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Pa. senators told of ERs in crisis Crowded hospitals diverting patients Tuesday, February 06, 2001 By John M.R. Bull and Anita Srikameswaran, Post-Gazette Staff Writers
HARRISBURG -- Hospital emergency rooms in Central Pennsylvania are becoming increasingly crowded, forcing patients to be diverted to other hospitals in a practice that is reaching crisis proportions, a state Senate panel was told yesterday.
The problem is not as severe in Western Pennsylvania, particularly in the Pittsburgh area, because there are several hospitals close enough to each other that it takes only a few extra minutes for ambulances to shift patients from one emergency room to another.
But in the middle of the state, where hospitals often are farther apart, emergency room crowding has become chronic.
In fact, one night several months ago, every hospital in the Central Pennsylvania region placed itself on "divert status," irritating patients and frustrating ambulance drivers who scurried to find any hospital that would accept more patients.
Another example cited to the Senate Public Health and Welfare Committee yesterday was the case of a woman from the middle of the state who recently spent 48 hours in a hospital emergency room for a heart condition, unable to be admitted because there was no available bed.
"Unfortunately, this is not an isolated incident," said state Sen. Harold Mowery, R-Lemoyne. "The treatment this woman received was unacceptable. It is not the type of treatment that any of us should accept or expect when we go to the hospital."
In this end of the state, emergency room crowding does occur sporadically.
A new code system for emergency personnel in 10 southwestern Pennsylvania counties shows that several hospital emergency rooms filled up temporarily and were forced to divert patients on a number of occasions last month.
Of Allegheny County's 23 hospitals with emergency facilities, seven declared "code red" status -- meaning they were full and that patients should be taken elsewhere -- a total of 49 times. One hospital called code red 24 times during the month. Each code red lasts for two hours.
On the busiest day, code red was declared 11 times by two hospitals, according to the Emergency Medical Services Institute, which oversees the southwestern counties. The next day, it wasn't used at all.
For 15 days in January, no emergency department in the county had code red status.
Philip Stoner, executive director of the institute, said the coding system was only implemented in December, so no statistical comparisons with previous months were available. But he said this sort of ebb and flow of emergency room activity is typical, particularly during winter months.
Also in January, 10 hospitals declared code yellow -- a four-hour warning that the emergency department is busy and that patients may have to wait -- 108 times. Data about code use in each emergency department gets logged and reported to the state Health Department's emergency medical services office. Similar information is being gathered from other parts of the state.
The emergency room problems in Central Pennsylvania have been growing for years, said Richard Lee, state Department of Health deputy secretary for quality assurance.
Financial woes have caused some hospitals to decrease their numbers of beds, which means there often is no place to put people who need to be admitted after emergency room visits, Lee told the committee.
Hospitals also are facing a nursing shortage, meaning there are fewer people to care for patients who are admitted, which sometimes results in hospitals diverting noncritical patients to other hospitals, he added.
HMOs are requiring more in-depth tests in emergency rooms before deciding if insurance will cover hospital admissions, which contributes to patient logjams in emergency rooms, he said.
"It's a domino effect," said Dr. Salvatore Alfano, assistant medical director of Holy Spirit Hospital in Camp Hill, Cumberland County. "Diverting is a symptom of a whole hospital system in distress."
Hospitals that put themselves on "divert" status still accept emergency room patients who need immediate attention, such as life-threatening cases or those in which someone is in danger of losing a limb.
So far, there is no record of anyone's life being jeopardized because of increasing hospital diversions, said Helen Burns, the Health Department's deputy director for health planning and assessment.
Lee said frustrated ambulance drivers in Central Pennsylvania are even turning to tricks to get patients to the hospitals that are on divert status. The drivers simply don't radio the hospital to say they are bringing in a patient until they pull into the driveway. By then, it's too late for hospitals to say no. Federal law prohibits hospitals from turning away anyone from emergency rooms once the patient is on the property.
The state should do more to bolster the number of nurses in the state, so that personnel shortages don't cause hospital diversions, said the Hospital & Healthsystem Association of Pennsylvania, which represents 250 hospitals and health systems in the state.
State tax dollars should be used to pay nursing school tuition for qualified students, in return for five years of service in a Pennsylvania hospital, said Paula Bussard, association senior vice president of policy and regulatory services.
Another solution would be for the state to give hospitals money to offset the $834 million annual bill they absorb to care for those with no health insurance or too little of it, she said.
Some lawmakers want to use funds from the state's $11 billion tobacco lawsuit settlement for that purpose, something the hospital association has vigorously advocated for two years.
"There is no single pill that will cure this problem," said state Sen. Tim Murphy, R-Upper St. Clair, adding that he would back a bill by Mowery to be introduced next week that would forgive student loans for some nursing students.
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