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Emergency Rooms Labeled 'Biggest Crisis in American Health Care'

By Mary Agnes Carey, CQ HealthBeat Associate Editor

June 22, 2007 -- Physicians told a House hearing Friday that the nation's emergency medical care departments are overwhelmed, understaffed, underfunded, and unready to take on the type of patient surge that could come with a major natural disaster or terrorist attack.

Despite numerous reports highlighting conditions such as patients being boarded in ER departments waiting for rooms elsewhere in the hospital or ambulances diverted to other facilities—creating treatment delays that have led to patients' deaths—federal agencies charged with overseeing the nation's emergency health care system have done little to ease the burden, witnesses told the House Oversight and Government Reform Committee.

"While the demands on emergency and trauma care have grown dramatically, the capacity to handle such demands has not kept pace," said C. William Schwab, who heads the University of Pennsylvania Medical Center's Trauma and Surgical Division. Schwab, who helped compile the Institute of Medicine's report released last June detailing key problems with ER departments and recommendations to fix them, noted that there has been little response from Washington.

"There has been perhaps some transient coverage in the media, several dissemination meetings in various parts of the U.S., but no response has come from our government," Schwab said in prepared testimony. "Despite efforts by all constituents, little seems likely to be done to begin to manage the biggest crisis in American health care."

Ramon W. Johnson, director of pediatric emergency medicine at Children's Hospital in Mission Viejo, Calif., and a member of the American College of Emergency Physicians' board of directors, said many factors are creating overcrowded conditions in ER departments throughout the country. Every day, he said, "critically ill patients line the halls, waiting hours—sometimes days—to be transferred to inpatient beds. This causes gridlock, which means other patients often wait hours to see physicians, and some leave without being seen or against medical advice," he said in testimony. Other factors that lead to overcrowding include reduced hospital resources, a lack of hospital inpatient beds, a growing elderly population, and nationwide shortages of nurses, physicians and hospital technical staff, Johnson said.

Committee member Elijah E. Cummings, D-Md., who chaired the hearing, said the Department of Health and Human Services (HHS) "appears to be ignoring the mounting emergency care crisis" despite the billions of dollars Congress has appropriated for biodefense and pandemic preparedness. Witnesses said the funding had not relieved any of the burdens in their emergency care departments, and Cummings said HHS has "not made a serious effort to identify the scope of the problem and which communities are most affected."

Cummings was clearly irritated that Leslie Norwalk, acting administrator for the Centers for Medicare and Medicaid Services, did not accept the committee's June 14 invitation to testify at the hearing. Of the 115 million emergency room visits in 2005, more than 40 percent were covered by CMS programs such as Medicare, Medicaid, or the State Children's Health Insurance Program. Norwalk said she could not attend due to scheduling difficulties and did not send another representative.

CMS spokesman Jeff Nelligan said the agency asked the committee to reschedule, but were refused. "However, we have provided written answers to several questions for which CMS input was sought," Nelligan said. Committee Chairman Henry A. Waxman, D-Calif., sent more questions to Norwalk on Friday, seeking comment in a variety of areas, such as what actions CMS has taken to address ER boarding of admitted patients in emergency rooms receiving Medicare and Medicaid funds or the diversion of ambulances from those facilities. Waxman asked Norwalk to respond by June 29.

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