The Associated Press

BATON ROUGE - In spite of closed clinics and other cuts, Louisiana's charity hospitals could face nearly $15 million in deficits this budget year.

It would be $5 million worse if the Baton Rouge hospital weren't running a surplus, according to a report on spending in the first quarter of the fiscal year which began July 1.

The two New Orleans hospitals will be $17.2 million in the hole if they keep spending the way they did from July through September, according to the LSU Health Care Services Division report.

Aside from Earl K. Long Medical Center in Baton Rouge, only one hospital in the system, Bogalusa Medical Center, is meeting its goals. It has a $127,074 projected surplus.

The lowest projected deficit is $229,843 at Lallie Kemp Medical Center in Independence. W.O. Moss Medical Center in Lake Charles is $1.38 million off pace.

The new report to the LSU Board of Supervisors tracks how hospitals are faring as they cope with a $66.5 million cut. Officials will use it to ensure the eight hospitals don't exceed the total $765.8 million budget appropriated by the Louisiana Legislature.

LSU hospital system chief Jim Brexler and LSU System executive Bob Plaisance said more cuts are coming for the New Orleans hospital, where LSU runs one of its two medical education programs.

"Their spending rate hasn't come down as predicted," Plaisance said, noting that "Big Charity" takes up half the system's budget. "The only way we can cut expenditures is shut down beds. ... Emergency rooms are our front doors."

Plaisance said the hospital only recently implemented a major employee layoff plan.

Many LSU hospitals are within their revenue and expenditure goals or in range of meeting them within a month or so, Brexler said. "New Orleans has much more to do than anyplace else right now. ... It's an early warning signal."

Earl K. Long is far ahead of the pace, on target for a $5.14 million surplus. It has been aggressively going after collections, and some of the surplus is a one-time increase, said its administrator, Dr. Fred Cerise. "Our Medicare business is not up significantly. It's scouring old accounts."

Cerise said the hospital is ahead of others because it took steps more quickly to reduce spending. "I wanted to go first. Some people were holding out, hoping there's going to be a fix." But he said the longer people waited, the deeper the cut.

Beginning next week, Cerise said, all patients whose income is more than double the federal poverty level will have to start paying something toward their clinic care. That will affect about 7 percent of the hospital's users, he said.

Clinic patients will be asked to make a $15 deposit and be billed for the balance on a par with Medicare rates, Cerise said.

A walk-in clinic that once saw 1,500 patients a month is closed. Earl K. Long also shut down about one-third of its emergency room beds to manage a nearly $6 million cut.

Cerise said the hospital is seeing some former walk-in patients in its family medicine clinic, where visits rose from 930 in September 2002 to 1,130 last month.

Although the number of emergency room beds went down 33 percent, the number of patients went down only 10 percent, he said. "We are getting people in and out quicker."

In July, the emergency room treated 3,806 patients, dropping in August to 3,587 and in September to 3,192.

Our Lady of the Lake Medical Center President Kirk Wilson said that hospital has seen an 8.5 percent increase in emergency room visits since the Earl K. Long cutback. "Nothing else major happened in the community to cause that to happen."

Earl K. Long still probably is seeing the sickest patients, Wilson said. "Our impact on the acute part - trauma, heart attack - hasn't been that much."

General Health Systems President Bill Holman said the system's two Baton Rouge hospitals have yet to see an overwhelming increase in emergency room patients. "However, we are seeing an increase in the number of patients admitted to the hospital through the emergency rooms - an indication that patients in the emergency rooms may be experiencing more serious health complications."