Coast Dilemma

Unless it is Florida, no State is so health-conscious as California. Besides suntanning themselves and developing their figures, Californians have keen interest in public medicine. This is partly cause, partly effect of the great migrations of U. S. invalids and oldsters who for a generation have poured into California to improve or end their days. And it is responsible for a dilemma in California's medical profession. At last week's convention of the California Medical Association in Coronado (across the bay from San Diego) there were the usual addresses on matters scientific, but the real muttons of the doctors' meeting were: What to do about earning a living?

California has about 11,000 doctors licensed to practice medicine. About half belong to the C.M.A. The Association is willing to take in some 1,100 more. As for the remaining 4,400 California doctors, they are "outlawed" on account of age, ignorance, ineptitude, cupidity, fee-splitting, dishonesty, or plain crankiness.

This medical setup might have been in comfortable equilibrium with the 5,600,000 people who were living in California when Depression began. Enough Californians then were healthy, enough doctors were wealthy, for everyone to be comparatively happy. This year California has 6,400,000 inhabitants. Old doctors who retired to balmy California for the rest of their lives have lost their savings and are resuming active practice. Younger doctors who were engaged in business, such as the Manhattan physician who took up house-wrecking in Santa Barbara, are again practicing medicine, for the most part outside the C.M.A.

At the same time patients have lost their jobs and savings. If actually impoverished, Californians have the right to free treatment and maintenance in the tax-supported county hospitals which citizens set up in better times. During Depression many a citizen who could have paid a private doctor some sort of fee has lied, wheedled or grafted his way into a free county hospital, to the anguish and anger of private practitioners.

Next November Californians are to vote concerning an extension of the county hospital system, if a petition now being circulated obtains the necessary number of signatures. According to the proposal, any Californian, rich or poor, may enter a county hospital, be charged as little as the county supervisors please.

Last week the doctors at Coronado feared that this proposal would become law. They foresaw more financial troubles for private hospitals and for themselves, poorer medical service by & large for the State's inhabitants. But they could agree on no procedure to avert the blow.

A slim nurse, Dagmar A. Nelson, had added to the C.M.A.'s discomfiture just as the Coronado convention opened. Nurse Nelson is a specially trained, competent anesthetist working in Los Angeles' St. Vincent's Hospital. In California, as in other States, doctors are striving with might & main to establish anesthesiology as a specialty which only doctors of medicine may legally practice. Dr. William Vare Chalmers-Francis of Los Angeles, president-elect of the International Anesthesia Congress, asked California courts to enjoin Nurse Nelson from giving anesthesia to a surgeon's private patients. The California Supreme Court decided that competent technicians like Nurse Nelson may practice their profession without let or hindrance by doctors.

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