DAN K. THOMASSON Nation's ER rooms need attention

WASHINGTON -- As if we didn't have enough health care problems in this nation, we are now being told that emergency service is not only a shambles but on the verge of collapse, a condition that should surprise no one who has ever had need of quick medical treatment recently.
That was the conclusion of a panel of experts assembled by the National Academy of Sciences' Institutes of Medicine. The experts spent two years investigating the situation and found the declining number of emergency rooms overcrowded, inefficient and seriously lacking the expertise to provide help.
If anyone doubts this, they should read the report of an official inquiry into the death of David Rosenbaum, a longtime correspondent for The New York Times who was mugged here while taking an after dinner stroll near his home earlier in the year. He was severely beaten with a pipe and died after a series of incredible blunders by emergency personnel who might have saved his life had they acted properly. It was a textbook case of incompetence up and down the line from the ambulance service to the ER that should send shivers through all of us.
But it gets worse. At the same time, the Department of Homeland Security just released a report that documents the lack of preparedness to respond to natural and manmade disasters across most of the nation. This echoes the Institutes of Medicine whose 25 experts found that the U.S. emergency care system lacks the stability and the capacity to handle large disasters or epidemics like the avian flu.
An inadequate plan
"The majority of the nation's current operating plans and planning processes cannot be characterized as fully adequate, feasible or acceptable to manage catastrophic events," the security department said. The report was issued in response to a request from President Bush as part of his administration's response to the aftermath of Hurricane Katrina.
Wonderful. Billions of dollars have been spent in the wake of 9/11 and the hurricanes that devastated the Gulf Coast and we are now being told that most of our states and major cities are wholly or partially deficient in their ability to respond to a crisis. Even more amazing is that this assessment is coming from the federal agency that was supposed to be in charge of getting the country ready and is clearly a leader itself in inefficiency.
The institute's panel of experts stated that in just normal situations, one can count on long waits with ambulances sometimes idling for hours to unload their patients. In some cases ER patients wait as long as two days before being admitted to the hospital. They said it would take billions of dollars to fix the system and they recommended that Congress create a new agency to provide the necessary leadership. That's just what this country needs most, another bureaucracy. How about designating the Department of Homeland Security to take over operation of the emergency rooms?
Why the federal infusion of funds? Because the study clearly shows that ER care and quality vary widely because they depend on the willingness of hospitals and doctors to lose large amounts of money. Many of the ER patients are without insurance but can't be turned away. Medicare for the elderly and Medicaid for the indigent account for about 37 percent of the 117 million ER visits each year. Hospitals report they lose sizable amounts on both categories of government covered patients. Quite clearly a sizable portion of the medical community is struggling with the losses. To its credit, the American College of Emergency Physicians, 24,000 strong, endorsed the report and urged that it be fixed.
Rosenbaum's misfortune is clearly not an isolated case. Who knows how many times it has occurred but gone unnoticed without the publicity afforded a highly visible and well respected figure. How often has a serious head injury been misdiagnosed as drunkenness or has an ambulance driver decided to pass up a close hospital for one nearer his own home? Obviously the hours Rosenbaum spent unattended in that distant hospital ER were critical but not unusual, if the institute's study is to be believed. David Rosenbaum's tragedy should be a wakeup call for everyone.
This nation's standard of living is supposed to be the best in the world. Yet the combination of these reports -- the ER deficiencies, the finding of a general lack of preparedness for disasters of every stripe, and the documented needless death of Rosenbaum -- are clear evidence that our claims are hollow. Without the ability to meet any crisis -- massive or individual -- with an efficient response, we are little better than a Third World country.
X Dan K. Thomasson is former editor of the Scripps Howard News Service.