[Congressional Record Volume 155, Number 177 (Wednesday, December 2, 2009)]
[Extensions of Remarks]
[Pages E2868-E2869]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




           EMERGENCY MEDICINE AND MEDICAL MALPRACTICE REFORM

                                 ______
                                 

                            HON. BART GORDON

                              of tennessee

                    in the house of representatives

                      Wednesday, December 2, 2009

  Mr. GORDON of Tennessee. Madam Speaker, as we debate and move forward 
on this historic endeavor--passage of health care reform with a goal of 
improving access and coverage for the millions of uninsured and 
underinsured individuals--I would like to take a moment to discuss the 
role of emergency medicine and review the various provisions in this 
bill which strengthen access to emergency care. As we work to improve 
coverage and enhance preventive and chronic care, we must remember to 
balance the acute care needs of patients, especially those treated in 
emergency departments.
  Emergency medicine is an essential part of our safety net and must be 
supported. Whether a patient ends up in the emergency room as the 
result of a suspected H1N1 influenza case, trauma, a natural or manmade 
disaster, or because they've lost their job and health insurance and a 
health condition escalates to the point of needing to seek emergency 
care, we all rely on quality emergency care to be there. In fact, the 
federal government demands it--unlike other doctors who can choose not 
to participate with various health insurance plans, Medicare or 
Medicaid, emergency physicians are required by federal law to treat 
every patient who walks through the door, regardless of their ability 
to pay. But, our emergency medical system is in crisis, and the severe 
problems facing emergency patients affect everyone.
  Earlier this year, the American College of Emergency Physicians 
(ACEP) released its annual report card on emergency care. The nation 
was graded a C minus overall, with 90 percent of states earning 
mediocre or near-failing grades. America earned a near-failing D minus 
grade in the ``Access to Emergency Care'' category. This is 
unacceptable and also terrifying news for the more than 300,000 people 
each day who need emergency care.
  Although my own state of Tennessee outperformed most states in some 
areas, we have a long way to go. The report states that Tennessee has 
only 8.9 emergency physicians per 100,000 people and needs an 
additional 60.2 full-time equivalent mental health care providers to 
serve the state's population. Also, it points out that these issues may 
contribute to hospital crowding and patient transfers, problems that 
have been identified as priorities among emergency physicians in 
Tennessee. Further, Tennessee has serious public health and injury 
prevention challenges. We have among the highest rates of infant 
mortality in the nation (8.9 deaths per 1,000 births), as well as high 
percentages of obese adults (28.8 percent) and adults who smoke (22.6 
percent). Tennessee has relatively high fatal injury rates: 22.7 
homicides and suicides per 100,000 people and 2.2 deaths due to 
unintentional fire and burn-related injuries per 100,000.
  Although the ``Affordable Health Care for America Act'' included 
provisions to improve coverage for preventive and chronic care, 
statistics like these for Tennessee demonstrate that access to quality 
emergency care will always be a priority and should not be taken for 
granted.
  The health care reform bill passed by the House on November 7 
included a number of provisions that would strengthen emergency care in 
the United States:
  Required Coverage for Emergency Services. Specifically, it would 
require that emergency services are part of any essential benefits 
package for all eligible health insurance plans.
  Emergency Care Coordination Center. Section 2552 would establish an 
Emergency Care Coordination Center. The Center will promote and fund 
research in emergency medicine and trauma health care, promote regional 
partnerships and more effective emergency medical systems in order to 
enhance appropriate triage, distribution, and care of routine community 
patients; and promote local, regional, and State emergency medical 
systems' preparedness for and response to public health events. It 
would also authorize a Council of Emergency Medicine.
  Pilot Programs to Improve Emergency Medical Care. Section 2553 would 
establish demonstration programs that design, implement, and evaluate 
innovative models of regionalized, comprehensive, and accountable 
emergency care systems.
  Demonstration Project for Stabilization of Emergency Medical 
Conditions by Institutions for Mental Diseases. Section 1787 would 
establish a demonstration project to reimburse psychiatric hospitals 
that provide required medical assistance to stabilize an emergency 
medical condition for individuals enrolled in Medicaid.
  Hopefully the emergency medicine provisions will be further 
strengthened as they move through the legislative process to include 
provisions based on legislation I've introduced to address the issue of 
emergency department boarding, ambulance division standards, and 
medical malpractice liability coverage for emergency providers and on-
call specialists. The ``Access to Emergency Medical Services Act,'' 
H.R. 1188, and the ``Health Care Safety Net Enhancement Act,'' H.R. 
1998, are two bills I've introduced to address these issues.
  Overcrowded emergency departments are compromising patient safety and 
threatening everyone's access to lifesaving emergency care. The number 
of emergency departments has decreased by 5 percent in 10 years, but 
the demand for care is up by 32 percent--up to 119.2 million visits in 
2006 (one in three Americans). Hundreds of emergency departments have 
closed.
  According to the Centers for Medicare and Medicaid Services (CMS), 
half of emergency services go uncompensated. To compensate for cutbacks 
in reimbursement, hospitals closed 198,000 staffed beds between 1993 
and 2003. As a result, fewer beds are available to accommodate 
admissions from the emergency department.
  Ambulances are diverted, on average, once a minute in the United 
States, away from the closest emergency department because they are so 
crowded they cannot handle any more patients. For patients with life-
threatening illnesses or injuries, those minutes can make the 
difference between life and death.
  Last year, the American College of Emergency Physicians released a 
report by its Task Force on Boarding titled, ``Emergency Department 
Crowding: High-Impact Solutions.'' ACEP established the task force to 
develop low-cost or no-cost solutions to boarding. The report is 
intended to help emergency physicians stop boarding in their own 
hospitals and ultimately improve patient care. The report identifies 
those strategies to reduce crowding that have a ``high impact,'' as 
well as those that have not proven effective. The report identifies the 
boarding of admitted patients as the main cause of emergency department 
crowding. The report outlines the impact of boarding on patient care 
stating that ``evidence-based research demonstrates that boarding 
results in the following: delays in care, ambulance diversion, 
increased hospital lengths of stay, medical errors, increased patient 
mortality, financial losses to hospital and physician, and medical 
negligence claims.''

[[Page E2869]]

  Madam Speaker, to ensure our access to emergency care is protected, 
we must address this issue. I believe the provisions in my bill, H.R. 
1188, ``Access to Emergency Medical Services Act'' will help by 
developing emergency department boarding and ambulance diversion 
standards and quality measures. I urge their consideration as the bill 
moves forward through the legislative process.
  Emergency care is the most overlooked part of the health care system. 
But it is the number one service that everyone depends on in their hour 
of need. It needs our attention now.
  In addition, we need to think forward to ensure that our system also 
accommodates future needs. To do so, we must address the shortage of 
board-certified emergency physicians. The Society for Academic 
Emergency Medicine, in 2008, published an Assessment of Emergency 
Physician Workforce Needs in the United States. The authors reviewed 
2005 data and found that the supply of emergency medicine residency-
trained, board-certified emergency physicians will not meet future 
demand. Specifically, they found that only 55% of the demand for 
emergency medical board-certified physicians currently is met.
  I agree with the need to enhance our prevention efforts and have 
introduced H.R. 3851, the ``Physical Activity Guidelines for Americans 
Act'' to help educate Americans of all ages regarding the need for 
physical activity, taking responsibility for one's health and staying 
fit. However, experience shows that not everyone will adhere to 
recommended guidelines, and genetic predisposition, trauma and seasonal 
flu or other illnesses such as H1N1 will continue to bring people to 
our nation's emergency rooms. Therefore, we must be sure emergency 
departments are equipped to handle our needs.
  In June 2006, the Institute of Medicine (IOM) released three landmark 
reports on the ``Future of Emergency Care in the United States Health 
System,'' detailing the challenges and concerns this nation faces in 
maintaining access to emergency medical services. The IOM reported that 
the nation's emergency medical system as a whole is overburdened, 
underfunded and highly fragmented.
  Emergency care has long been overlooked and as a result it is 
stretched to a breaking point. As Congress focuses on health reform 
this year, I urge my colleagues to recognize the role emergency 
medicine plays in our safety net and support the provisions in the 
health reform bill that strengthen emergency care. Further, I urge my 
colleagues to work to adequately support our emergency medical system 
by further addressing boarding and diversion as the bill moves forward.

                          ____________________