American Crisis: The Emergency Room

In the United States, there has always been a secure feeling that if a medical emergency arose, the hospital emergency room would always be there. Particularly in the larger cities, people are used to seeing the signs that direct people to the ER without having to waste precious time going through a lobby. Emergency Rooms over the years have evolved in many hospitals into trauma centers, being one of the main players in the critical "Golden Hour" we have heard so much about. Yet they in other ways, have de-evolved into a center that also now provides primary care for many people. People without medical insurance, senior citizens, and caring for patients which catch the overflow of work that the clinics and private offices are unable to see. The result? Emergency Rooms that are so busy that a serious injury or illness can sometimes result in a patient delay. Sometimes these delays are inconvenient, sometimes they are life threatening and sometimes they are deadly. But the worst possible outcome is beginning to be seen scattered throughout the country. Emergency Rooms are closing their doors. According to Dr. Howard Koh, Commissioner of Public Health for Massachusetts, "The emergency care system in America is on fire and it’s burning down."

In the ten years from 1988 to 1998, over 1,000 emergency rooms across the nation have closed down due to budget cuts and other problems. Part of this problem is that many emergency rooms are unable to deal with the overload of patients who do not have any insurance coverage. While some may think that these patients are the nation's poor and underprivileged, in reality, they are common working people, faced with health insurance costs that have grown at a staggering rate in the past few years. Rates in many areas for a family of four now exceed $500 per month for coverage that only a few years ago ran in the $100 per month range. Since salary increases have not kept pace with these insurance raises, families are faced with reducing their standard of living, even on basic essentials, or dropping health care. Many opt for the latter. The most recent figures show that 42.5 million Americans are without health insurance, and when private physicians or clinics will not treat them, they turn to the emergency room as a primary health care provider.

Another problem is that of overcrowding. Many hospital emergency rooms are too small to serve the population of patients who pass through their doors and simply have to turn away patients. Because of those millions of uninsured, the patient load at emergency rooms across the nation has reached the point that quality care can not be provided. According to the American Hospital Association,"If the emergency rooms don’t work well, there is no place else for patients to go...so this is a sign of our health care system under extraordinary stress." Costs to increase the size of emergency room facilities and to provide the medical professionals needed to man those facilities is prohibitive, since many of the patients are unable to provide payment in the amounts that are required to maintain the system effectively. As a result of this financial crunch, emergency rooms operate understaffed and when the care is affected, many hospitals consider closing their doors rather than operating a sub-standard facility or at a deficit.

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