Public Support Needed to Save Access to Emergency Care

Challenges facing access to emergency care in the United States today have been brewing for years, but now, several problems have come together to create a dire situation that is threatening everyone's access to emergency care. Nearly every day, news stories report the imminent closure of emergency departments from Pennsylvania to California. At the same time, the number of people seeking emergency care continues to increase dramatically.

The reasons for this crisis include decreasing federal, state, and private reimbursements; accelerating amounts of uncompensated care provided by hospitals and physicians; shortages of nurses and support staff; and soaring medical liability insurance premiums for emergency physicians and other specialists, forcing many to retire early or move to states with lower premiums.

Neither our community nor any others are immune to the impending collapse of the health care safety net. Emergency departments at hospitals all over the U.S., including many here in southeast Michigan, are experiencing 6-7 hour delays in seeing a physician, patients lying on stretchers in the hallways, prolonged waits for inpatient beds, and ambulance diversions.

The American College of Emergency Physicians, a medical specialty organization with nearly 23,000 members, is asking the public to contact their elected officials to urge them to recognize that emergency care is an essential community service that must be preserved.

The most important thing the public can do to preserve emergency care is to urge their Senators to support the HEALTH Act (H.R.5), which will limit health care liability actions and reduce the ridiculously high liability awards being issued today. Outrageous awards and frivolous lawsuits are driving physicians from the practice of medicine, and leaving patients without access to physicians. Left unresolved, the crisis will be devastating to patient care in many states.

The HEALTH Act contains provisions to cap noneconomic damages in medical lawsuits at $250,000. There are no caps on economic damages, which include lost earnings, medical care, and rehabilitation costs. In addition, the bill establishes time limits on filing lawsuits and on attorney's fees. The HEALTH Act also addresses the growing shortage of on-call medical specialists who provide back-up to the emergency department, including neurosurgeons, thoracic surgeons, obstetricians, and orthopedic specialists. Many of these physicians are moving to other states for lower liability premiums or no longer performing certain procedures out of fear of lawsuits. These shortages are contributing to the nation's overcrowding crisis and longer waiting times in emergency departments. Both the high cost of liability insurance in many states and the lack of insurance companies willing to offer policies are forcing specialists to move to other states, which causes hospitals to limit or close emergency and trauma services and cancel surgeries.

The HEALTH Act recently passed the U.S. House of Representatives, but the Senate still needs to take action. Public support is greatly needed to help move this measure through the 108th Congress and on to President Bush's desk for his signature.

Second, Congress took a step forward this year in preserving resources for the health care system by enacting legislation that prevented this year's reduction in Medicare payments to physicians and provided a small increase. However, the legislation did not correct the formula that calculates the payments, which Members of Congress and the Administration agree is flawed, which means that physicians could again be facing more cuts. Physicians today are paid less for Medicare visits and procedures than they were in the early 1990s. The public can help preserve emergency care by urging Congress and the White House to correct the Medicare formula so that future payments are correctly calculated.

Finally, the public can help save emergency care by calling on the federal government to pay for care provided under the Emergency Medical Treatment and Labor Act (EMTALA), the federal law requiring emergency departments to provide care to everyone, regardless of their ability to pay. Funding EMTALA would decrease the huge amount of uncompensated care provided by hospitals and physicians.

Until these problems are solved, everyone will be at risk of losing their access to quality, around-the-clock emergency care. Although most people rarely think about emergency care until they need it, the time is now to act before your ambulance pulls up to an emergency department with a "closed" sign on the door.

The nation's emergency departments are at the breaking point. The lack of capacity and causes of emergency department overcrowding must be addressed, but it will take years to solve these problems and to rebuild the nation's health care infrastructure. However, in the short term, public support is needed for legislative and regulatory actions that could provide quick relief, before the nation loses access to its specialists, emergency departments, and trauma centers.

James C. Mitchiner, MD, MPH

(Dr. Mitchiner is an emergency physician in Ann Arbor and the former president of the Michigan College of Emergency Physicians)