Hospitals: Emergency Care: Improvement Needed

A woman with a sick six-month-old baby is turned away from a private hospital in Houston because her husband does not have $50 for a deposit. The baby dies on the way across town to an other hospital. A New York doorman suffers a heart attack while on duty; he is refused emergency treatment at a hospital across the street because it lacks cardiac emergency equipment, and he must risk death attempting to reach another hospital.

Lumped loosely in the category of emergency care, such cases claim untold lives each year. But how can such tragedies happen in an age and a nation where severed limbs are restored, kidneys are transplanted, and "dead" hearts are restarted routinely in intensive-cardiac-care wards? Among the causes of the problem are obsolete equipment, understaffed and overcrowded hospitals, administrative ineptitude, poor judgment, and the nearly nation wide absence of an organized approach to the problem. Each of the 6,000 general hospitals in the U.S. should be at least morally bound to accept and treat any emergency case, regardless of the patient's age, ability to pay or the medical affiliation of his doctor. Hundreds of hospitals, well equipped, properly staffed and organized for the task, fulfill the responsibility. Others fail to.

Dumping the Sick. At New Yorks Coney Island Hospital recently, a combination of delayed treatment and the common practice of "dumping" emergency patients on other hospitals contributed to the deaths of two men. The emergency-room diagnosis for one was gastrointestinal hemorrhage and shock. Claiming a lack of beds, the hospital ordered the patient transferred to a larger institution. Still waiting for transfer three hours later, the man died. An other patient died after waiting six hours to be dumped. Subsequently, New York State's Investigation Commission found that on one of the patients' entry cards, the word "Transfer" had been crossed out and replaced with "Admit."

Medical regulations can also stand in the way of proper emergency treatment. When former Speaker of the House Joe Martin fell into a coma in Fort Lauderdale, Fla., last month, his doctor ordered an ambulance service to take him to a distant hospital, by passing one eight blocks away because the doctor was not affiliated there. Reported dead by the ambulance driver when he arrived, Martin, 83, was then taken to a third hospital, 15 miles away, for an autopsy. There he was officially pronounced dead on arrival. His life might have been saved had he been taken to the nearest emergency room in the first place.

In Chicago, a mistaken diagnosis in an emergency room led to the death of a 15-year-old girl last November. Sent to Cook County Hospital with a physician's note that read "Poss. acute appendicitis," the girl, mistakenly diagnosed as having VD, was given a penicillin shot and instructed to seek help at a clinic. She died of gangrenous appendicitis within 24 hours.