Emergency Rooms

The Federal Emergency Medical Treatment and Active Labor Act (1986) mandates that hospitals must provide care to anyone needing emergency healthcare treatment regardless of ability to pay. About one out of every five Americans visited an emergency room (ER) in 2007, resulting in roughly 110 million emergency room visits, or nearly four visits every second. Emergency rooms are straining to serve their communities, and, in many ways, are failing. About once every minute, an ambulance carrying a sick person is turned away from an overburdened ER and diverted to another, wasting precious minutes that could mean the difference between life and death for many people. Even more troubling are the horror stories about patients who died in the waiting rooms of emergency departments, sometimes having waited hours to be seen, even after exhibiting classic symptoms of conditions that require immediate treatment. ERs are burdened beyond capacity, and yet, even as the number of those seeking emergency care rises, ERs across the country are disappearing as more and more hospitals are closed. Further, there is deep disagreement regarding just what type of patients visit ERs, seeking what type of care.

Despite the common myth that it is the uninsured who make up the majority of ER patients, a 2010 report by the National Center for Health Statistics (NCHS) reveals that the uninsured were no more likely than the insured to visit an ER. The report also found that most ER patients have insurance and that 90 percent of those who visited an ER were seeking care for an urgent medical condition, refuting the notion that ERs are overtaxed by those seeking nonurgent care.

The NCHS report also found that Medicaid recipients make up the largest proportion of those seeking ER care, likely due to the difficulty of finding primary care doctors who [Page 147]accept Medicaid. Faced with the inability to find a primary care doctor, many Medicaid recipients put off seeking medical attention until their condition demands emergency care. Making Medicaid more attractive to doctors could improve the overall health of a significant portion of the population while easing the burden on ERs.

Recent healthcare reform legislation may further overwhelm ERs, as around 30 million newly insured people will enter into a paradox that finds them with healthcare insurance but no primary healthcare provider. There is growing consensus around the notion that the United States lacks the primary care infrastructure necessary to cover the 30 million newly insured patients that healthcare reform legislation will create. While some argue that previously uninsured people who gain health insurance will go to a doctor rather than put off care until faced with an emergency, others claim that newly insured people will still seek primary care at ERs because they do not have doctors. Pointing to the 2006 Massachusetts bill that created near-universal coverage for its residents, many note that despite claims that insurance coverage would ease ER traffic for Massachusetts's hospitals, wait times there have either increased or stayed the same.

It has been three decades since emergency medicine was recognized as a specialty by the American Board of Medical Specialties, and today, board-certified emergency physicians are available at more than half of all ERs. Still, a 2004 survey by the American College of Emergency Physicians found that 66 percent of emergency department directors stated that inadequate on-call specialist coverage was a problem in their ERs. A nationwide nursing shortage further chips away at the ability of ERs to meet patient needs. Further, hospitals often reserve in-patient beds for those entering hospitals for elective surgeries who have established their ability to pay for care; conversely, the payment status of the next patient to visit the ER is unknown. This establishes a cycle of reserving in-patient beds for elective surgeries, boarding patients in the ER until acute care beds become available, and diverting ambulances carrying patients who may not be able to pay for service to another hospital. This overcrowding is also difficult for the caretakers themselves to manage, as they struggle to meet the needs of too many patients seeking emergency care while witnessing terrible human suffering, which creates a heavy psychological burden. Overrun with patients and lacking proper resources and specialists, America's ERs are themselves sick, and those who staff them and those who seek out care in them each pay a different yet exacting price for what some call a systemic failure in healthcare.

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