Harsh economy crowds ERs with uninsured

Fayetteville, N.C. — Cape Fear Valley Medical Center has seen a sign of dire economic times: an increasing number of emergency room patients who are uninsured, laid off or can't find care elsewhere.

"There's an ever-increasing burden on us to take care of everyone who comes in the door," said Dr. John Reed, director of the emergency room that ranks as the 70th-busiest ER in the country. The rankings are based on visits in 2007.

Nearly 83 percent of ER doctors responding to a national poll by the American College of Emergency Physicians said they are seeing more unemployed patients who have lost their health benefits. Eighty-eight percent of doctors said they had patients who had been turned away from other medical facilities because they couldn't pay.

"When you're sick and you ain't got no health insurance, you're laid off – the only place you can go is the ER," said patient Jarrell Lester, who recently lost his job and insurance. His friends brought him to Cape Fear's ER because he felt sick and had nowhere else to go.

About 400 patients come to the Cape Fear ER daily, and about a quarter can't foot their bills, Reed said. The budget strain has put some ERs nationwide at a greater risk of closing, he said, adding that he doesn't see Cape Fear closing its ER.

"We don't have enough nurses. We need more people on call," Reed said. "We have to run 24 hours and be prepared for anything. That costs a lot of money."

Quality of care has also been strained as ER doctors treat patients whose illnesses aren't real emergencies, Reed said. About 40 percent of patients at the Cape Fear ER have minor problems that should should have been handled elsewhere, he said.

In the national survey, nearly 73 percent of emergency physicians said they had seen delays in care cause serious medical problems for patients.

Marcia McLucas has one functioning kidney. She said she had been waiting in the Cape Fear ER for five hours Thursday.

"That's dangerous to my health," McLucas said. "The doctors are OK here; it's just the wait."

As a national solution, the ACEP is urging Congress to pass the Access to Emergency Medical Services Act of 2009, which would create a bipartisan commission to study and recognize the need for more resources in ERs. It would also order the Centers for Medicare & Medicaid Services to develop standards for ambulance service.

Meanwhile, Cape Fear has opened three urgent care facilities, called ExpressCare, to treat minor health problems that might otherwise end up at the ER. Unlike other urgent care facilities, ExpressCare facilities can take uninsured patients since they operate under the auspices of the Cape Fear ER.

While annual projected visits for ExpressCare are lower than those for the ER, Reed said, they do help manage the burden.

Between October and January, 119,496 patients entered the Cape Fear ER, and 23,753 visited ExpressCare. But ExpressCare's growth rate from the same period a year earlier is nearly double that of the ER – 14.5 percent more people sought care at ExpressCare, contrasted with 7.5 percent more at the ER.

Still, harsh economic conditions often fill ExpressCare facilities to capacity, Reed said.

"Access to emergency care is a real problem," he said.

ExpressCare facilities

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CFVH was contacted requesting an explantaion as to why the offer was refused. We were informed that it was too low of an amount. It was explained that this is all that there is to offer and would they re-consider. The response was NO. Yes it was a lower amount, but an offer to pay something was offered (and still willing to do) and each creditor was treated the same equally. As it stands at this time, CFVH will receive nothing due to their own choosing. There are some folks who are willing to do the best that they can, even if it is not to full amount. It would have been easy to have ignored the bill totally, but I wasn't willing to do that.

It does make you wonder how many others have made the effort without acknowlegement. I am sure the debt will still out weigh the asset, but please know that there are some who are willing to do the best that they can.

cwillis28
March 2, 2009 10:53 a.m.

It is unfortunate that there are so many people with the security of health insurance and feel they have to rely on our ERs to provide them with health service. It does make it hard on everyone from the patient to the caregivers to the financial end of "not having enough."

However, there are times the hospital is responsible for lack of funds just as much as the public.

My personal experience. My husband passed away a few months ago, (at home & pronounced doa at CFVH ER) and unfortunately for all concerned did not have any health insurance.

During the process of liquidating his personal property it be- came clear very early on that there would not be enough funds in his estate to take care of all of his debt 100%. Once all personal property was liquidated, each creditor (including CFVH) was contacted and informed that their bill could not be paid 100% and a offer of equal amount to each creditor was proposed. Each creditor EXCEPT for CFVH graciously accepted.

cwillis28
March 2, 2009 10:47 a.m.

I am too an ED nurse and can agree with the fact that it is not the uninsured who are the problem. It is by far the medicaid patients who abuse the system the most. They have a horrible sense of entitlement. All the pediatric clinics in town have walk in hours everyday, but everyday I see kids brought in the ER for colds and rashes, and am told by the parents "oh we didn't want to wait in office, so we came here." Then they have the nerve to demand a cab or bus fare for the ride home "but I have medicaid" It's out of control.

ERRN
February 27, 2009 1:31 p.m.

As an ED nurse,I can say with certainty that the wait times affect all of us. It's hard for us to know that pt's sit in the waiting room for hours on end,feeling horrible,and that we don't have the rooms to put them in. Instead of blaming the ED, people need to look at the entire system. We can't move pt's out and up when there are no inpatient beds to put them in. We begin treatments (labs, xrays etc) on pt's while they are in the waiting room,hoping that it will expedite their care. We get yelled at,cursed at,and disrespected EVERYDAY because people want to be treated & released as soon as they walk in the door. Not a day goes by that I don't explain to a waiting pt,that the people who go back before them may have a life threatening illness or injury. The abuse of the ED & EMS is out of control. There are other options,like a primary doctor. Many towns have free clinics, but it requires initive on the publics part to find them.

traumahi
February 27, 2009 12:07 p.m.

Fmr. Sen Daschle wrote in his book, that he would tell the next president (he did not know who that would be) to put the healthcare bill inside another bill and not open it up for debate.

Just like Rahm Emanual says you can't waste a good crisis.

Pres. Obama is the next Hugo Chavez, Democratic Socialist

Tom) Daschle says health-care reform "will not be pain free." Seniors should be more accepting of the conditions that come with age instead of treating them. That means the elderly will bear the brunt.

james27613
February 27, 2009 11:28 a.m.