Stating the nation’s emergency care system is “teetering on the brink of collapse,” emergency physicians shared examples of emergency departments that “remain woefully underfunded, understaffed, overcrowded and overwhelmed,” while testifying before a congressional hearing focused on what the federal government has done since the release of the landmark “The Future of Emergency Care in the United States Health System” Institute of Medicine (IOM) reports one year ago.
“The recent death of a patient in the waiting room of the emergency department at Martin Luther King Jr.-Harbor Hospital in Los Angeles is the latest illustration of a problem that has tragically become all too common in emergency departments across the country,” said Dr. Ramon Johnson, American College of Emergency Physicians (ACEP) Board of Directors member and emergency physician from Los Angeles.
“The Government’s Response to the Nation’s Emergency Room Crisis” hearing is being held by the U.S. House of Representatives Committee on Oversight and Government Reform, chaired by Rep. Henry Waxman (D-CA).
“Emergency physicians and nurses are dedicated to saving lives,” Dr. Johnson said. “But in a system struggling with the closure of hundreds of emergency departments in the last 10 years because of huge amounts of uncompensated care, and in which ambulance diversions and the ‘boarding’ of patients in ER hallways for hours and sometimes days at time have become commonplace, we simply can’t always get to everyone. And if we can’t get to you, we can’t save your life.”
Dr. Johnson, who is associate director in the department of emergency medicine at Mission Hospital Regional Medical Center, Mission Viejo, Calif., noted that as frontline emergency caregivers, he and his colleagues are “painfully aware of how emergency department overcrowding and underfunding adversely affect patients on a daily basis.” As an illustration, he related stories of emergency patients “waiting up to 11 hours to be seen, patients on stretchers lined up against the walls waiting for beds for three or more hours, and ERs packed with patients because of a lack of available beds in the intensive-care-unit.
“In short,” Dr. Johnson said “we are no better off than we were one year ago, when the IOM’s reports were released. So today I stand before you and ask: ‘What will it take for our nation’s policymakers to respond?'”
Joining Dr. Johnson on the panel, among other experts, were Dr. Robert O’Conner, professor and chairman, department of emergency medicine, University of Virginia, Charlottesville, Va., and Dr. C. William Schwab, professor and chief, division of traumatology and surgical critical care, University of Pennsylvania Critical Care, Philadelphia, Pa.
Together the panelists outlined measures ACEP and other organizations have taken in recent months to address the nation’s emergency department crisis, including:
- A September 2006 Capitol Hill rally involving more than 4,000 emergency physicians and nurses who gathered in the nation’s capital to protest Americans’ endangered access to emergency care and demand that Congress pass legislation that would end the boarding of admitted patients in hospital emergency departments, support emergency medical care as an essential public service and solve the professional liability crisis in emergency medicine.
- The release of ACEP’s first “National Report Card on the State of Emergency Medicine,” in January 2006, which measured a state-by-state commitment to train emergency physicians and provide appropriate practice environments for them and the patients they serve.
- The promotion of the findings of the three IOM reports on emergency care through two summits, including a March 2007 summit in which 15 allied health-care organizations developed a consensus on several of the reports’ recommendations and began working together to see that they are implemented.
In addition, U.S. Reps. Bart Gordon (D-TN) and Pete Sessions (R-TX) have introduced the Access to Emergency Medical Services Act of 2007 (H.R. 882) in the House of Representatives, and U.S. Senators Debbie Stabenow (D-MI) and Arlen Specter (R-PA) have sponsored a companion bill (S. 1003) in the Senate. This proposed legislation seeks to address the dangerous trends outlined by the 2006 IOM reports, including specifically the widespread lack of preparedness for disaster.
“If enacted, this legislation will ensure that our emergency departments will have the resources they need to stay open and provide patients with timely and sufficient urgent care,” Dr. Johnson noted. “In addition, the proposed legislation requires hospitals to report to the Department of Health and Human Services statistics on how many patients are boarded and for how long. And it will create a commission to examine the factors that affect the delivery of emergency medical services.
“We know the public cares deeply about emergency medical care and expects legislators to make it a priority in the 110th Congress,” said Dr. Johnson. “It is now up to Congress and the other branches of our federal government to fulfill their obligation and ensure that our nation’s patients have the resources they need in emergency-care situations.”
ACEP is a national medical specialty society representing emergency medicine with more than 25,000 members. ACEP is committed to advancing emergency care through continuing education, research and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies.
