No easy fix for emergency rooms, experts say

A lack of staff, space and equipment hobbles the U.S. emergency medical system and almost no steps have been taken to improve things despite numerous warnings, emergency room professionals told Congress on Wednesday.

But emergency room physicians and members of Congress alike were at a loss about what to do to fix a system that almost everyone agrees is at a breaking point.

“It isn’t too clear and that is because what is required is so big,” Dr. Rick Blum, an emergency room doctor from West Virginia who is president of the American College of Emergency Physicians, said in an interview.

“These are really problems of the healthcare system overall. Our health care delivery system is flawed,” he added. “There is no band-aid for this. What is required is major surgery.”

A subcommittee of the House of Representatives Homeland Security Committee held the hearing to ask if there was anything the federal government could do to address the problems raised by three Institute of Medicine reports issued in June that found severe problems in emergency rooms and other emergency medical services.

The reports found, for instance, that emergency medical services got only 4 percent of Department of Homeland Security first responder funding in 2002 and 2003.

The Institute committee also found that between 1993 and 2003 the number of emergency department visits grew by 26 percent, while the total number of emergency departments declined by 425—with 198,000 fewer beds.

“The message here is that the safety net is fraying,” said Dr. Steven Krug, a Chicago emergency room doctor who testified on behalf of the American Academy of Pediatrics.

So what happens if pandemic influenza comes, or someone sets off a biological weapon, or giant earthquakes or hurricanes hit?

“We are neither prepared nor capable of responding,” Washington Republican Rep. Dave Reichert, chairman of the House of Representatives Subcommittee on Preparedness, Science and Technology, told the hearing.

Hospitals that were flooded out and even destroyed when Hurricane Katrina hit the Gulf Coast last August made headlines, but little has been done to help address the problem of what to do with the sick and frail in an emergency, Blum said.

“I can tell you without qualification that the emergency care system in this country in general ... is worse today than it was last year and if we don’t change things by next year it will be worse than today,” Blum told the hearing.

For instance, Blum said, he and colleagues were unable to go and pitch in for two weeks or so to relieve overworked emergency room doctors in New Orleans.

“I wanted to go help for a while, but the politics and bureaucracy of it was simply more than could be done,” he said.

Emergency rooms are overfilled even on a quiet day because of the way doctors are paid, Blum noted.

“One of the side effects of managed care is that primary care practitioners are very, very tightly scheduled,” he said. So outside of office hours, what should be a routine office visit is sent to the emergency room, he said.

Both for-profit and not-for-profit hospitals run on a budget, Blum said. “They often make the decision that they can’t afford to lose the money that they are losing in the emergency department,” he said.

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