National Crisis in the ER

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Not that we need another crisis in this country but here is one you should all pay very close attention to as it will most likely touch you or a loved one soon, if not already…..Hospital Emergency Rooms Are Disappearing!! No segment of our critical care structure has been put into a more precarious situation than the hospital ER’s in major population areas. The massive influx of immigrants, both illegal and otherwise, has created enormous numbers of people with absolutely NO health care coverage and they have but one quality option when in need of medical assistance…..The ER.

Federal mandates insure that NO person will be refused care at the ER and hospitals are lucky to recover 23% of these costs. Family’s without a physician are using the ER’s as their family doctor and ‘choking’ the system to death. The ugly result of this problem is the closer of many ER’s throughout the nation and you may find yourself hard pressed to get emergency care the next time you require it.

I am fortunate to have substantial health coverage and recently I had to access the ER at our local hospital. There was never any mention if I had insurance until the initial care was administered. Most of the people I observed in the ER were young Hispanic mothers with small babies or children that were NOT in a traditional need of emergency care. Two sisters were there with babies with colic but they had no idea of why the children were crying so they brought them into the ER. Another family had brought their father in because he would not eat dinner and they were concerned that he had something wrong with him.

These examples are not unique, as countless numbers of people have created a ‘siege’ scenario at ER’s with this mentality. For the most part they have no money or insurance and they know the hospital ER must take them in with no questions asked. Where is this going? I hate to see anyone refused emergency health care but where will the money come from? Hospitals are shutting down ER’s in alarming numbers, as this is their only recourse to avoid the mounting financial burdens.

You may have not seen this situation in Huckleberry, Oregon but in the Greater Los Angeles area it has reached critical mass.

Comments?

-- Barry (bchbear863@cs.com), February 01, 2001

Answers

"Let them eat cake" - Lars

"Market forces will solve the problem" - Ken Decker

"Only little people need Emergency Rooms" - Maria

----

"Take what you have and give it to the poor" - unemployed Egyptian

-- (@ .), February 01, 2001.


"So does this mean the world is safe from George Clooney?"-Unk D

-- Uncle Deedah (unkeed@yahoo.com), February 01, 2001.

My experience is totally different. I live in a metro area with an immigrant population that's growing at leaps and bounds. While the emergency rooms have seemed pretty busy every time I've gone, I've never noticed any one ethnic group outnumbering another. We haven't had any emergency rooms shut down here (though we've lost a couple of psych wards). I'd be curious to see any kind of data on the alarming numbers of ERs being shut down. Most of my family is in the medical field, and none of them have mentioned this.

BTW, I had to go to the ER the other night after getting bitten by a vicious gold retreiver in our neighborhood. No need for rabies shots, but I did get to have a tetanus shot and a few stitches. I had to give my insurance information prior to treatment, but there were big signs all over the reception room saying essentially that you won't be turned away for lack of funds or insurance. They looked like they'd been there for awhile.

-- Tarzan the Ape Man (tarzan@swingingthroughthejunglewithouta.net), February 01, 2001.


Is the dog OK?

-- Barry (bchbear863@cs.com), February 01, 2001.

Hey -@.

Don't quote me saying what I never said. Two can play that childish game.

-- Lars (larsguy@yahoo.com), February 01, 2001.



Well Ape-Man, I should have known you would put your ignorant spin on a truly critical problem. So, for you and your ‘relatives’ in health care I have found this article in a major professional nursing magazine for your education. You continue to show us all how really uninformed you are with these mindless responses. Of course, I will apologize if you live in Huckleberry, Oregon. Otherwise, take your head out of your ass prior to approaching the keyboard. ______________________________________________________________________

Ambulances turned away, daylong waits and patients packed in hallways. Increasingly, this is the scene in California’s emergency rooms – the ones that are still open, that is. Although by no means alone in the trend, California leads the nation in shuttered ERs. In the past 10 years, the number of ERs in the state has dropped from 5,000 to 4,600. In the past 20 years, Los Angeles County saw 20 percent of its ERs disappear. According to the National Health Foundation, unless dramatic action is taken, Los Angeles County will face a serious shortage of emergency regions in all areas except the Westside by 2005.

Bad for patients

The exodus has left the state’s remaining ERs to deal with more and sicker patients, which in turn produces overcrowding and longer waits. According to a January study in the Annals of Emergency Medicine, stressed-out ERs foster a variety of ills, including decreased staff productivity, increased staff frustration and ambulance diversion, putting patients at risk for poorer outcomes, patient dissatisfaction, and prolonged pain and suffering for some patients, This is not news to health officials in Orange County, which experienced record numbers of ambulance diversions during last year’s flu season. "When you have a situation like a flu epidemic and a larger volume of patients, the system backs up. It’s hard to work under these conditions. It’s hard on the nurses, the physicians, the patients and families," said Cece Waite, RN, director of emergency services for Orange County. Then there are the horror stories, all reported by the media:

 A 7-year-old boy who died of spinal meningitis last year after waiting for hours in a crowded waiting room at Kaiser Walnut Creek.

 A 39-year-old woman who died in an ambulance after spending six hours in a standby ER in Richmond.

 An 84-year-old man with shortness of breath who died after waiting four hours for care.

Nationwide concern

The problem is by no means confined to California. "There are ERs closing all over the country," Benjamin Marett, MSN, RN, president of the Emergency Nurses Association, said. "We have 23,000 members and this is what they’re talking about." In their Annals of Emergency Medicine study, authors Robert Derlet, MD, and John Richards, MD, of the University of California, Davis, Medical Center, warned: "Unless the problem is solved in the near future, the general public may no longer be able to rely on emergency departments for quality and timely emergency care, placing the safety of the people of this country at risk." In laying blame, officials point in several directions: to increasing numbers of non-emergency patients who use the ER as a clinic, more Americans without health insurance who have nowhere else to go, and people who turn to ERs out of frustration with managed care programs that deny them ready access to physicians and nurse practitioners when symptoms are easiest to treat. "It’s not just an ER problem, it’s also a hospital problem," Waite said. "Populations go up and hospitals close. The hospitals that remain don’t have the beds or the staff." On top of that, there is the nursing shortage, which makes it more difficult to find staff, and looming retrofitting costs, which could force many of the state’s poorer hospitals to close, she added.

Ape-Man,the full article can be found here:

http://www.nurseweek.com/features/00-05/er.html



-- Barry (bchbear863@cs.com), February 01, 2001.


7 Million illegals.

-- KoFE (your@town.USA), February 01, 2001.

And growing as we type. Just type.

-- Carlos (riffraff@cybertime.net), February 01, 2001.

What do you expect when you live in Los Angeles you dumb shit? Just wait until we cut off your power! Hahahahahaaa!!!

-- Eat trash dumbass! (Life is good @ Huckleberry. Oregon), February 02, 2001.

When YOU cut off OUR power, then YOU will not have any food. Of course, being a Hawk, YOU can eat shit and love it. Lights out numbnuts!!

-- Barry (bchbear863@cs.com), February 02, 2001.


The only thing California contributes to the rest of the country is a bunch of low-life loudmouth trash like you. We're going to laugh our asses off when you scum die!! BWAAAAAHAAAAAHAAAAHAAAAAHAAAAA!!!!!!!

-- LMAO (Ra@what.a.loser!), February 02, 2001.

Hey Carlos, I think you ought to name your sourcs when you dispute my claim.

-- KoFE (your@town.USA), February 02, 2001.

Whoa, looks like Barry needs to try decaf. All I was talking about were my own observations here in the metro Atlanta area, and those of my family. For the record, my dad and my sister are doctors, and my middle brothers an intern in New York. Dad works here, my sister works in the DC area.

You really should try to not take every post so personally. Sometimes an opinion is just an opinion.

-- Tarzan the Ape Man (tarzan@swingingthroughthejunglewithouta.net), February 02, 2001.


Hey Ape-Man, you have a habit of being quick on the draw to oppose any story that does not agree with your world tint. Also, you are normally insistent that ironclad facts be brought forth to certify a poster’s position. So I say to you that YOU are full of shit and have little or no credibility. You say that NO ER’s have been closed in the Greater Atlanta area? You have all of those doctors in your family and they have never discussed this major threat to healthcare in this country? How bout if YOU post some proof to back-up this crap? I’ve always wished you well in your health struggles but you should pay more attention to your critical thinking skills. BTW, it should come as no surprise to you that I hate decaf.

-- Barry (bchbear863@cs.com), February 02, 2001.

Hey Ape-Man, you have a habit of being quick on the draw to oppose any story that does not agree with your world tint.

Maybe, but I didn't do that here. Take a deep breath and re-read my post.

Also, you are normally insistent that ironclad facts be brought forth to certify a poster’s position.

You said that there's a crisis in ER care in this country. I asked for a citation. And you have a problem with this why?

So I say to you that YOU are full of shit and have little or no credibility.

Oh please. If you can't offer any more proof than one article about California, that does not speak to my credibility. The irony of it all is that I haven't even contradicted you. Your frothing-at-the- mouth anticipatory defense makes me wonder if there really is a problem at all. After all, if you really had any more proof, would you be so inclined to be this hostile to someone who hasn't even questioned your original point?

You say that NO ER’s have been closed in the Greater Atlanta area?

Nope, not to my knowledge. We've lost a couple of psych wards recently. My guess is this impacts you greatly.

You have all of those doctors in your family and they have never discussed this major threat to healthcare in this country?

You're making a mistaken assumption, since you really haven't established that this is a major threat to healthcare in this country. At this point, all you have is an opinion and an article which focuses on one state out of fifty.

Quite frankly, this issue has never come up. Just in case you are ignorant as to the finer points of the healthcare industry however, not all doctors are involved in the ER (just all the ones on TV). It is quite possible that this is a crisis and it hasn't affected them yet, or it's possible that they've heard discussion and haven't mentioned it. I'm willing to keep an open mind on this topic. Can you do better than the Nurses article?

How bout if YOU post some proof to back-up this crap?

What, exactly, would you like me to provide? If you are at all familiar with the basic points of logic (and I somehow find it easy to believe you aren't) you will know that there is no way to prove a negative. There is no documentation out there that says, "ER's still exist in Atlanta" or "Every Thing's A-OK in the ERs of ATL". It simply isn't news, since it isn't a change from the status quo. I would, of course, be happy to provide you a list of every single hospital in Atlanta, along with a phone number, so that you can personally call each and every one of them and ask if they still have an ER. Just say the word.

By the same token, I can't provide you with proof that no one in my family has ever mentioned hosptials closing their ERs. I will not provide you with their names and numbers for the same reason you won't provide me with the names and numbers of members of YOUR family.

I’ve always wished you well in your health struggles but you should pay more attention to your critical thinking skills.

And you should actually get some in the first place. You can't even recognize when someone isn't actually disagreeing with you. Your entire response boils down to "You've disagreed with people I like in the past so I JUST KNOW you're going to disagree with me now! My knee jerk reaction is totally justified because YOU CAN'T PROVE there's NOT a huge problem with ER's closing around the country! And just because you claim that's not what you were saying doesn't mean it's not what you said!"

-- Tarzan the Ape Man (tarzan@swingingthroughthejunglewithouta.net), February 02, 2001.



Tarzan's first line of his initial post:

My experience is totally different.

Barry, he didn't spew at you. He spoke of his experiences where he lives and the lack of mention of this crisis by family members in the field of medicine. Then he asked for more information.

What is your problem? Why do you insist on using this board and the people who populate this community to divest yourself of anger? Those you attack are flesh and blood. They breath, eat and excrete. They are not car doors to be slammed. They are not hanging leather-filled bags to be punched for your relief or enjoyment.

Your lack of discipline is alarming. Your lack of restraint disturbing. Your inability (I think unwillingness might be more accurate) to communicate civilly pitiful.

You have much to offer, but delivery is as important as content. Put people off and your message is lost. Unless your message is to piss-off, in which case you do achieve your goal with remarkable regularity.

TGIF

-- Rich (howe9@shentel.net), February 02, 2001.


You say that NO ER’s have been closed in the Greater Atlanta area?

Nope, not to my knowledge. We've lost a couple of psych wards recently. My guess is this impacts you greatly

Tarzan: The above IS a classic....thanks for making me LMAO...

I needed the smirk. :-)

FWIW, I surely thought it was Rich writing that instead of you.

I luv dry humor

-- sumer (shh@aol.con), February 02, 2001.


In Barry's defense, I have been known to be very demanding with opponents on certain topics and I have been known to hurl invective from time to time. It stands to reason that at some point or another I argued with an opponent Barry agreed with. Barry may have decided not to enter that debate but to wait for an opportunity to address me directly (I have certainly witnessed debates where I thought the party I agreed with could make different arguments, but decided not to enter the fray for whatever reason). He may have jumped the gun a little rather than simply have been spoiling for a fight.

Thanks for your words, Rich and sumer.

-- Tarzan the Ape Man (tarzan@swingingthroughthejunglewithouta.net), February 02, 2001.


Naw, I just had a hair up my ass:>) You folks have a great weekend and we'll continue this fun next week!

-- Barry (bchbear863@cs.com), February 02, 2001.

By the way, can anyone explain to me what a world tint is and how a crisis in emergency care would disagree with whatever it is? Thanks.

-- Tarzan the Ape Man (tarzan@swingingthroughthejunglewithouta.net), February 02, 2001.

BTW, the 'psych wards' rib gave me a good chuckle too.

-- Barry (bchbear863@cs.com), February 02, 2001.

Welcome, Tarz.

Good weekend all.

-- Rich (howe9@shentel.net), February 02, 2001.


Doesn't look that good around greater Boston either...

L ink

Friday February 02 11:45 PM EST

Emergency Rooms Increasingly Closing Doors Ambulances Find No Place To Take Patients

It used to be that when you picked up the phone and dialed 911, you expected a quick ambulance ride to the nearest emergency room. But that's no longer the case.

NewsCenter 5's Jorge Quiroga reports that hospitals are diverting patients from their emergency rooms more often than ever. Last year set an all-time record, as the two dozen ERs in Greater Boston were so backed up with patients that they closed down to all but the sickest patients for more than 5,700 hours -- a combined 237 days.

"Before, you might see one hospital on divert maybe once a week, but now it's every single day, sometimes three, four, five, six at the same time," paramedic Joanne Distefano said.

Night or day, more emergency rooms in Greater Boston are so overcrowded that they are turning away ambulance patients to other hospitals for hours at a time, accepting only the sickest patients.

In a race against the clock, patients wait longer for needed treatment.

"I wouldn't say we have had a tragedy yet, but we are on the brink," Boston EMS Chief Richard Serino said.

Even on slow days, ER waiting rooms and hallways are packed. Funding cuts, hospital closings, staff shortages and the rising number of uninsured people using ERs for primary care have created an emergency in the emergency room.

"So somebody comes in and they have had abdominal pain for two days and they are now vomiting, unfortunately as much as we would like to treat them, they may have to wait for an hour or a couple of hours," Dr. Alasdair Conn of Mass. General Hospital said.

Patient Joanne DiAngelo recently waited eight hours.

"It's kind of scary," she said. "I was pretty scared that night because I was in a lot of pain."

And when the hospital is almost full, everything backs up in the emergency room. One patient recently was waiting for 24 hours in the emergency room, because there was no room available in the main hospital.

If the problem is bad now, ambulance operators say that it will get worse soon. A new round of Medicare cuts could prove devastating.

Starting in April, ambulance companies will no longer get reimbursed for life support services like oxygen, drugs and cardiac defibrillators. Mileage rates will be cut by more than half.

"It may no longer be feasible for ambulance companies to offer full 24 hour a day service," Brain Connor of the Mass. Ambulance Association said.

Fewer ambulances available for routine patient transports out of the hospital means fewer open beds upstairs. The result is more crowding at emergency rooms and more ambulance diversions.

"It's only going to get worse," Connor said. "It's not going to get better."

There is little optimism. The experts agree that the only long-term solution is reversing an old trend. Massachusetts lost a third of its hospital beds over the past 20 years. But with many hospitals still loosing money and more scheduled for closing, increasing available beds won't happen soon.

In recent months, Mass. General and Brigham and Women's Hospital have managed fewer "on-diversion" hours by adding staff and resources. But critics say that's only a band-aid on a systemwide crisis.

-- Peg (pegmcleod@mediaone.net), February 03, 2001.


Barry & Tarz....I'm STILL LMAO :<)))))

-- sumer (shh@aol.con), February 03, 2001.

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