Emergency Care - A Vital Issue in the Health Care Reform Debate

Preamble

The American health care system is in crisis and in need of comprehensive reform.  Nowhere is that more evident than in the nation's emergency departments, which treat five million more people each year (115 million in 2005), while hundreds of emergency departments have closed.  More and more people seek emergency care for many reasons, including an aging population with chronic health problems, cost cutting by federal and private health plans, a growing uninsured population, and increasing problems with accessing health care by everyone, including people with health insurance.   

While policy and political leaders focus on cutting costs, emergency physicians and departments are providing millions in uncompensated care each year.  While the debate focuses on preventing medical emergencies and educating people to eat right and exercise, most people who seek care in emergency departments do have medical emergencies and need to be seen in 24 hours or less.  Only a small percentage (13.9 percent) are classified as nonurgent, according to the Centers for Disease Control and Prevention. 

As the nation's health care system fails, emergency physicians and nurses are serving as an essential health care safety net for everyone.  They are dedicated to saving lives and providing the best care for all their patients.  At the same time, the net is breaking under the load, crowded conditions are worsening, and patients are suffering.  In addition, severe shortages of on-call specialists and nurses are affecting everyone's access to lifesaving emergency care.

The American College of Emergency Physicians (ACEP) believes that reforms to the nation's health care system must reflect the role of emergency medicine and provide support the nation's emergency departments.  The following are fundamental rights of everyone to emergency care: 

Right To Emergency Care. -  In a medical emergency, everyone has the right to come to an emergency department and be medically screened and stabilized.  This fundamental right is outlined in a federal law - EMTALA - the Emergency Medical Treatment and Labor Act, but the lack of resources, such as inpatient bed, the loss of more than 100,000 beds, as well as hundreds of emergency departments across the country, threatens everyone's access to emergency care. 

Right To Move To an Inpatient Area Once the Decision is Made To Admit to the Hospital. - Emergency patients lie in hallways, sometimes for days, waiting for hospital inpatient beds.  Sometimes they are forced to be in rooms not normally used for treatment, such as closets.  This is harmful to patients and ties up resources and staff in the emergency department, hampering their ability to care for more patients from the waiting room or from an ambulance.  The routine "boarding" of admitted patients in emergency departments is unacceptable and dangerous. Once a decision is made to admit a patient to the hospital, he or she should be moved from the emergency department and be cared for in an inpatient unit, not while "boarding" on a gurney in a hallway.

Right To Privacy.  Patient privacy is protected by law, but when people are left to lie end-to-end in hallways, they don't have privacy.  There is no privacy in a hallway for patients who are using bedpans, vomiting, bleeding, or convulsing.  There is no privacy when doctors are forced to explain a patient's medical condition within earshot of everyone.  There is no privacy for children who are lying near elderly patients who need resuscitation or near drug addicts going through withdrawal.

Right To Appropriate Back-up Medical Specialists and Followup Care.  Medical specialists, such as neurosurgeons, cardiologists, and orthopaedists, are increasingly not available in emergency department.   Shortages of these critical care specialists result in longer wait times for treatment and are a threat to patient care.  Patients need access to appropriate medical care for all medical conditions. 

Right To Be Treated Within a Reasonable Amount of Time. - Emergency patients, whether they come by ambulance or on foot, should be seen and treated by an emergency physician in a reasonable amount of time, based on the acuity of their symptoms.  Too many patients leave emergency departments without being seen and face potential adverse consequences of delayed treatment, because waiting times are too long.  Too many ambulance patients are being diverted because hospitals are too full and patients are boarding in the emergency departments.  Delays in care can be dangerous for many medical conditions and can result in greater illness, disablement and even death.   The practice of "boarding" decreases throughput and is the main reason people have to wait.

Right To Health Plan Coverage Based on Symptoms. - Health plan coverage should be based on a patient's symptoms, not the final diagnosis - this is called the "prudent layperson standard."  Some health plans deny payment for emergency care, when the final diagnosis turns out not to be a medical emergency, even though the patient had the symptoms of a medical emergency.  Patients should not be forced to diagnose their own medical conditions out of fear the visit will not be paid by their insurer.