WhiteCoat

Archive for April, 2009

Another Emergency Department Closure

Thursday, April 2nd, 2009

San Leandro Hospital’s Emergency Department in California is on the verge of closing its doors.

Because profitable procedures are being done elsewhere and people are coming in without insurance, San Hospital has taken a financial hit. Hospital administrators “would be happy if the hospital would just break even, but it regularly loses money, coming up $1.5 million in the red just in the month of February alone.”

Community leaders argue that because the Suter health care system is profitable at its other facilities, it should subsidize San Leandro as a service to the community.

“We have a community that is aging and will need these services. Not to mention if a disaster like an earthquake were to happen. There is an obligation to trauma services in this community.”

Businesses cannot operate at a loss – whether those businesses are donut shops, car dealerships, or hospitals.

More patients + less emergency departments = recipe for disaster.

The Dropped Call

Thursday, April 2nd, 2009

My disdain for cell phones in the emergency department continues.

A gentleman came in looking for help with a “personal” problem. Read that as he had pain at the tip of his woo hoo and it hurt when he urinated. No, it wasn’t the same guy from this post.

I got the history and then the gentleman dropped trow so I could evaluate the problem.

I had the gloves on and was evaluating Mr. Happy when … Gentleman’s cell phone started blasting out some rap song lyrics. Whatevah.

Instead of letting the most important call go to voice mail, Gentleman flips the phone open and starts talking … while I’m sitting there holding his pecker in my gloved hand.

The phone’s speaker is on “I forgot my hearing aid” mode, so I can hear the whole conversation.

“Yo, homey, what up?”
Gentleman doesn’t say “I’ll call you back.” He says “Nuffin. I’m chillin’.”
“Oh really,” I think to myself.
“You goin’ clubbin’ tonight?” asks the voice.
“We goin’ to Danny Z’s first and pick up some bitches …” says Gentleman.

About this time I needed to obtain a culture specimen to test Gentleman for sexually transmitted diseases. Performing this test involves putting a sterile cotton swab inside the urethra to get the sample. Unfortunately, since Gentleman was in the midst of an important and scintillating cell phone conversation, I didn’t want to be rude and interrupt him. So I took the Q-Tip and inserted it into Gentleman’s urethra as he continued to converse on his cell phone.

“An’ we gonna git AAAAAAAAAAAAAAAAAHHH!”
[silence]
Voice on other end says “DAAAAAMN! What UP wit choo, dog?”
Gentleman says “I gotta go” and hangs up the phone.

I see a “love dart” in your future, sir.

I guess I add urethral cultures to the ways in which I can get people to turn off their cell phones.

Quite effective.

ED Abuse

Wednesday, April 1st, 2009

From Statesman.com …

Nine patients.
Six years.
2,678 emergency department visits.
$3 million in bills to the taxpayers in Austin, TX.

And so many Americans won’t get basic health care because they can’t afford it.

Something ain’t right.

Ambulance Driver has some suggestions on a cure. 911Doc also beat me to the post.

The fact that so many emergency medical providers are highlighting the article should tell you something.

UTMB Closes ED, Opens Urgent Care Center

Wednesday, April 1st, 2009

236px-hurricane_ike_off_the_lesser_antillesThe University of Texas Medical Branch in Galveston trauma center was significantly damaged by Hurricane Ike in September 2008. After the storm cleared, UTMB kept its ED open only to treat patients with minor ailments or to provide stabilizing treatment and transfer to patients who needed higher levels of care. About 600 patients needed transfer since Hurricane Ike struck the area.

UTMB’s program appears similar to a program at the University of Chicago that evoked public outrage not too long ago.

According to an article in today’s Galveston County Daily News, UTMB stopped the “treat and transfer” program that it had been using since September.

Instead, UTMB decided to close down its emergency department.

Now no one has access to emergency care at the hospital. Everyone with an emergency condition must call 911 to be transferred to another hospital – apparently in Houston which is a 48 mile trip according to Google Maps.

Instead of continuing to provide emergency services, UTMB is running an “urgent care center” out of the emergency department. For those of you who haven’t read my previous posts, urgent care centers don’t have to treat any patient that walks through the door looking for care. EMTALA laws don’t apply to urgent care centers.

Oh, and by the way, the article states that “the urgent care facility will require patients to undergo financial screening.” I don’t know the hospital’s official policy, but that statement sounds like the urgent care center is doing a wallet biopsy on potential patients and triaging out those whose biopsies come up short. Sound familiar?

The comments section to the article was a mixture of desperation from patients and disgust from some medical professionals. One person stated “Many of us have severe problems and are desperate.” Another asked “Why should Houstonians suffer with longer waits in the emergency room because Galveston and UTMB can’t get their act together? They shouldn’t have to.” One PA stated that he was “really ashamed that I graduated from UTMB and have to witness this travesty of medical care to the citizens of and visitors to Galveston.”

It should be noted that UTMB stated that it plans to reopen its emergency department in 3-4 months – albeit with less services available. It should also be noted that, unlike the University of Chicago, UTMB is the only game in town in Galveston.

I predict that the speed with which UTMB gets its ED functioning will be directly related to how well the urgent care center does financially.

Welcome to the new face of medical care in this country, folks.

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