Tag Archives: emergency rooms

Past The Point of No Return

There was a report out yesterday about climate change that basically said we’ve reached a point where dramatic changes to the climate, to sea levels and to weather patterns were irreversible, that even if we dropped everything and eliminated every single carbon emission it would take perhaps thousands of years to return to equilibrium.  I feel the same way about California’s finances.  If every Yacht Party member suddenly turned into Paul Wellstone and we changed every revenue source and dysfunctional structural barrier, we’d STILL be in a world of hurt.  A couple stories today make that clear.

First, a coalition of emergency room doctors has had enough and is suing the state for additional funding to stave off a total collapse of the ER provider network.

Frustrated emergency room doctors filed a class-action lawsuit against the state Tuesday, saying that California’s overstretched emergency healthcare system — which ranks last in the country for emergency care access — is on the verge of collapse unless more funding is provided.

Across the state, scores of hospitals and emergency rooms have shut their doors in the last decade, leading to long waits, diverted ambulances and, in the most extreme cases, patient deaths.

Doctors say the situation is only getting worse. State officials, struggling to balance the budget, have proposed another $1.1 billion in Medi-Cal cuts.

“Are people truly suffering consequences? Absolutely,” said Irv Edwards, one of the doctors represented in the lawsuit and president of Emergent Medical Associates, which staffs 14 emergency rooms in California. “This could happen to you or me. We could be traveling through San Francisco or San Jose, get in a car accident, have a broken leg and end up in the ER, where it takes hours to be treated regardless of our screams. Then we get to diagnosis, and they say, ‘There’s no orthopedic on call. I’m sorry.’ “

ER doctors are required by law to treat whoever comes through the door, and rising ranks of the uninsured have stretched the system beyond repair.  Further, specialists are frustrated with the low reimbursement rates and are taking their names off of call sheets for referral in case emergencies require their services.  A physician on KPCC’s “Air Talk” today described the suit as a “canary in a coal mine,” warning that without increases in rates, not just restoration of funding but increases, there will be no emergency room network in California, period.

Then we have Standard and Poor’s downgrading the state’s credit rating for economic recovery bonds once again, meaning that investors will see a lower-than-expected return and will be far less likely to buy whatever else California sells in the future, which by the way is how we fund our state government.

Finally, you have two ignorant lawmakers, Arnold Schwarzenegger and Jerry Brown, asking the US to halt federal oversight of state prisons even though precious little has been done to manage the crisis.  Brown and Schwarzenegger are more interested in saving a few pennies than the Constitutional rights of those incarcerated.  The failure to understand this problem over 30 years have put these disgraced leaders in the position to lie to their own citizens because they can’t face up to their responsibilities.  And as the accountability for this shocking behavior is remote, there is no reason for it to stop.

State Attorney General Jerry Brown feigns to be shocked, outraged and appalled that a proposal to build prison facilities for older, chronically ill, physically impaired, feeble prisoners includes exercise rooms, TV rooms, gardens and natural light.

Taking all this away, as Brown surely knows, wouldn’t save much money – but it would make life difficult for prison workers to manage the prison population. Hey, why not take away air conditioning, too? […]

Brown whines that a federal court-imposed solution would violate “state sovereignty.” Yet he knows perfectly well that the state could avoid any court-imposed solution if it would simply take responsibility for a solution on its own.

One such solution had been proposed by the governor and was supported by legislative Democrats, a bond package for facilities. Senate Republicans killed it last May.

And nothing stops the state from working with Kelso on a negotiated settlement that would reduce the population of older, feeble, chronically ill prisoners or build facilities to house them.

But none of that is happening. Despite all the complaining about the federal courts, the governor, lawmakers and Attorney General Brown seem quite content to let the courts decide – deflecting blame to the judges and away from themselves for the choices that have to be made.

Jerry Brown doesn’t believe that prisoners are human beings and that they lost their Constitutional rights upon conviction, even if they are being held for the medical condition of drug addiction (which he ensured by opposing Prop. 5 in the most dishonest manner possible).  His attitude is retrograde and horrifying and shows a complete failure to account for his own actions.

He’s also the top candidate to be the state’s next governor.

We are past the point of no return.

King-Harbor on the road to shutdown

You never know when the traditional media will latch on to a story, but they’ve certainly raised the case of L.A.’s King-Harbor Medical Center to new heights by publicizing the tragic story of a woman who died while waiting in the lobby of the emergency room while hospital staff casually walked by her.  It’s become a powerful symbol of our broken health care system.  In fact, King-Harbor has been troubled almost since the moment it opened in 1972, and the tales of woe emanating from the medical center are numerous. 

Among the cases cited:

•  One patient in King-Harbor’s emergency room told a triage nurse on April 30 that he was seeing “aliens and devils” and that he was thinking about drinking bleach to commit suicide. He was left in the lobby for more than an hour and not seen by a physician for almost seven hours. A mental health evaluation was not completed for 17 hours after he arrived, according to the federal report.

At that time, the patient denied being suicidal and was discharged without receiving treatment.

•  A female patient went to the emergency room on March 8 complaining of two weeks of stomach pain. She said she had nausea and rated her pain as a 10 on a scale of 1 to 10. “The patient identified that the pain she was experiencing was constant and that nothing provided relief.”

Even so, she was given no treatment to alleviate pain or reduce her fever. Two hours later, she was checked again and again offered no treatment. She was not seen by a physician until nearly seven hours after she arrived. “The patient experienced severe pain throughout her [emergency stay],” the report said. Eleven hours after she arrived, she went to surgery.

•  A patient went to the emergency room on May 11 complaining of spotting during pregnancy. An hour later, a triage nurse saw her, gave her a pregnancy test and sent her back to the waiting area. When staff called her name two hours later, she had left without being seen.

Three days later, the same woman returned to the hospital with complaints of vaginal bleeding and severe pain. A nurse didn’t evaluate how much she was bleeding and had her wait four hours without pain medication. During an ultrasound, she had a miscarriage and was discharged a short time later.

So today, state regulators have moved to close the hospital.  But is that the right thing to do?


Both the governor and a portion of the LA County Board of Supervisors seem resigned to King-Harbor’s closure:

Two of the five members of the Los Angeles County Board of Supervisors said Thursday that they now support closing the hospital without delay.

“I think it’s over for us,” Supervisor Gloria Molina said. “I’m in fact terrified that somebody else might be hurt or neglected or abused at Martin Luther King hospital.”

Supervisor Mike Antonovich agreed. “The time has come to put patients’ lives before incompetent employees or political agendas,” he said.

The state’s decision, which was approved by Gov. Arnold Schwarzenegger, is subject to appeal. That process could take six months to a year.

So for the next year, King-Harbor would remain open until the process is complete.  But what would be in place in the wake of any closure?  In the CA-37 debate, the district which includes the area around King-Harbor, almost all of the candidates stressed the fact that there are few options for the low-income residents that King-Harbor serves.  Most of them use public transportation and can’t afford an ambulance to take them to the next closest hospital.  And the trauma centers in the area are already overburdened, and another 47,000 ER visits per year (the approximate average at King-Harbor) could create the very problem regulators are seeking to avoid.  If there is an extended, year-long process to close King-Harbor, plans MUST be made to provide for some replacement access for the citizens who would be left with practically no alternative should they become sick or injured.  Community advocates are saying the same thing.

“We are playing with not only fire, we have gasoline in the other hand,” said Lark Galloway Gilliam, executive director of Community Health Councils. “That emergency room, you can’t let that go. Closure to me is not an option.”

Finally, this really stresses the need for a better safety net for all citizens than a crippled emergency room system that acts as a faux-universal care apparatus.  People deserve better than this.  They need to have access to preventative care instead of going to the ER for a fever.  King-Harbor’s problems are part of the larger health care crisis in America.