SACRAMENTO -- Emergency rooms are seeing more and more patients, but are having a harder time recruiting doctors willing to work on the front lines.

Proposition 67 -- At A Glance Would add a 50-cent surcharge to residential phones that would go to the 911 Emergency and Trauma Care Fund. Would add a 3 percent surcharge to businesses and cellular phones. Expected to raise $500 million a year. Money raised would go to hospitals (60 percent), clinics (5 percent) and doctors (30.5 percent) who often don't get reimbursed for treating uninsured patients in emergency situations. Firefighters, paramedics and other first responders would get 3.75 percent of the funds for training and equipment. A small percentage of the money raised, .75 percent, would go to bolster 911 emergency phone system. Requires majority vote.

That's because they don't get paid for their works, says the California Medical Association. That's why the group is a sponsor of Proposition 67, which would raise $500 million a year for hospitals, clinics and emergency medical services through a surcharge on telephone service.

"I've been practicing in Los Angeles for 31 years and I've never seen it worse," said Dr. Brian Johnston, a veteran emergency room doctor and trustee with the California Medical Association.

"It's not uncommon for patients to wait a day in the emergency room before they can get upstairs to a hospital bed," Johnston said. "We're really heading toward Third World medicine."

State and federal laws say anyone seeking emergency medical care must be treated, regardless of the patient's ability to pay. The poorest patients are covered by Medi-Cal, the state and federally funded health program.

But hospitals, clinics and on-call physicians say treating the working poor -- who earn too much to qualify for Medi-Cal, but don't have insurance -- is leaving medical providers with massive unpaid bills.

Doctors, clinics and firefighters say Proposition 67, which would increase the 911 surcharge on telephone bills and raise $500 million, would help eliminate the financial shortfall.

Opponents of Proposition 67, which includes telecommunication companies, and groups representing California sheriffs and senior citizens, agree the financial burden on hospital emergency rooms, physicians and clinics must be relieved, but say it unfairly taxes one class of consumers.

"There's no question that the emergency medical system and hospitals in this state are in trouble," said Nick Warner, spokesman for the California State Sheriff's Association, an opponent of the initiative. "We just don't think that using the name 911 to impose a tax that doesn't fund 911 is the answer to that problem."

Proposition 67 would increase the current 911 surcharge to levy a 50-cent charge on most residential phone lines. Business and cellular phone customers would be charged 3 percent of their bills.

The money would flow into a new account, the 911 Emergency and Trauma Care Fund, and much of it would go to hospitals and physicians to reimburse them for caring for uninsured patients.

The opponents, funded by five major telecommunications companies, say the name is misleading -- only a fraction of the money raised goes to help the 911 emergency phone system, which already paid for by a .72 percent charge on phone bills.

"The will not add a single new bed to a hospital, it will not allow for a single additional patient to be seen by a doctor, all it does is increase the profit margins of a medical corporation," said Todd Harris, spokesman for the No on Proposition 67 campaign.

The anti-Proposition 67 campaign has been funded by five major telecom companies, led by SBC, which has donated $5.1 million. Others major donors to the Stop the Phone Tax campaign include Cingular, T-Mobile, Verizon and AT&T.

Along with the sheriffs, the California National Emergency Number Association (CalNENA), a coalition of 911 directors, is also opposed.

"If you look at 911 calls, 85 percent are for law enforcement, and less than 15 percent are emergency medical services calls," said Chip Yarborough, president of CalNENA. "People will be paying for the tax and 85 percent of those who responds to 911 walls won't be getting any benefit of the tax."

But supporters say the 911 surcharge is linked to emergency medical care.

"When someone picks up the phone and calls 911, they want to know there's someone on the other end who can save your life," said Peter Warren, spokesman for the Yes on Proposition 67 campaign, the Coalition to Preserve Emergency Care.

Johnston, the LA emergency room doctor, said the costs to consumers would be minimal. "It will cost a residential phone user 50 cents a month. It will add 90 cents to your cell phone bill."

But, he added, if it's not approved "it will have a very direct effect on everyone, even those who have insurance because there won't be any place to go."

The California Healthcare Association, a trade group for hospitals, spent $2.4 million on the pro-67 campaign before pulling out of the coalition after polling last year showed that support for the measure was waning among voters, said Jan Emerson, CHA vice president.

"There is no question that they're drowning in a sea of red ink," Emerson said of emergency rooms. But if the initiative fails, "it could make it even harder to find a solution."

Hospitals, clinics and doctors don't have a figure for how much they lose each year treating patients who can't pay, but in 2000-01, they estimated that it was about $540 million.

Since January, six hospitals have closed, Emerson said, "and we're going to see more before the end of the year."

Many factors contribute to the hospitals' struggles, she said, "and this initiative wouldn't solve them all. But it would help with the biggest factor, the uninsured. Until we solve that bigger societal issue, this would be a Band-Aid."

The state and counties pay for some of the shortfall, but not nearly enough, say supporters of Proposition 67. About $32 million raised by a tax on cigarettes goes to hospitals for this purpose, and counties can devote a portion of the criminal penalties they levy to help pay for medical care for the uninsured.

The state already collects a .72-percent surcharge on phone service that goes toward the cost of the state's 911 emergency phone system. In 2002-03, that surcharge totaled $139 million.

That money pays for the equipment, but not for the salaries of 911 dispatchers, said Yarborough. If voters approve Proposition 67 and it is later challenged in court, opponents fear that could jeopardize the current surcharge.