Emergency medicine nation's 'safety net'

Sunday, November 13, 2005

Physicians believe that phase of care should have status as essential public service

By Bill Byrd - Times West Virginian

FAIRMONT - In recent years, obstetricians and surgeons in West Virginia have been pushing for changes in the state's insurance system and civil law, seeking to cap awards in medical malpractice suits and asking for affordable liability insurance.

Now, doctors who practice emergency medicine in the state are pushing on the national and state levels for changes they say are needed.

“The state tort reforms of 2001 and 2003 are a good start, but by no means is this issue over,” said Leah Heimbach, the longtime executive director of the state chapter of the American College of Emergency Physicians.

If there is a bioterrorism attack or an avian flu pandemic, thousands of patients may find themselves without the emergency medical care they need, groups like ACEP are warning.

Congress must treat public emergency care as an essential public service, making it eligible for public funding, ACEP believes.

Under federal law, emergency physicians must provide free care to millions of uninsured patients. But the majority of the nation's 4,000 hospital emergency departments report they are operating at or over critical capacity, ACEP claims.

The nation's hospital emergency rooms are “under-funded, over-crowded, and suffer from staffing challenges caused by rising costs of medical liability insurance,” the group states.

Emergency department visits have soared 26 percent in the last decade, while the number of emergency departments has decreased by 14 percent, according to the national organization.

At the state level, says Heimbach, the net result is that “we are having trouble keeping our emergency medical physicians in West Virginia - and it is almost impossible to recruit more to come here.”

As a paramedic, registered nurse and lawyer specializing in health-care issues, Heimbach knows emergency medicine inside and out.

She's been the executive director of the state chapter of ACEP since its inception in 1986.

“I was a paramedic in Harrison County, and I was going to nursing school,” she said.

“When I was running as a paramedic on the ambulance, these were the emergency physicians who were on the radio giving me orders,” she said. “They needed an executive director, so I agreed to take on the business management of their organization.”

For the last three years, she and Patti Hodges have been advising health-care practitioners on business and regulatory issues. Located on Morgantown Avenue in East Fairmont, their business is called Healthcare Management Solutions, LLC.

When Heimbach's husband, Jonathan Newman, an emergency medical doctor at United Hospital Center in Clarksburg, first started to practice, the couple sought malpractice insurance. They checked with seven insurance companies.

“All seven said they wouldn't even write an emergency medical insurance policy in the state because of the malpractice environment,” Heimbach said.

When they found an insurer, they discovered that emergency medical physicians in the state pay much more than their peers in other states.

Her husband joined a group emergency medicine practice, which got a contract from UHC. The hospital agreed to pay the group's malpractice fees.

But eventually, as those rates climbed and climbed, the hospital could no longer afford those fees, she said.

The hospital then opted to self-insure for the first $2 million to $3 million of coverage, leaving it up to the physicians themselves to buy “excess” malpractice insurance coverage.

The doctors found themselves paying about $80,000 per year for the “excess” coverage.

“Doctors can't afford that in this state,” Heimbach said. “That's why they either leave or won't come.”

About 160 - or 40 percent of the estimated 400 doctors practicing emergency medicine in the state - are members of the state chapter, Heimbach said.

The popular perception of doctors and nurses in emergency rooms is that they are busy with victims of accidents or criminal violence. But the reality is much different.

While emergency physicians treat car crash and crime victims, as well as those suffering heart attacks and strokes, they also must care for “a huge” number of elderly and uninsured patients.

The latter go to hospital emergency departments for primary care “because they have no other choices and no money.”

Emergency medicine has become the nation's and state's “safety net for the health care of those who are uninsured, underinsured or elderly.”

“The patients who come to emergency departments in rural West Virginia are usually so sick by the time they get there because they've waited so long” to see a doctor, she said.

“So, you take really poor reimbursement, you take really sick patients, you take overcrowding resulting in ‘boarding' (keeping patients for hours or overnight in the ER room before they are admitted as inpatients because hospitals don't have enough specialists to treat them), you take the malpractice environment ...” and there is a crisis looming in emergency care nationally and in the state, Heimbach said.

ACEP is circulating petitions nationally calling for Congress to pass House Resolution 3875, the “Access to Emergency Medical Services Act of 2005.”

Dr. Frederick C. Blum of Morgantown is president of the national group. The group will issue a national “report card” next month, spotlighting ER conditions on a state-by-state basis.

Baseless lawsuits are causing doctors to avoid working in ER departments, where critically ill patients often need intricate and immediate interventions, ACEP claims. The group wants a national cap on non-economic damages in malpractice awards.

Congress should also provide supplemental funding for emergency departments. And it should provide financial incentives to hospitals to adopt procedures to reduce “boarding” in ERs. Emergency doctors also want a 10 percent boost in Medicare payments for emergency-room care.

On the state level, Heimbach said emergency medical professionals would like to see Gov. Joe Manchin III convene a task force to respond to a Hurricane Katrina-like disaster or worse, a terrorist attack.

“And the ‘boarding issue' is going to become an issue for every hospital in the state,” she said.

“You come to an ER, you have a condition that warrants you to be admitted. Or worse, that you have surgery and should be admitted. But there are no beds, so you are admitted to the ER,” she said.

“This sets up a disaster. Now introduce a plane crash, a bus wreck or worse yet, a flu pandemic. My point being is that we're at capacity now.

“It's time we dealt with this issue before it becomes real,” she said.