Docs call emergency care in USA a disgrace

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Doctors call emergency care `national disgrace'

90 percent of states get poor or failing grades in nationwide report

card By and Tracie Potts msnbc.com and NBC News

updated 10:06 a.m. ET, Wed., Dec. 10, 2008

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 Wood 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 ( 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,

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. "

The American College of Emergency Physicians' 2009 National Report

Card on the State of Emergency Medicine graded the states on 116

measures of care in five categories: access to care, quality and

patient safety, medical liability environment, public health and

injury prevention, and disaster preparedness.

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...

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.

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. "

http://www.msnbc.msn.com/id/28148474/