EMERGENCY CARE: State May Be Hit Hard By Shortage
"A crisis is brewing in California's emergency care, critics say, because too many hospitals have closed and those that remain are sometimes overburdened and understaffed," the Contra Costa Times reports as part of a series of articles on emergency care in the state. And, while "[m]ore hospitals are likely to close ... there's no system to warn health planners when downsizing has gone too far." Not only has Northern California's ER system been "rocked in the past year by reports of long waits in crowded emergency rooms, shortages of beds in intensive care units and several troubling patient deaths," but "Los Angeles authorities fear they also face a serious emergency bed shortage."
Going, Going, Gone
In Alameda and Contra Costa counties, there are currently 21 hospital ERs, eight fewer than a dozen years ago. At the same time, the area's population has increased by more than 300,000. In addition, "one more East Bay hospital, and possibly two others, may close their emergency room doors." Art Lathrop, director of Contra Costa County's Emergency Medical Services Agency, said, "That certainly has the potential of overloading emergency departments at other facilities. A lot will depend on what steps (the closing hospitals) take to move the non-urgent patients, which make up the majority of those going to emergency departments, to other types of care, such as urgent care clinics." Dr. Joseph Barger, ER medical director for the Contra Costa Regional Medical Center in Martinez, said, "There are plenty of emergency rooms most of the time. But for the first time, as places close and consolidate, we're not sure if we have enough for the peak periods. We need a way to accurately assess whether we feel we're getting into hot water."
Time For A Change
State "Assemblyman Martin Gallegos (D-Irwindale), author of a bill that would require public hearings into proposed emergency room closures," said, "Emergency rooms have been allowed to close, and no one really is checking to see what the impact is on the local community." His bill, AB 2103, "proposes the first statewide assessment of emergency medical services." In addition, to meet the growing demand for ER services, "[h]ospital administrators say they're expanding emergency departments, intensive care units and staffing to handle the closures and are confident there is enough capacity to meet demand."
The Contra Costa Times reports that "[c]oncern isn't limited to Northern California," with "[a] study by Los Angeles hospitals and emergency planners last May protect[ing] a 26% shortfall in emergency room capacity in that region within six years." Virginia Hastings, director of the Emergency Medical Services Agency in Los Angeles, said, "We've been on the verge of a crisis locally for a long time. In the mid 1980s, we had 103 acute-care hospitals in Los Angeles. Today we have 81, and not all provide full services." She added, "As hospitals merge and downsize, this will be a continuing problem. The north state is now beginning to experience what we've experienced in the south for a few years" (Appleby, 4/19).
Part of the ER shortage problem, the Contra Costa Times reports, may be due to a staffing shortage in hospitals around the state. Sometimes, patients are held in the ER because intensive care and regular beds are not available, because, while the beds are empty, there are no staff to attend them. Shirley Fannin, director of disease control for Los Angeles County, said, "Hospitals don't have any depth in their staffing. When they get a little extra heavy load, it becomes an emergency." The lack of staff is due to managed care influenced reductions in total staffing, as well as a move to "just-in-time staffing" that attempts to project "anticipated patient loads" and schedule staff accordingly. In addition, "some regions don't have enough specialty physicians willing to be on-call to tend to emergency room patients with ailments such as strokes, heart attacks and head injuries" (Appleby, 4/20).
Not So Urgent Care
Another factor contributing to continuing problems with ER care in the state, the Contra Costa Times reports, is a shortage of urgent care facilities. "While there are a handful of urgent care centers in Alameda and Contra Costa counties, some don't take all types of insurance, a few accept only cash and others don't accept drop-ins." Also, many do not keep late hours. The Los Angeles County Health Department's Fannin said, "Emergency rooms cannot be turned into acute-care clinics, and I think they have been." In addition, social services "such as shelters for the homeless and food banks" are "stretched thin," which adds to overcrowding in ERs. Dr. Pat Gary, medical director of the Alta Bates Medical Center's ER, said, "I don't think we have an emergency room shortage. I think we have a shortage of options other than ERs." But, "many doctors say that it is unlikely that more urgent care centers will open," because "[s]ome insurance plans won't pay for urgent care centers at all, while most don't add much of a subsidy for keeping offices open late" (Appleby, 4/20).