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Nickel-a-beer proposal aims to shore up California ED system

A state bill would earmark money from a special tax for a trust fund devoted solely to paying for emergency services for alcohol-related injuries.

By Tanya Albert, amednews staff. April 14, 2003.

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Some California lawmakers say it's the beer, wine and distilled spirit industry's turn to pick up the tab for alcohol-related emergency services.

A California Senate committee in March passed a bill 8-2 that would collect a 5-cent fee per drink from wholesale distributors of distilled spirits, beer and table wine sold in California. The money -- an estimated $700 million annually -- would be used dollar-for-dollar to reimburse on-call physicians, emergency departments, trauma centers and first responders for alcohol-related incidents.

Physicians and hospitals say the money is desperately needed to keep cash-strapped emergency departments from closing. California EDs lost $390 million in uncompensated care in the last fiscal year, according to the California Medical Assn. and the Office of Statewide Health Planning and Development. Physicians lost an additional $150 million in uncompensated care to patients in emergency departments.

Los Angeles emergency physician Brian Johnston, MD, said he knows the proposed tax wouldn't solve all of the problems in the health care system -- issues such as nursing shortages and a dearth of hospital beds would still need to be addressed. But, he said, it's a place to start.

"In the short run, we have to do what we can to keep the doors open and the lights on," said Dr. Johnston, a CMA trustee. "It's the most urgent place to start right now."

California emergency systems, like others around the nation, have had to make tough choices in the past decade. The hospital diversion rate in Los Angeles County rose to 25% in 2002, up from 6.2% in 1995. And since 1990, 60 California emergency departments -- 15% of EDs in the state -- have shuttered their doors, according to the CMA. Ten have closed since Jan. 1, 1999, and health officials fear more will disappear if financial needs aren't met.