ORANGE COUNTY VOICES : Baby Doe’s Death Illustrates Health-Care Crisis

It was another busy Sunday afternoon at the UCI Medical Center emergency department. Every bed was full. There were many additional patients in the waiting room. Suddenly a voice called out: “Sick child in Resuscitation Room A.”

As emergency physician in charge of the department, I hurried to the room to find the bed already surrounded by doctors, nurses, and other staff. I saw a tiny 8-month-old child, Baby Doe, who was in shock, not breathing, and had a distinctive type of rash. The most likely diagnosis: meningococcomia, a severe and sometimes fatal type of bloodstream infection. The assembled medical team provided state-of-the-art emergency care, in an effort to save the child. Unfortunately, even after nearly an hour of resuscitation, those efforts were unsuccessful.

This family had no medical insurance. They had driven nearly 40 miles to get to UCI from Los Angeles, bypassing at least 20 to 30 closer hospitals because they felt no other hospital would accept them. One can only speculate as to the effect of this delay on the resuscitation effort.

After Baby Doe was pronounced dead, I observed emergency physicians and nurses with tears in their eyes. These are strong, highly competent, caring individuals who treat a host of serious medical and social problems that are being inadequately dealt with in other sectors and which consequently end up in the emergency department. They regularly witness death and suffering, as well as people who have experienced restricted access to care because they have no insurance.

There are many patients, like Baby Doe, who arrive in emergency departments, particularly those of public teaching hospitals, desperately seeking delayed care for potentially preventable problems. Emergency departments are required to provide medical care to all who seek it regardless of ability to pay. When the uninsured and underinsured are unable to find care elsewhere, they often end up in the emergency department with a more serious, and more costly, problem.

Examples include patients who develop strokes because they were unable to get blood pressure medicine, and those with serious infections which worsened because they could not get early antibiotic treatment. The outcome of all these cases is costly treatment in already overcrowded emergency departments and hospital wards for advanced conditions that were potentially preventable, or more readily curable at an earlier stage.

Unfortunately, health care costs are out of control in this country. We have now reached an annual national health budget of $700 billion. The reasons include: an aging population, defensive medicine, expansion of technology, high patient expectations and the lack of adequate health insurance coverage for many of our citizens. Until a comprehensive health reform solution is found, there will be more Baby Does. Sadly, despite the fact that frontline emergency physicians along with others have been advocating reform of the health system for years, there is still no consensus among the major political players.

Comprehensive health reform that will actually benefit Americans and reduce costs, may still be years away. Many members of these interest groups have never had to speak to a grieving family, look a patient in the eye. They may never have been a hospital patient. If we could only assemble them, politicians, and health administrators together in the emergency department on some busy weekend, perhaps significant strides toward solving the crisis in our health system could be made. It might even save the life of some future Baby Doe.