Doctors call emergency care ‘national disgrace’

msnbc.com and NBC News
By Alex Johnson and Tracie Potts

90 percent of states get poor, near-failing grades in nationwide report card

The nation’s emergency care system is “a ticking time bomb,” with demand far outstripping the capacity of hospital emergency departments already crippled by a widespread shortage of doctors and nurses, according to a national report on the state of emergency medicine.

The annual report card by the American College of Emergency Physicians gave the nation a D- grade for Americans’ access to emergency care, saying the emergency care system was “fraught with significant challenges and under more stress than ever before.”

That stress is likely to worsen as the weakening economy forces public officials and health administrators to cut back even further on costs, the report said.

The report, which was issued Tuesday, was one half of a double whammy for America’s state and local emergency officials. The same day, the Trust for America’s Health and the Robert Wood Johnson Foundation declared in a separate study that the United States was underprepared for a major disaster, such as a biological attack or a pandemic.

Access to emergency care was one of five categories the physicians’ group assessed to come up with a C- grade for the overall U.S. emergency health system.

The group found serious problems across the board, choosing to give no state an A. Massachusetts (B) and the District of Columbia and Rhode Island (both B-) — all with high concentrations of advanced medical institutions in small geographic areas — were the top three, while Arkansas came in last with a D-.

Scores were so low — 90 percent of the states earning mediocre or near-failing grades — that Nebraska’s grade, a C+, was good for fifth in the rankings.

“That is a national disgrace,” said the organization’s president, Nicholas Jouriles, an emergency physician in Moreland Hills, Ohio. “The nation’s emergency physicians have diagnosed the condition and prescribed the treatment. It’s time to get serious and take the medicine.”


Too many patients; too few resources
The organization said rising costs were forcing hospitals to close emergency departments at the same time that demand for their services was skyrocketing, thanks to a rise in the number of Americans who seek treatment in the emergency room because they have no health insurance.

“The emergency care system in the United States remains in serious condition, with numerous states facing critical problems,” the report said, concluding that “the nation has too few emergency departments to meet the needs of a growing and aging population.”

The report found that emergency room visits had grown by 32 percent in the last decade as the number of emergency rooms had fallen by 7 percent. Other factors contributing to the crisis were:

Shortages of nurses, primary care physicians, emergency physicians and other specialists.
Hospital crowding leading to boarding of patients in emergency departments.
Inadequate reimbursement from public and private insurers.
“Adverse legal environments” — that is, rising medical malpractice claims and an accompanying rise in malpractice insurance costs — that are leading emergency physicians to retire early, cut high-risk services or move to states with less liability exposure.
Chronic lack of state-level programs to address preventable illnesses, resulting in “avoidable health care expenditures and additional demands on the medical system.”
The physicians’ group stressed that it was not passing judgment on the quality of emergency room doctors’ and nurses’ care; instead, it was assessing resources and availability of critical care.

Angela Gardner, an emergency room doctor in Galveston, Texas, who is president-elect of the physicians’ group, said the emergency care system was a “ticking time bomb.”

“Doctors are working in a war zone out there,” Gardner said.

“They’re being asked to do more with less every single day. They’re being asked to see more patients,” she said. “They’re being asked to do so with fewer nurses, with fewer beds in the hospital, so they have no place to put the patients that they’re seeing.”


Comprehensive reform urged
The doctors’ group called on Congress and the incoming Obama administration to enact a comprehensive health care reform program with an emphasis on boosting resources for emergency departments.

Reform of federal and state liability regulations is also critical, the report said, to lure qualified doctors and nurses back into emergency rooms.

“Emergency medical care is the most overlooked part of our health care system, and also the one everyone depends on in their hours of need,” Jouriles said. “Policy-makers must make strengthening emergency departments a national priority.”

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