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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