[Congressional Record (Bound Edition), Volume 152 (2006), Part 9]
[Senate]
[Page 12246]
[From the U.S. Government Publishing Office, www.gpo.gov]




             EMERGENCY ROOMS HAVE REACHED A BREAKING POINT

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                         HON. CHARLES B. RANGEL

                              of new york

                    in the house of representatives

                        Wednesday, June 21, 2006

  Mr. RANGEL. Mr. Speaker, I rise today to introduce a New York Times 
editorial entitled, ``Emergency in the Emergency Rooms'' into the 
Record. This article emphasizes the fact that our Nation's emergency 
rooms and hospitals are seriously ill-equipped to manage major 
disasters such as the human costs of natural disasters or the 
occurrence of pandemic influenza. They are also failing to meet the 
challenge of increased demand by the poor who must use the emergency 
room for primary care because they cannot afford or do not have health 
insurance.
  According to the Institute of Medicine, about 500,000 (five hundred 
thousand) ambulances are being redirected from full emergency rooms to 
others far away. Furthermore, patients awaiting admission to the 
hospital may spend from eight hours to two days in the emergency rooms 
before a hospital bed becomes available. Not only are our emergency 
rooms filled past capacity, but they also lack the services of critical 
specialists such as neurosurgeons, further crippling the ability of 
hospitals to immediately treat patients in medical crisis.
  The editorial identifies a few causes for the emergency room crisis. 
First, the number of people seeking treatment in emergency rooms has 
increased sharply over the past decade. Also, in the same time period, 
some 700 hospitals and 425 emergency departments have been forced to 
close due to cost pressures. More importantly, the result of these 
situations is serious overcrowding, only worsened by a massive influx 
of patients who seek routine care in emergency rooms because they are 
either uninsured or on Medicaid but incapable of finding doctors who 
agree to treat them.
  This issue has grave consequences on the United States population as 
a whole, but it particularly affects the more than 60 million plus 
uninsured people in the United States, a population that will increase 
as employers are gradually eliminating health coverage. Ultimately, the 
United States will suffer greatly at the hands of large scale disasters 
if we do not improve our preparedness in hospitals and emergency rooms.
  Some proposals to develop our emergency rooms include an end to 
diverting seriously ill patients to far away hospitals and 
alternatively diverting poor patients who congest emergency rooms 
seeking standard care. Of course, this would necessitate expanding 
health insurance coverage to the millions of uninsured and offering 
more primary care clinics and doctors to underserved neighborhoods. 
However, in the long run, the addressing of the emergency room crisis 
will cost the United States much, much less than the consequences.

                [From the New York Times, June 21, 2006]

                    Emergency in the Emergency Rooms

       The nation's emergency rooms have been stretched thin for 
     at least a decade or more, but a new analysis suggests that 
     they have reached a breaking point. Their plight underscores 
     how dreadfully unprepared we are to cope with a major 
     disaster like pandemic influenza or mass casualties from a 
     terrorism attack.
       The crisis in emergency medical care was laid bare in three 
     reports issued last week by the Institute of Medicine, a unit 
     of the National Academy of Sciences. Half a million times a 
     year ambulances are diverted from emergency rooms that are 
     full and sent to others farther away. Emergency room patients 
     who need admission to the hospital often spend eight hours or 
     more--sometimes even two days or more--on gurneys in the 
     hallways, waiting for a hospital bed to open up.
       Some emergency rooms lack the services of key specialists, 
     such as neurosurgeons, who shy away from emergency room duty 
     because many uninsured patients can't pay and their 
     malpractice premiums would skyrocket because of the risky 
     nature of emergency cases. What is not known is how many 
     people die as a result of delays in treatment or inadequate 
     care under chaotic conditions. No measurement system tracks 
     such data.
       The emergency room crisis has many causes, none of them 
     easily or cheaply resolved. The number of people seeking 
     treatment in emergency rooms has jumped sharply over the past 
     decade or so, from 90 million in 1993 to 114 million in 2003. 
     Over the same period, cost pressures forced the closing of 
     some 700 hospitals, almost 200,000 hospital beds and 425 
     emergency departments. The result is severe crowding, 
     exacerbated by a huge influx of poor people seeking routine 
     care who are either uninsured or on Medicaid but unable to 
     find doctors willing to treat them. By law, emergency rooms 
     must accept all patients, whether they have insurance or not.
       The institute's experts have many proposals for easing the 
     situation, ranging from new regional systems to improve the 
     flow of patients to the most appropriate and least crowded 
     emergency rooms to an infusion of money to cover unpaid 
     emergency care and to bolster preparedness for large-scale 
     disasters. The most important change would be to stop 
     diverting seriously ill ambulance patients and divert instead 
     the poor patients who clog emergency rooms seeking routine 
     care. That would require extending health coverage to the 
     uninsured and providing more primary care clinics and doctors 
     in poor neighborhoods.

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