Danger at the Emergency Room

The Dire Results of ER Shutdowns

ERs are also being strained on other fronts: Entire hospitals have been closing down, too, creating a scarcity of inpatient beds to which ER patients can be admitted, while a dire nursing shortage means that available beds sometimes remain empty because there isn't adequate staff to care for patients. The result is risky bottlenecks in the ER, where patients can end up stranded for up to 48 hours waiting to be moved upstairs.

Furthermore, even as medical costs skyrocket, almost half the care that emergency rooms provide never gets reimbursed. A federal law requires emergency departments to treat everyone who comes through their doors regardless of ability to pay. Known as the Emergency Medical Treatment and Active Labor Act (EMTALA), the 1986 legislation banned patient "dumping," a practice by which uninsured patients were stabilized at one hospital and then shuttled to another for follow-up care.

According to a 2003 American Medical Association study, ERs lost $4.2 billion a year in revenues by providing care mandated by EMTALA, leaving many facilities drowning in a sea of red ink. And because some ERs perform services they were never designed to, such as delivering primary medical care, they are feeling the burden.

In California, which is often a bellwether for the nation, one ER after another is being shut down because of financial losses accrued by emergency departments. Private hospitals, which are in business to make a profit, can no longer afford to finance their perpetually money-losing emergency rooms, and a reported nine in the state have closed in 2004 alone. In Los Angeles County, only 75 ERs now serve nearly 10 million residents, down from 94 facilities for 9 million people a decade ago.

Since 1992, hundreds of emergency departments across the country have shut down at hospitals that were closed or financially ailing. These closures create a domino effect, because when one ER closes its doors, it puts greater pressures on those that remain open. The situation is also a concern in rural areas, where small community hospitals typically aren't equipped to deal with medical catastrophes and 12 percent of emergency rooms have closed over the past decade. In fact, a 2005 University of Pennsylvania study revealed that nearly 50 million Americans do not have access to a trauma center within an hour's transportation -- by either ambulance or helicopter.

When you factor in the challenges of finding available beds at already overcrowded urban trauma centers, transferring a critical patient from a small hospital to a high-level facility can be delayed by up to eight hours.

Ultimately, everyone suffers, not just people in outlying areas or the poor and uninsured. Being affluent or having excellent health coverage won't help if the nearest emergency rooms are filled to capacity when your husband wakes up in the middle of the night with chest pain, or your daughter has an asthma attack. "This crisis hits everyone in all classes equally," says Joel Geiderman, MD, cochair of the emergency department at Cedars-Sinai Medical Center, in Los Angeles.