Category Archives: State and Local Governments

Our Floundering Emergency Rooms

Recently on a trip to Las Vegas my wife had a serious, but not life threatening digestive problem At about 9:00 in the evening. When her condition worsened we decided we had no choice but to seek treatment at an hospital emergency room. After seeking advice of the hotel staff we took a cab to Sunrise Hospital in the center of Las Vegas.

Arriving at the hospital emergency room we found a large modern facility which was apparently well staffed. However, there were large number of people in the seating area apparently waiting to receive treatment. My wife checked in and they told her to take a seat until they could evaluate her condition. She continued to grow more and more uncomfortable experiencing considerable pain while waiting. After about 40 minutes they called her into examining area where later she told me the nurses did x-rays and other preliminary tests.

While I waited for her in the seating area I begin to pay more attention to my surroundings. There were probably about 40 to 45 people sitting in the waiting area either awaiting treatment or with others who were. The vast majority of these people chatted away in Spanish so it was obvious that they were Mexican or Latin American immigrants. Given what I know of the make up of the Las Vegas area it wouldn’t surprise me at all if the majority lacked legal status. Many of those people were there when we arrived and were still there waiting for treatment when we left about three hours later. More arrived while we waited. I heard one Hispanic gentleman say to one of the hospital staff members in broken English that he had been waiting for treatment since early morning. In fact most of the immigrants in the waiting area look like they had been there for quite some time.

Emergency room personnel use a procedure they called triage by which they evaluate the various conditions of the patients that come in for treatment so they can treat the most serious cases first. Obviously people in life-threatening situations, like the victims of heart attacks, stokes and accidents, need to receive treatment first while those in less serious conditions have to wait their turn. The condition of Spanish-speaking Individual who is been waiting for treatment for at least 10 to 12 hours had apparently been previously evaluated to be less serious then those of others who arrived later. While we were waiting I saw several ambulances carrying patients who were brought in stretchers. I knew that they would take precedence over my wife who is able to walk in off the street.

After about an hour and a half or so my was told to return to the waiting area until a treatment room became available. She asked the staff how soon it would be before she could be seen by doctor, and she was told that they did not know. (Of course they didn’t know because they could never predict when another seriously ill patient or accident victim would arrive via ambulance.) After about an hour or so my wife was absolutely miserable. She had asked again when she might be seen by a doctor and was again told that that was uncertain. She told me she could wait no longer since there was no assurances that she would be seen before morning. We discussed going to another hospital emergency room, but there was no assurance that the situation at another emergency room would be any better. So we took another cab back to the hotel.

Fortunately this story has a decent ending. After several hours without sleep and feeling miserable my wife’s condition started to improve. By morning she was worn out and drained, but okay. However I couldn’t help but think back about the situation we had encountered the night before.

The activity of a hospital emergency room cannot be predicted in advance. Some nights might see less traffic while others bring more seriously ill patients than could they could possibly treat in a reasonable period of time. That is a situation that will continue to exist regardless. However, there is no denying that much additional pressure is put on emergency rooms by individuals who do not have emergency situations, but who are seeking emergency room treatment nevertheless. The vast majority of these people are those who do not have insurance and cannot afford to pay for a regular doctor’s visit. They know that the emergency treatment centers cannot turn them away by law so that’s where they go for their medical treatment regardless of the severity of their illness. Then they simply say that they cannot pay for the treatment they have received.

While emergency room personnel use triage to treat more serious situations first, I cannot be convinced that the many individuals who seek emergency room treatment for nonserious conditions do not put a severe pressure on emergency room facilities and staff. Just the evaluation of these non-emergency conditions takes time and resources that could be better focused on patients who really need emergency care. In situations where emergency rooms are already overstressed, the additional pressure of individuals with non-emergency conditions can push them to the breaking point.

In addition, treating patients in an emergency room situation is the most costly type of medicine. It would be much less expensive to treat these non emergency patients in a doctor’s office setting. Since hospitals are not reimbursed for the treatment of these individuals, they have to make up the revenue elsewhere. Therefore they raise the rates of those of us who have insurance and can pay for our treatment. Of course the rates we pay for our insurance continue on an upwards spiral.

The Affordable Healthcare Act, better known by most as Obamacare, increased the number of people who have insurance by millions of individuals, but apparently it is not done enough.
I was unable to determine whether Nevada has opted to expand Medicaid under the Obamacare legislation, but that would certainly reduce the number of people that are uninsured in the state. However this would not reduce the situations where illegal immigrants are taxing the emergency care system as it is apparently the case at Sunrise Hospital. I suspect the hotels in Las Vegas employ many illegal immigrates to do menial jobs such as room cleaning, etc. because they are much cheaper to employ. Illegal immigrants obviously are not eligible for government programs so only a complete rework of immigration laws can improve that situation.

Ironically my wife and I were in Las Vegas in order for my wife to attend a convention for medical administrators. One of the first speakers at the convention was doctor who is a major proponent of putting more emphasis on preventing illness. He said he moved to Nevada from California because Nevada is one of the states which could most benefit by an increase of preventive care medicine. His point was that if the medical profession and government programs put a great deal more emphasis on preventing disease in the first place, individuals would be much less likely to need medical care and would be much less likely to go to an emergency rooms. As a result practicing medicine would not only be more efficient, but also less costly.

Obviously Obamacare was a good first step, it’s not the ultimate solution. One of these days we will look back on Obamacare and expanding Medicaid coverage under the Affordable Care Act as the first steps on the road to vastly improving medical care in the United States.

Cajun. 6/9/2015