The rush of cranky customers began around Christmas. Just as hordes of frazzled parents were descending on shopping malls, crowds of feverish, aching bodies were flooding the emergency department at Thunderbird Samaritan Medical Center outside Phoenix, Ariz., desperate for relief from this winter's nasty, widespread strain of flu. On many days, a couple of hundred patients, from wheezing senior citizens to crying babies in their weary mothers' arms, clogged the waiting room, sitting for up to six hours to see a doctor. It didn't take long for the 35 beds in Thunderbird's ED, and many on its other floors, to fill up. The hospital occasionally had to go on "bypass," shutting its doors and diverting patients to other EDs.
Most of the visitors cramming the hallways were the usual hard-luck suspects, some of the estimated 44 million Americans who have no health insurance and nowhere else to go. But many others were a relatively new breed: refugees from managed care--which managed not to be available to them. "More people seem to be told, 'We can't see you until next week,'" says Dr. Kathryn Perkins, who has watched annual patient volume at Thunderbird's ED nearly double in the past five years. "When nobody will see them, they come here."
Who can blame them? After all, emergency departments must treat any patient, regardless of his or her ability to pay. And most of us would like to think that in the event of an accident or sudden illness, an ambulance would be on the scene in minutes to whisk us off to the emergency department, where doctors would be at the ready.
Well, don't bet your life on it.
This winter's flu onslaught has added another talking point to the health-care debate: the declining state of emergency services. Certainly the doctors are good, and the equipment gets better every year; in fact, the number of trauma centers that can deal with serious injuries is on the rise. But the ability to deliver service is being compromised. Medicare funds have been slashed as the number of uninsured patients has skyrocketed. A lack of beds and skilled nurses hasn't helped matters. In the past decade the total number of EDs in the U.S. has dropped from about 5,000 to 4,600, while the volume of visits has steadily risen, reaching 100 million in 1998, according to the National Center for Health Statistics.
Simply getting to the ED has become potentially life-threatening. Financially strapped EMSs are having trouble keeping pace with a growing slate of 911 calls. In many communities, emergency transportation has been taken over by for-profit ambulance companies that were supposed to increase efficiency and save taxpayer money. But in some cases they've been lethally inefficient--and none too profitable to boot.
The bottom line: "Unless something is done in the near future," warns a report in the current Annals of Emergency Medicine, "the general public may no longer be able to rely on EDs for quality and timely emergency care."