Closed Door at the ER

We can be rich. We can have health insurance. We can have our federal tax rebate check in our back pocket. None of this will do us any good if we’re in the back of an ambulance and the nearest hospital emergency room is full.

Nothing brings home the disparity between the nation’s private economic boom and its public miserliness like the increase in hospital emergency rooms with more patients than staff or beds, emergency rooms forced to turn ambulances away.

As reported by Times staff writer Peter G. Gosselin in stories Sunday and Monday, the United States is coming off the longest economic expansion in its history without a corresponding boom in investments that benefit the public good. Consequences range from a near-universal frustration over flight delays at airports to the particular horror of an Atlanta neighborhood flooded with raw sewage from erupting manhole covers. The emergency care crisis goes beyond inconvenience, wasted time and ruined property. It costs lives.

The United States has experienced a swelling number of uninsured, an aging population with increasing health problems and medical advances that save lives, but often at great expense. All this has put pressure on a health care system already squeezed by its reliance on market forces to hold costs down. The changes have been more dramatic than many of us realize.

Hospitals once thought to be fat with excess beds have closed entirely or effectively eliminated beds by not staffing them. Behind the lack of space in emergency rooms, at least in part, is a lack of beds to move patients into, particularly in intensive care.

Long-term solutions include expanding health insurance to enable more of the working poor to seek health care outside of emergency rooms; recruiting more nurses, respiratory therapists and other skilled workers in short supply, and answering the politically charged question of whether a need as critical as emergency health care should be left so entirely to market forces.

In the short term, hospitals must recognize that this is a national problem, share information and establish regional clearinghouses to get patients to the nearest hospital as quickly as possible. And hospitals need to reexamine a hierarchy that allows patient traffic to back up and even be turned away from the emergency room while business in the rest of the hospital goes on as usual. Of course it’s not good to have beds in hallways, but if the emergency room is crammed, the rest of the hospital can and must take the overflow.

The three public and 10 private hospitals that provide emergency services in Los Angeles County estimate that collectively they lost $35 million to unreimbursed care last year. It’s no wonder that some are in danger of shutting down their emergency rooms.

Any one of us could suffer an injury or a sudden illness and need immediate treatment. In this age of medical miracles, we take emergency rooms for granted. None of us can do so any longer.