. Mark Ghaly, recused himself. Ghaly is married to the director of the Los Angeles County safety-net hospital system, Dr. Christina Ghaly.

The average wait to see a specialist in the L.A. County system was 89 days, according to a Times data analysis of more than 860,000 requests for specialty care at the county’s Department of Health Services, which serves more than 2 million people, primarily the region’s poorest and most vulnerable residents.

Even patients waiting to see doctors whose prompt care can mean the difference between life and death — neurologists, kidney specialists, cardiologists — endured delays that stretched on for months, according to the data, which consisted of nonemergency requests from primary care providers to specialists from 2016 through 2019.

Several doctors who now work for the county or recently left called for reform, including better communication between primary care providers and specialists as well as a dramatic increase in hiring of specialists.

Dr. Michael Hochman, a primary care physician and associate professor of clinical medicine at USC’s Keck School of Medicine, who has practiced at safety-net health systems on both coasts, said Los Angeles County’s is “the least effective system that I’ve worked at in my 14