Emergency in The Emergency Department
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Happy Monday Healthcare Advocates
Still collecting inputs from state insurance commissioners on the rate of health insurance denial in their state. I will publish what I learn here. Please post subjects you’d like to see by clicking the comment button at the bottom of the newsletter. Any comments you have for me are most welcome.
Emergency Department Woes
A short while ago we wrote an article about racial/ethnic/financial discrimination in the Emergency Departments (ED) of hospitals. It covered over 300,000 individual cases and found that men are treated before women, white people before non-white, insured before uninsured or those with Medicaid.
Here is another view of the ED. Thanks to Jodi for pointing it out. The reference is MedPageToday
There was a crisis in the Emergency Department years ago. The problem was that patients were not being treated, often for lack of ability to pay, and they would die. There were hearings in Congress, because this is heartless and smacks of financial eugenics. A new law was passed called the Emergency Medical Treatment and Labor Act. Essentially, if your facility receives federal funds you have to examine and stabilize a patient in the ED. If you cannot treat them, then you transport them to where they can receive treatment. (PS - there is an open federal case in court about this rule conflicting with Texas abortion bans - we’ll do that another day).
OK, the law sounds good - make sure people get care. But the bad news is that the rule isn’t well followed. Here is a particularly sad example from 2008 of a woman who collapsed and died in the ED. She was unattended for an hour. There is a photo at the link so if you are squeamish, don’t click the link.
A couple of months ago a good friend of mine was having heart issues in the ED and he had a heart attack sitting in the hallway for 11 hours. While he was admitted (eventually) they pretty much refused to treat him.
Here’s a recent article about a patient dying in the ED waiting 5 hours to be treated.
Here’s one about a man in 2021 abandoned in the ED and drops dead.
Boarding a patient is putting them somewhere until a bed can open up for them. It can take hours or even many days. Your health does not improve while boarding. In fact, NIH has been studying this and has found that offering palliative care, and treating people right away all improve outcomes and result in fewer deaths.
New data from two studies, recently published in JAMA Network Open document what patients, nurses, and doctors already know: the system is failing too many patients because there are insufficient resources and too many patients. Hold that thought.
At the end of 2021, in the hardest-hit hospitals, more than one in 10 ED patients left without care. Half of the sickest patients in the department -- those requiring admission -- waited 9 or more hours for an inpatient bed. A friend who works in a hospital pointed out that sometimes providers in the ED ignore patients when translation is needed or there is complicated documentation required. Its just easier to help someone else.
Look, lots of hospitals are operating for profit, even if they are nonprofits. Many have outsourced their Emergency Departments to private companies to manage. The private companies can trim costs by paying staff less, using lower cost staff instead of physicians, and reducing overhead by having a smaller footprint. Many hospitals have closed EDs all together claiming they were not profitable. And in addition to that we have a large uninsured population that seeks basic care in the ED.
Solution - increase the number of EDs and staff them appropriately. Global budgets as specified in Universal Healthcare the much improved Medicare for All Act, HR 3421, address that. Regional administrators identifying needs like new facilities and more providers, will be able to do it with facilities and education budgets for those purposes. And most important, since everyone has insurance under HR 3421 all of us will be able to keep up our preventive care and reduce the crush in the Emergency Departments.
ACTION
Let’s let our representatives in the Senate and in Congress know that the Hospital Emergency Departments need help. Their contact info is here. or use RESISTBOT, On your cell phone text to 50409 SIGN PZHMYE to send the email below to all three.
I am your constituent and I just learned that there are unattended people dying in Emergency Departments at hospitals who could be saved if they were treated. 10% of people leave without treatment, many EDs have been outsourced to increase profit or closed entirely. Many people without insurance use them as a first-line for healthcare. Too many patients and not enough resources.
Solution - increase the number of Emergency Departments and staff them appropriately. Global budgets as specified in Universal Healthcare the much improved Medicare for All Act, HR 3421, address that. Regional administrators identifying needs like new facilities and more providers, will be able to do it with facilities and education budgets for those purposes. And most important, since everyone has insurance under HR 3421 all of us will be able to keep up our preventive care and reduce the crush in the Emergency Departments.
Lives are at stake and I want you to cosponsor and pass it. Thank you.
Find My Elected Officials
Contact the White House https://www.whitehouse.gov/contact/
Contact State and Federal Representatives
https://www.commoncause.org/find-your-representative/addr/
Important Healthcare Resources
League of Women Voters Healthcare Reform Toolkit
Our Newsletter resources including reproductive healthcare
Healthcare Advocacy Reading List
Organizations to Contact
National Nurses United Medicare4All
Physicians for a National Health Plan
Reproductive Health
NARAL - Pro Choice America
Planned Parenthood
Miscarriage and Abortion Hotline has references about where to procure abortion medications. They also assist women in the process of self managed abortion or miscarriage by phone or text and will respond in an hour. Details and hours of operation at their website.
United State of Women Reproductive health page (bottom of the page) has important resources such as medical support, access to Telehealth, prescriptions by mail, and legal support references.
Practice careful communications - The Digital Defense Fund has a number of tips to keep texts, calls, and internet use private. Here is their site.
If you need financial help with an abortion try abortionfunds.org
Claims Denials and Appeals & What to Do
Appeal a Healthcare Decision
Appeal/Negotiate a Hospital Bill
Save Democracy
Chop Wood, Carry Water by Jessica Cravens
RESISTBOT
Link to the RESISTBOT site to learn more
Link to Chop Wood, Carry Water Resistbot write up