Service Clinics Crowded : Navy Will Shift Family Care to Civilian Doctors

A growing shortage of manpower and space at the Navy Hospital in Balboa Park and the medical clinic at Miramar Naval Air Station will mean that some military families will be referred to civilian facilities--at some personal expense--the Navy warned Tuesday.

Hospital and clinic staffers will give patients with less pressing problems a list of civilian hospitals and doctors accepting payment under the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS), the tax-supported insurance program for military personnel.

Patients who elect to go, rather than face longer waits for emergency-room attention or appointments, will not receive free care as they do at the Navy Hospital and clinic. Under CHAMPUS, patients are required to pay 20% of the allowable charges for the service.

“If (military dependents) will read down at the bottom of their (identification) card, it clarifies there that medical care is subject to availability of resources and space,” Lt. Gene Elliott, a Navy spokesman, said in justifying the new policy. “It is a privilege, and it is not in black and white that it is a right.”

Elliott said the new triage policy will go into effect in the Navy Hospital emergency room only during periods of heavy overcrowding, when all 18 beds and the chairs in the waiting area are filled. He insisted that the emergency-room and clinic staffs would not turn away urgent cases.

“We’re not cutting services,” Elliott said. “It’s only potentially and it’s not all the time. It’s only at times that the loading necessitates that the system be enforced. We need for people to know this.”

The system is to begin Tuesday at the Navy Hospital. It begins May 1 at Miramar.

The two facilities, which serve 400,000 active-duty members of all branches of the military, their family members and retirees, have faced a dramatic increase in patients in recent years as a result of population growth in the San Diego area, Elliott said.

For example, the number of people seeking care at the hospital emergency room rose by 20% between 1982 and 1985, Elliott said. During the same period, he said, there was no increase in the number of doctors or emergency-room staff serving those patients.

As a result, the wait in the Navy Hospital emergency room has stretched to as long as four hours during crowded times like Friday and Saturday nights. The wait for an appointment at one of the outpatient facilities can extend into weeks, Elliott said.

“You have to balance the quantity of people you see and the stringent quality-assurance programs that we have on line,” Elliott said. “You can’t effectively do that by overloading the facility and overtaxing physicians and health-care providers.”

Even though the emergency room expects eight new nurses and four civilian emergency-room doctors, Elliott said the shortage and delays will persist. He said the new hospital currently under construction in Balboa Park will help ease the pinch by improving efficiency.

Elliott could not say what percentage of civilian doctors are willing to accept CHAMPUS patients. But he said a new list of hospitals and other urgent-care facilities that accept CHAMPUS cases suggests patients would not have to drive long distances.