Monday, July 28, 2008

ER Tragedy: Update

Earlier this month, we saw horrific video of a woman literally dying on the floor of a Brooklyn hospital, as uncaring hospital staff stood idly by. Esmin Green died at the relatively young age of 49, killed as much by an apathetic health care provider as her pulmonary embolism.
And while the circumstances of her actual death are horrible to contemplate, there's an even scarier sub-text: why she had the embolism in the first place. Ms Green had been waiting -- sitting -- for so long that blood had begun to pool in her legs, perhaps because of a shortage of inpatient beds.
Whoa, Henry, what's the one got to do with the other?
It could be worse, of course: the MVNHS© routinely parks its ER patients in the (actual) parking lot, waiting aboard the ambulances which brought them.
The problem here is that, if there's no place for admitted patients to go, then they're going to begin stacking up somewhere, and that somewhere is often the ER. This is especially becoming the case for those hospitals serving poorer communities [ed: Hello! Grady, anyone?]. It's called "boarding," and it's a growing problem.
Simply put, boarding is when a hospital, knowing that it has finite bedspace, looks toward filling that space with insured or other private pay patients, as opposed to the indigent. It's sort of a balancing act between EMTALA and the bottom line. The problem is, the folks who end up on the wrong end of that balancing act may be the ones who need care the most.
The challenge is that there's really no ideal solution. As noted above, it's just as much a problem for gummint-run health care systems as our own. More beds means less waiting, but it also means higher costs. And of course higher health care costs leads to higher health insurance costs [ed: just had to get that in there, didn't you?].
None of which excuses the unconscionable treatment afforded the late Esmin Green. Unfortunately, it's too late for her.
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