How hospitals are killing E.R. patients.

by Chris Sturr | July 27, 2008

This is from Joel A. Harrison, author of our recent feature, Paying More, Getting Less, which provides a novel argument in favor of a single-payer health care system.

The issue of long waits at emergency rooms has been in the news, and even the Institute of Medicine has looked at the problem of “divert status,” where ambulances are told by the nearest emergency room they are filled up and they need to go to another more distant emergency room. One story told of an ambulance spending 45 minutes before finding an emergency room willing to accept a patient.

Keep in mind that divert status has nothing to do with being insured! Some of the reasons are: 1. Because emergency rooms can’t refuse treatment, they lose money on the uninsured, and many hospitals are closing their emergency departments; 2. Patients who are uninsured or underinsured use emergency rooms for primary care and/or wait until their conditions get serious, thus ending in emergency.

Now a new article in the online magazine Slate adds one more nail in the coffin of the profit-motive in health care, which puts us all at risk. Notice that in “socialized-medicine” England, the government requires and enforces that 98% of patients be seen within 4 hours. Of course, since everyone has health insurance and a family practitioner, one of the reasons for crowding is eliminated.

Notice also that American hospitals are fighting tooth and nail against even keeping waiting statistics. A recent report by the Commonwealth Fund put United States dead last in ability to get medical attention at night and on weekends among advanced industrialized nations, and poor placement in getting to see primary-care physician within 48 hours.


Waiting Doom
How hospitals are killing E.R. patients.

By Zachary F. Meisel and Jesse M. Pines

Last month, Esmin Green, a 49-year-old mother of six, tumbled off her chair and onto the floor of the Kings County psychiatric E.R. waiting room in New York City. Members of the hospital staff saw her lying there but did nothing for about an hour. When Green was finally brought into the E.R., she was dead. An autopsy revealed that she died from a pulmonary embolism, which occurs when a blood clot forms in the leg, breaks off, and travels to one or both lungs. This can also kill long-haul airplane passengers who sit in one spot for hours: The blood sits stagnant in their legs for so long that it clots. You could say that Green, too, had been on a plane ride of sorts. She’d waited for a psychiatric-unit bed to open up for more than 24 hours, roughly the same time as a trip from New York to Tanzania.

The surveillance video of Green collapsing and lying untended, as hospital staff at Kings County fail to respond to her collapse, is inexcusable by any stretch. And so Nancy Grace, for one, focused on the negligence. But what’s largely missing from this story is the likely cause of Green’s pulmonary embolism. The answer lies in a far more systematic and widespread danger in hospital care: E.R. waits. Why was Green sitting and waiting while blood pooled in her legs? Despite increasing evidence that crowded E.R.s can be hazardous to your health, hospitals have incentives to keep their E.R. patients waiting. As a result, there has been an explosion in E.R. wait times over the past few years, even for those who are the sickest.

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1 comment

One Comment

  1. I suppose an alternative solution would be to let hospitals turn away the uninsured.Subsidies for medical insurance can provided to the extent that it will be a public good, not a private good at the expense of the public.

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