ATLANTA - The health safety net of last resort in
the United States provided by hospital emergency rooms is
critically overburdened and in some places in a state of near
collapse, a conference heard on Wednesday.
The Society for Academic Emergency Medicine heard a series
of presentations that painted a scary picture of the situation
in the nation's emergency health system.
``In Arizona we have the perfect storm, a disaster situation
where a combination of things makes you take on water so fast
you can't fix it,'' said Todd Taylor, vice president for public
affairs at the Arizona College of Emergency Physicians.
``Most Americans still have no idea how dangerous it has
become to be ill or injured and go to an emergency room. The
chance of surviving a heart attack now depends more on the time
of day, the day of the week and your type of insurance than any
other factor,'' he said.
Taylor asked his audience of doctors and nurses to raise
their hands if they had direct experience of patients dying of
heart attacks while waiting for treatment in an emergency room.
About half the hands in the room went up.
The emergency symposium was called in response to a report
last year by the Institute of Medicine . It concluded that the
health safety net was ``in a state of serious jeopardy.''
Researchers say several factors have contributed to the
crisis, including the continuing rise in the numbers of
Americans without health insurance -- now more than 44 million.
The uninsured use hospital emergency rooms as their sole source
of treatment and typically receive no preventive care.
Managed Care Pressure
Also cited were constant pressure from managed care
agencies to cut costs, rising immigrant populations, most of
whom lack insurance, hospital closings and a dire lack of
``Things could get even worse. The economy could take a dip,
and it is taking a dip. Guess who will take the hit,'' said John
Billings, director of the Center for Health and Public Service
Research at New York University.
He presented figures showing that in New York, 50 percent
of children had no contact with any medical personnel in the
first 30 days of their lives. But 50 percent showed up in
emergency rooms during their first year.
President Bush promised to invest $5 billion in the health
safety net during last year's presidential campaign. But
Billings said Bush's proposed budget, with its tax cuts of more
than $1 trillion, contained no net increase in federal funding
for emergency health care.
``The glass is almost empty,'' he said.
In 1988, there were 81 million visits to U.S. emergency
rooms, according to the National Center for Health Statistics.
Ten years later, the number rose above 100 million while the
number of emergency departments fell from about 5,200 to just
Under federal law, emergency rooms are required to allow
all patients access to care 24 hours a day, regardless of
ability to pay. But waits have become so long that substantial
numbers give up and leave before they are seen.
Patients Must Wait Hours
Karin Rhodes, an emergency physician at the University of
Chicago hospital, recounted how a patient died last week of
cardiac arrest after waiting for five hours with chest pains
without being examined.
Rhodes said research in Chicago suggested that 15 percent
of those who went to an emergency room left without being seen
Ula Hwang, chief resident of emergency medicine at the
Mount Sinai School of Medicine in New York, cited a study
showing that of those who left before seeing a doctor, 11
percent needed to be hospitalized in the subsequent week.
Even more worrisome is the amount of time emergency rooms
declare themselves ``on diversion,'' meaning they will no longer
accept patients being brought in by ambulance.
In Northern Virginia, according to Dr. J.B. Orenstein
writing in the Washington Post last month, the area's 13
emergency rooms placed themselves ``on diversion'' for more than
4,000 hours in January.
``Almost half the time back in that icy January, if you
needed an ambulance to get to an ER you were SOL; severely out
of luck,'' he wrote.
The situation in emergency rooms is driving away nurses
because working conditions are so stressful and unpleasant, the
conference heard. As a result, the average age of nurses is
rising and some emergency rooms do not have even minimum staff
much of the time.
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