Stuck In The Emergency Room? You May Be Sitting Next To A Dead Man.

The story of Jon Verrier is a sad one. Verrier went to a New York City emergency room in the West Bronx to get treated for a rash. Eight hours later he’s found stiff, cold, and dead in the waiting room. The worst part?

A spokesman said an in-house review found “all guidelines were met,” but an ER worker told WABC-TV the policy should be changed. “There’s no policy in place to check the waiting room to see if people waiting to be seen are still there or still alive,” said the ER worker.

You read that right. There’s no policy to check to see if you’re sitting in an emergency room NEXT TO A DEAD PERSON. And Verrier’s wait time wasn’t all that unusual; the average wait time for that particular hospital is 306 minutes, compared to the 137 minute countrywide average, according to Medicare statistics. But that is the state of our health care system–if you don’t have insurance, there’s a good chance you’ll be treated like you don’t matter.

On yesterday’s show #TeamBlackness discusses the most recent idiocy to come out of Rand Paul’s mouth, a new app that lets white people experience the everyday racism of being a minority, and why it’s not so bad that Hilary Clinton hasn’t driven a car since 1996.

Subscribe on iTunes | Subscribe On Stitcher | Direct Download | RSS

The Morning Crew discusses a disturbing story about female inmate sexual abuse in an Alabama prison (27:00), the soft, pink gun for ladies (37:41), pajama jeans (49:03), and specialized boob deodorant (57:00).


Subscribe on iTunes | Subscribe On Stitcher | Direct Download | RSS
Want to support TWiB? Shop at Amazon using this link: http://twib.me/amazon – make a purchase, it contributes to TWiB!






77 replies
  1. 1
    Pincher says:

    You still hear right-wingers say that we don’t need ACA because “poor people can always go to the emergency room and get treated.”

  2. 2
    Violet says:

    This happened to someone my parents know. White woman. Over 80. Went to ER with chest pains or something similar. Had to wait for four hours before being seen because her case “wasn’t urgent”. She died there.

  3. 3
    Amir Khalid says:

    Having to wait five hours for emergency medical attention is obscene, let alone eight hours. That hospital seems terribly understaffed. Yet Jon Verrier couldn’t have died of a rash. Did he happen to die of heart failure from a previously undiagnosed condition? It’s been known to happen even to professional athletes.

  4. 4

    That recent study out of Oregon found that expanding Medicaid didn’t reduce ER visits and in fact increased them — something other states have experienced as well. Instead of this being a failure of the Medicaid expansion it’s actually a failure of the healthcare system, with most of the ER visits a result of patients being unable to get appointments with their primary care physicians.

  5. 5
    aimai says:

    @Violet: This happened to us, too. The problem is that ERs, even “good” ones are run in a crazy way–once you have been defined as an important or significant patient–like bleeding or critical–you get bumped to the head of the line. So if they first or second time you are triaged you were not serious, or couldn’t make a big enough fuss, you get bumped down (without being told). There’s no big board with your name on it that you can see that tells you when you will be seen, so you and your family (if they are there with you) have to make a decision without information about whether to stay or go. The ER is, in many cases, counting on patients triaging themselves right out the door so the limited medical staff can concentrate on the patients whose needs are the noisiest or the best covered or who have personal physicians calling in.

    They also don’t have the flexibility, because it costs a lot, to call more doctors and nurses into the system when the system gets overloaded. I had an enormous fight with our local hospital and ER over the treatment my husband (white, middle aged, fully insured) got over two separate days. I could shit a better system, since I’m an anthropologist and systems are my business. But though they admitted everything I told them about how craptacular their system was was true, they have decided to keep running things this way because mostly, on the whole, they don’t get in trouble and no one dies on their hands and it saves money.

  6. 6
    chopper says:

    of course, the fact that hospitals are being closed left and right in NYC will totes make wait times better, amirite?

  7. 7
    Cluttered Mind says:

    @Amir Khalid: I don’t know, that sounds like the sort of question one might want to ask a doctor. Oh wait, he tried, and they ignored him until he died. That’s the worst part of all this to me. How can they tell which cases are “severe” or not without examining people? Obviously a rash wouldn’t ordinarily be fatal, but in this case the guy’s life was clearly in the balance. If everything there was done according to in-house guidelines, then the ER worker is absolutely correct that the guidelines are inadequate.

  8. 8
    rikyrah says:

    New GOP Plan Makes Everything They Hate About Obamacare Even Worse
    Dylan Scott – January 28, 2014, 6:00 AM EST6771

    For the last couple months, the Republican critique of Obamacare has been founded on President Barack Obama’s broken promise: “If you like your health plan, you can keep it.” It was a pledge that the health care reform law wouldn’t disrupt the existing insurance system, that those satisfied with the status quo would be protected from any unwanted intrusion.

    It’s been an effective line of attack, given the sinking approval ratings for both Obama and his eponymous insurance expansion. Which makes the new GOP alternative to Obamacare, proposed Monday by three Republican senators, a bit baffling. Because the bill seems to based on another fundamental disruption of the individual insurance market — and on top of that, it could upend the employer insurance universe, through which most Americans receive health coverage, forcing many to either pay more or lose their coverage.

    That was the conclusion of several health policy wonks who spoke with TPM about the new proposal, put forward by Sens. Richard Burr (NC), Tom Coburn (OK) and Orrin Hatch (UT). One way or another, millions of people would likely lose the plan they already have.

    The GOP’s plan starts with repealing the Affordable Care Act, and it seems explicit that everything must go: “The first step toward achieving sustainable, affordable, patient-centered health care is to repeal the Patient Protection and Affordable Care Act (PPACA) and the Health Care and Education Reconciliation Act (HCERA).” The only items untouched would be changes to Medicare, which weren’t related to covering the uninsured anyway, according to a footnote.

    That would appear to immediately toss out Obamacare’s coverage expansion, which has already covered several million Americans (three million have signed up for private coverage, and hundreds of thousands if not a couple million have been covered through expanded Medicaid — the exact numbers aren’t available yet).

    http://talkingpointsmemo.com/d.....disruption

  9. 9
    Mnemosyne says:

    @Southern Beale:

    Hm. I can’t find it right now, but I’ve seen other stories about that study that said that ER use peaked after 18 months, but went down after that as people who had previously been uninsured were able to find primary care doctors. I don’t think the other stories I saw had the twist saying that primary care physicians were telling people to go to the ER because they didn’t have appointments for them.

  10. 10
    Cluttered Mind says:

    Though I suppose had he been howling in pain they might have been even more encouraged to ignore him, like what happened with that one woman who was hauled out of the emergency room because she was being too loud and disruptive (due to the intense pain) and then died in a jail cell that night still begging for medical attention. They all thought she was just a wino in need of a drug fix right until she died. Great country we’ve got here.

  11. 11
    elmo says:

    @Cluttered Mind:

    Am I right in believing, without any evidence and not having previously seen the story, that the woman in question was nonwhite?

  12. 12
    Culture of Truth says:

    In a way I’m surprised this doesn’t happen more — after all, people go to the ER with a medical emergency. Clearly, something went wrong, but if somene shows up with a non-urgent problem like a rash and has no friends or family, I can see how the ER would not have a policy of checking on him every 15 minutes or every hour. Still, they ought to have a better system, given it’s a n “emergency” room, and appararently hours went by. Also, if you can avoid it, don’t go to the ER alone.

  13. 13
    Gex says:

    Deleted for irrelevance.

  14. 14
    Mnemosyne says:

    @elmo:

    I hate to depress you even more, but there’s been more than one instance of that happening, so I’m not sure which case Cluttered Mind is referring to. In one of the lovely cases here in Los Angeles, Edith Rodriguez died as they were taking her to the police car because she was being too disruptive. You know, as she was dying from a perforated bowel.

  15. 15
    Fred Fnord says:

    I cringe when I hear of things like this. Our local hospital (on the border between a ridiculously wealthy section of San Francisco and an economically depressed section) has never kept me or anyone I’ve escorted there (two people so far, go me!) waiting more than 40 minutes, nor do I think anyone there waited much more than that in at least three of the cases. (The fourth I have no idea because we barged straight through the waiting room without even pausing.)

    San Francisco is somewhat progressive, but honestly, living here, I wouldn’t have expected this different an experience, because we’re rarely willing to put much money where our mouths are. I wonder if this is because of the Healthy San Francisco program (so the ERs could actually count on being paid for most of their services) or something else.

  16. 16
    Amir Khalid says:

    @Cluttered Mind:
    I’m saying nothing in the story shows that Verrier’s long wait in the ER staff had anything to do with his death. With a potentially fatal heart condition, he could have been asymptomatic right up to the moment his heart failed. So there might have been nothing to tip off the medical staff who first assessed him. As it was, Verrier came in at 22:00hrs, and was alive and mobile at 03:45hrs. Had he been promptly treated for his rash and released, he might have died back at home.

  17. 17
    Punchy says:

    the average wait time for that particular hospital is 306 minutes

    My shitty math says this is over 5 hours. Holy sheeyot.

  18. 18
    elmo says:

    @Mnemosyne:
    Thanks – you’re right, now I’m depressed. I’m thinking about the many times I’ve taken my (then) partner (now wife, yippee!) to the ER for various things – burst appendix, blinding migraine that I was afraid could be a brain bleed, injured neck, concussion from being thrown from a horse. She’s unlucky that way. But even though for most of those visits she was a Medicaid patient, we are still white, present well, articulate, etc. So even if she were screaming, I think it would be automatically coded as “pain,” and not “crazy welfare bitca.”

  19. 19
    Chickamin Slam says:

    @Pincher: You get commenters on Balloon Juice that pontificate the same talking points. They are democrats though, they once gave some money to a Harold Ford campaign so it’s all good.

  20. 20

    On a slightly different note. You know what’s even more scary, when your primary care physician sends you to the ER and you get to jump the line and have a team of doctors and nurses fussing over you and the patient as soon as you get there. Immediate thought bubble, my God what is wrong, is he dying?

  21. 21
  22. 22
    Roger Moore says:

    @Cluttered Mind:

    They all thought she was just a wino in need of a drug fix right until she died.

    Of course, part of the reason they might have thought that is because ERs have a serious problem with exactly that kind of thing. ERs aren’t allowed to turn anyone away, so people who don’t have anywhere to go wind up in the ER faking symptoms so somebody will do something for them. It’s like some of the problems Kay talks about with schools having a hard time focusing on education because they’ve been turned into general purpose dispensers of social welfare to poor kids. It’s one of the hidden costs of gutting the welfare state.

  23. 23
    Violet says:

    @Amir Khalid: This is very true. And given the craptastic state of our medical system–which hopefully will improve with the ACA, but not all states are participating in the same way so some will still suck–the ERs are flooded with people who aren’t critical but don’t know where else to go. Or who can’t afford to go anywhere else.

  24. 24
    rikyrah says:

    Louisiana backs off abortion waiting period
    01/28/14 10:20 AM
    By Steve Benen

    As 2013 came to an end, the Guttmacher Institute reported on a striking trend: policymakers at the state level had approved more restrictions on reproductive rights in the last three years than during the previous decade.

    We’re only a month in 2014, but social conservatives apparently don’t intend to change course.

    In Louisiana, for example, the state’s Department of Health and Hospitals recently moved forward on a policy that would require a 30-day waiting period before a woman could terminate a pregnancy. As Katie McDonough reported, the policy would require women seeking an abortion to have certain blood tests done 30 days before their procedures.

    South Dakota and Utah have three-day waiting periods already on the books, but this new regulation would create a delay 10 times as long.

    Laura Bassett reports this morning, however, that the state is pulling back in the face of public scrutiny of the policy.

    DHH is considering an “emergency” set of rules for abortion clinics, which currently includes new building standards and an unprecedented requirement that a woman take certain blood tests at least 30 days before she can have an abortion. This last requirement would force women seeking abortions to have the procedure later into their pregnancies, making it riskier and more costly, and could make it impossible for some women to obtain a legal abortion before Louisiana’s 20-week gestational limit.

    Moreover, the blood tests indicated by the new rules, which check a patient’s hematocrit and hemoglobin levels before a surgery, are normally performed the day of an abortion procedure because they need to be as current as possible, women’s health care providers said

    http://www.msnbc.com/rachel-ma.....ing-period

  25. 25
    ruemara says:

    Not new. When I had dvt, I got to go to highland hospital. Nearly 2 hours travel to someplace only 30 minutes away by car. Even when early for my appointment, I’d wait to be seen for up to another hour or more & that includes checkups. When working in Solano & I had my nose blowout, I was brought in choking on my own blood, blood running from my nose and mouth, coughing up clots, blood all down my shirt. The spotless, expensive, lying about my sole $200 responsibility, kept me waiting for over an hour or more, things got hazy after a while. It was only me there. Picture yourself spewing blood. You can hardly answer a question, because-dur- blood… and you just gotta wait. Hate hospitals. Speaking of which, has there been a Betty check-in?

  26. 26
    Violet says:

    @schrodinger’s cat: I accompanied a friend to the ER. Her primary care physician sent her there. We didn’t get to jump any line. How does that happen? We waited in the hallway for three hours. She did get on a gurney but never into a room. The waiting room wasn’t that full so I think that’s why she got on the gurney.

  27. 27
    smith says:

    @Mnemosyne: There was this diary at GOS about the initial rise and then falloff in ER visits after Romneycare went into effect in MA. The effect was most pronounced among people who lived in poorer zip codes. In other words, it takes a couple of years for the effects of reform to work themselves through the system.

  28. 28
    Cluttered Mind says:

    @Amir Khalid: Yeah, I should have been more clear in saying that you’re right that he may not have been saved if they’d seen him, and that they do have to prioritize based on visual symptoms when the ER is overcrowded. My frustration was borne from how we’ll never actually know if he could have been saved, because he wasn’t treated.

  29. 29
    Just Some Fuckhead says:

    I think all dead people should be required to go to the hospital so we can make sure they aren’t harboring any fetuses and Baby Jesus has ok’d their dying.

  30. 30

    @Violet: I guess, because he was really sick and we were lucky. He did have excellent coverage through work.

  31. 31
    PurpleGirl says:

    @Cluttered Mind: There will probably be an autopsy which should provide information about other, silent conditions he might have had.

  32. 32
    PurpleGirl says:

    Elmhurst Hospital, where I’m a patient of the adult clinic, has an ER AND a trauma center. The two are next to each other and connected but someone coming in with severe injuries will be sent to the Trauma Center. The ER handles other less severe medical conditions. First you will see the financial counselors about insurance or how you will pay for the visit. Then you see the triage nurse who takes your history or gets your file (computerized system). You may speak with a triage nurse two or three times until you are taken into the medical exam room where the doctor examines you. One time I was there, it took two hours before I got to the medical examination room. I was there actually to establish a case so that the ER could refer to the Adult Clinic for continuing care.

    ETA: Elmhurst is a city hospital, part of the Health and Hospitals Corporation; its doctors are staff from Mount Sinai Medical Center and Medical School.

  33. 33
    Yatsuno says:

    OT: shots fired at a Hawai’ian school. Apparently the kid assaulted a cop, so he obvs needed to be shot down.

  34. 34
    gelfling545 says:

    @Mnemosyne: Here in WNY where doctors are plentiful it can take a weeks to months wait to get an appointment with a new physician. For people whose coverage started on 1/1 when a lot of practices are running on a reduced schedule anyway due to holidays I imagine that it might take a while for people to be able to connect with a PCP and thus people would take care of immediately troubling conditions via the ER. I am just wondering if this ER figure includes the use of “immediate care” facilities which cost a good deal less than an ER visit. I’ve made use of immediate care on a few occasions & have found it to be a very satisfactory alternative to an ER visit out of my PCP’s office hours.

  35. 35
    🎂 Martin says:

    @rikyrah: Why not just introduce a national 40 week waiting period and call it a day?

  36. 36
    Keith G says:

    @Yatsuno:

    Authorities say a police officer shot a 17-year-old runaway in the wrist at a Hawaiii high school after the teen cut one officer with a knife and punched two others.

    Sounds like the kid got off rather light. Dan-o did really didn’t do that much damage, all things considered.

  37. 37
    aimai says:

    @Amir Khalid: That is certainly true. We’ll have to wait for the autopsy to determine cause of death. But its also the case, speaking from experience, that ERs aren’t set up to handle the idea of a progressively worsening condition in a potential patient–if you are on the wrong side of the door and have not been assigned a doctor or a nurse you are shit out of luck. The original triage view of you “not too serious” will obtain regardless of the fact that the conditions under which you are being held might themselves be dangerous to you.

    In my husband’s case he came in an ambulance, immobile from back pain, after lying on the floor for six hours in agony. We actually made it straight into the ER proper, and got “on the board” but kept getting bumped by more serious patients until he’d spent another SIX HOURS immobile from pain–that in itself was really bad for him in a technical sense, like your body doesn’t like that and then needs remeidiation for that. But it was kind of no one’s business to check on his deterioration.

    The whole idea of the waiting room is incredibly dangerous, I think–because people are there, waiting in line, but there is no sense that the hospital is accepting a duty to care for you until you cross some magic threshold. The patient can’t tell–they can either leave, having accomplished nothing, or stay and not know that they won’t ever be seen. There needs to be a clock ticking from the moment each person walks into the emergency room and hospitals need to be held accountable for each person who enters, tries to get seen, and doesn’t get seen. Only by keeping a record of these attempts to be seen (who does it, when, why, with what result) can the appropriate resources be brought to bear.

  38. 38
    sparrow says:

    @rikyrah: Jesus titty-fucking christ, I hate these forced birthers. How stupid is it to force a 30 day delay. If you REALLY thought fetuses were “pain-capable”, I’m sure it will help a lot to grow them for a whole ‘nother month. Typical hypocrisy.

  39. 39
    aimai says:

    @ruemara: One of my earliest memories was of a massive, massive, nosebleed I had as a child. So massive that they took me to the ER where I sat with a bowl under my nose to catch the blood I, too, was gagging up. They saw person after person ahead of me, as I recall. Eventually they cautorized my nose and sent me home. But I remember thinking, I was probably about 8, that for all the blood I was gunking up it apparently wasn’t considered very serious.

  40. 40
    Roger Moore says:

    @🎂 Martin:

    Why not just introduce a national 40 week waiting period and call it a day?

    That would be just a tiny bit too obvious.

  41. 41
    Villago Delenda Est says:

    OT from Noisemax, guaranteed military grade stupid:

    Live NewsmaxTV: Allen West, Dick Morris Respond to Obama, Watch 9 P.M.

  42. 42
    cermet says:

    @schrodinger’s cat: Been there, been that and yes, the situation was bad; not sure I in any way felt privileged by that experience … surgery was at first going to be with no local and just start cutting but I objected; at that point they at least injected a numbing agent – the specialist showed up in a regular suit and just started cutting – no mask, gloves … still, at that point, I really didn’t care since the pain was past worrying about that aspect of the process. All from a spider bite. They were in a hurry to remove the venom and dead tissue.

  43. 43
    Cassidy says:

    @aimai: I’m thinking there’s a lot about the triage process you don’t understand. I get it, it’s easy to be pissed from the waiting room side of the door, but there is so much more that goes on back there.

  44. 44
    🎂 Martin says:

    @Roger Moore:

    That would be just a tiny bit too obvious.

    27% of voters wouldn’t think it long enough.

  45. 45
    SiubhanDuinne says:

    @Yatsuno:

    Sigh. I can’t keep track any more. What is this, the fourth in as many days? And exactly what I was afraid would happen is happening: I’m getting numb to all these shooting rampages and SYG and “accidents” happening to “responsible” gun owners. And I hate admitting that, because of course it plays beautifully into all the NRA RWNJ talking points. I want to keep the outrage level up, but … I just can’t.

  46. 46
    SiubhanDuinne says:

    @Keith G:

    Sounds like the kid got off rather light. Dan-o did really didn’t do that much damage, all things considered.

    I’m still tired of it. Gun fatigue.

  47. 47
    celticdragonchick says:

    @aimai:

    Yep.

    Also, don’t forget the whole “drug seeking behavior” category that they can shoehorn you into.

    I was taken to Moses Cone ER via ambulance after I blew my L1/L2 disc while installing panels in the aft cargo pit of a 757 at the airport. Typical on the job injury…right?

    Apparently not. I was left on a gurney for over two hours until my spouse called my mom in California (a former ICU nurse) who in turn started calling people at the hospital demanding to know why I was being left unattended in agonizing pain.

    They wheeled me into a room, gave me shot and sent me home an hour later. No X-ray or imaging, and I never saw a doctor. They refused to even help my spouse load me into a vehicle (I swear I saw the security guard curling his lip at me).

    When we got home, I collapsed and rolled/fell into a drainage ditch. Walking was utterly out of the question, and so my spouse was panicking over having to call the ambulance again to take me back to the fucking ER.

    I finally managed to crawl on my hands and knees out of the ditch and made it to our front door and onto the couch.

    When I saw the orthopedist the next day, he was thunderstruck that Moses Cone hadn’t even taken a basic X-ray. I found out later that they consider patients with back injuries to be exhibiting “drug seeking behavior” and deny treatment if possible.

  48. 48
    pat says:

    @Violet:

    Hah, at my hospital if you say you are having “palpitations” or chest pain of any kind, you are hustled right in and hooked up to a monitor. Immediately.

  49. 49
    FlyingToaster says:

    @smith: That’s certainly been our experience with Romneycare.

    Another protocol that expanded from MassGeneral in the 90s: two facilites at the hospital, the ER for goddam emergencies and the Ambulatory Care clinic for “needs dealing now with but doesn’t need it right this second.”

    When I had a UTI (pre-Romneyacre) I went to the MassGeneral AC and had to wait about an hour (after checking and peeing in a cup) to see the doctor for a scrip. Fair enough.

    When HerrDoktor had an emergency two years ago (the night before Father’s Day), he called our practice (got my doctor) and she sent him to the Mount Auburn Emergency Room. He waited 20 minutes from check-in (the MD told them he was coming and his chronic condition), was examined, diagnosed and the scrip called into CVS within the hour, and was home an hour-and-a-half after he left. And surgery 3 months later to fix it once and for all.

    It took more like 3 years to get the ER problem worked out in the Boston area (mostly the expansion of community clinics and getting more GPs into and out of the pipeline for private practices), but it DOES WORK. Suck it, GOP.

    The one thing that we learned up here is that we need more general practicioners and pediatricians. Obamacare is going to multiply that demand by 50. Seriously.

  50. 50
    rea says:

    @Cluttered Mind: How can they tell which cases are “severe” or not without examining people?

    In my experience–but maybe this is just a local thing–you come in the door and (unless you get delivered by ambulance) you see a triage nurse, who asks a few questions, maybe looks at you briefly, and determines how urgently you need to be seen. Someone who comes in complaining of a rash very obviously isn’t in a very urgent catagory. But, what’s disconcerting about this guy is (1) the ER is so backed up that the non-urgent people aren’t being seen until after a 5 hr. wait, and (2) nobody is paying attention to the people who have been triaged into long waits.

  51. 51
    maximiliano furtive, formerly known as dr. bloor says:

    @aimai:

    There needs to be a clock ticking from the moment each person walks into the emergency room and hospitals need to be held accountable for each person who enters, tries to get seen, and doesn’t get seen. Only by keeping a record of these attempts to be seen (who does it, when, why, with what result) can the appropriate resources be brought to bear.

    Emergency departments are well aware of the problems, but unfortunately, that awareness doesn’t magically result in the appropriate resources–in this case, real estate and staffing–being brought to bear on the situation. They don’t make people wait because they’re too busy shooting up drugs, it’s because they already have sick/injured folks stacked up like planes over O’Hare in the treatment area. You can implement checks to monitor/re-triage folks who have already signed in once, although it would be interesting to see if the staffing time you devoted to that task was worth it in terms of actually reshuffling the waiting patients due to changes in condition.

  52. 52
    Violet says:

    @Cassidy: I used to work with doctors and knew quite a few ER docs. You are right that there is a lot that goes on in the ER that people don’t know about. However, adding in a system where patients who are waiting get checked on every 15 or 30 minutes or so would be a good idea.

    If someone gets assessed as having a less urgent issue but it becomes worse, there’s not much way for the medical staff to find out under the current system. They’re classified as non-urgent and they wait. That’s what happened to the elderly woman my parents knew that I posted about upthread. She didn’t have family with her and she died. She didn’t need to because her heart condition was treatable.

    That issue could be fixed. It would have helped the guy in this article and the woman I posted about at the beginning of the thread. I’m sure they’re not the only ones.

  53. 53
    mai naem says:

    I think the PCP calls in for the patient because they know the history of the patient and the patient needs something that absolutely has to be done through the ER. It can mean the patient jumping the line but not necessarily.

    As far as Verrier, the NYDN story says he had a history of drug abuse and I am figuring they’ll probably try and blame it on that -assuming they can get away with it with patient privacy regs.

    I know,bottom line, its the hospitals problem but I’ve been at ERs and I’m wondering how nobody sitting near him didn’t notice that he was dead. It’s a Sunday night. I am guessing the ER has to be somewhat busy. It’s a pretty sad statement about our society when we can’t even look over and notice that somebody’s blue and dead.

  54. 54
    aimai says:

    @maximiliano furtive, formerly known as dr. bloor: I had a really, really, long talk with this with the head of ER at my local hospital, and even the head of the hospital. They told me they had done a “cost benefit” analysis but I pointed out that the “cost” was to the patient and the “benefit” was to the hospital. Of course its going to cost a bundle to have, in essence, overcapacity in medical staffing in order to handle temporary oversupply of patients. And of course that which costs too much is the first thing that is dumped. They admitted as much to me–they ahd had a better system but they dumped it. The real costs only become obvious, like crashing into a brick wall obvious, when someone dies or now, under the ACA, where readmitting the same patient within 48 hours is finally seen as a problem.

  55. 55
    aimai says:

    @FlyingToaster: Hey flying toaster! YOu are a neighbor! My nightmare ER experience was with the Mt.Auburn ER, oddly enough. They are our local hospital and our actual doctor is there, in the building.

    They can be great or they can be awful–one interesting thing I want to add is that one is often sent to the ER by one’s physician because the ER is the gateway to a differential and admittance to the hospital floor for care once a diagnosis has been made. Your physician sends you to the ER because the ER doctors have priority in getting certain tests done so they are going to bump your physician, anyway, if he tries to have you come to his office and order tests.

  56. 56
    Violet says:

    @pat: I would say the story was urban legend-y, but my parents were friends with this woman and her husband. He’d died a few years before. She went to the ER on her own. Heck, I even met her once. I don’t know exactly what she told the ER docs but she was one of those nice old ladies who wouldn’t want to cause a fuss so probably downplayed what was happening. The word “palpitations” probably didn’t get said. She might have said she was having a “little pain”. Sad. It made my parents pretty afraid to go to that ER and it’s considered a good hospital.

  57. 57
    maximiliano furtive, formerly known as dr. bloor says:

    @aimai:

    They admitted as much to me–they ahd had a better system but they dumped it.

    I doubt they weren’t “admitting” anything to you as much as they were simply acknowledging that they work within tight budgetary constraints. I suppose in some cases overstaffing cuts into a hosptials profit margin, but at every hospital I’ve ever been affiliated with it’s more a matter of keeping your doors open for business. And not all the places I’ve been at have managed to do that.

    Readmitting a patient within 48 hours has been considered a problem for the last twenty years, btw.

  58. 58
    Violet says:

    @aimai:

    The real costs only become obvious, like crashing into a brick wall obvious, when someone dies or now, under the ACA, where readmitting the same patient within 48 hours is finally seen as a problem.

    A friend of mine was the primary caretaker for an elderly relative. When the woman was nearing the end of her life she started going to the ER more regularly. At some point they had her in the hospital but didn’t actually admit her because of this type of regulation. She was waiting for Medicaid to kick in and the hospital people told my friend that if they admitted her it counted against them in some way. So there was some loophole where they could keep her there, basically like any admitted patient, but not actually admit her. And then that in turn caused problems for my friend in dealing with Medicaid and other stuff. It was a mess. This was about a year ago, so relatively recent. The hospitals are well aware of this kind of regulation and they’ll find ways to work around it.

  59. 59
    TAPX486 says:

    The new GOP plan continues with the absurd rational that if the patient has more skin in the game they will be more careful in using medical resources. That people abuse the system because it is ‘free’, i.e. they don’t know how much the bill really is. Now maybe some people are really that stupid and can’t read the EOB that they get from their health care provider but I doubt it is that many. When you have chest pains you are not going to start comparison shopping for the cheapest ER/doctor. When your kid is in pain the cost doesn’t matter. You just want the child cared for. I can’t really believe that these conservatives believe this nonsense. I don’t care if the procedure includes a round the world cruse on the Queen Mary II, with the latest SI swimsuit model as a date I’m not going to get a bypass done just because it is free.

  60. 60
    pseudonymous in nc says:

    @FlyingToaster:

    The one thing that we learned up here is that we need more general practicioners and pediatricians. Obamacare is going to multiply that demand by 50. Seriously.

    And that’s going to require incentives at the med-school level including tuition forgiveness. America doesn’t need any more fucking dermatologists, and Americans don’t need to see specialists for all their booboos.

  61. 61
    Tissue Thin Pseudonym (JMN) says:

    @aimai: Okay. What do you want them to stop doing? You’re irate that they are too busy to do what you think they should be doing but that’s worthless unless you can specify what it is that they are currently doing that is less important. Either that or tell me how much more you’re willing to pay for emergency care.

    Resources aren’t infinite and we’re talking about one of the places where the medical system is the most expensive. It’s also one of the places within the system where hospitals are the most likely to get stiffed on the bill, though hopefully that will be less of an issue going forward. So it’s likely that significantly improving emergency care is going to lead to equally significant cuts somewhere else.

    So where do you want them?

  62. 62
    PurpleGirl says:

    @pseudonymous in nc: This is a problem going back decades. The AMA and medical schools keep a close rein on the number of medical school admissions and students. Their control is so tight as to monopolistic. We don’t just need incentives for people to become GPs but to loosen the gripe of the AMA and admit more students. Lots more students.

  63. 63
    xenos says:

    Living in a country that has had an Obamacare-type system for a couple decades, you see a setup that looks a lot like what is being described here for Massachusetts. No doctor offices of any kind are open after 5:00 pm, but the neighborhood ones often have a couple hours for walk-ins in the early mornings. Anything serious that can’t wait until morning gets seen at the hospital, at the “policlinique”. Triage gets done, so you might be waiting a while for a rash.

    Anything serious, you call the equivalent of 911 and they send an ambulance, and if the ambulance driver takes you in you get to the ER.

    I have spent many, many evenings at the childrens’ policlinique.

    As an aside, this sort of system really does bend the hell out of the cost curve. The government set up a union for the doctors and makes them lobby through that single, regulated syndicate. Doctors can operate independently but it is illegal for any clinic, hospital, or joint practice to be anything but non-profit. Excess revenues not paid out in salaries or reinvested in the practice get severely taxed.

  64. 64
    Aimai says:

    @maximiliano furtive, formerly known as dr. bloor: look–my spouse and i are not stupid and this was thouroughly gone over with the hospital at the time, everyone from the head of the er to the fucking president and our physician got involved. You can stop explaining to me what it meant or how it works.

  65. 65
    pseudonymous in nc says:

    @PurpleGirl: It’s not just the AMA, though: as Atul Gawande has pointed out, American med students have to think about their career earning potential from day one, and that usually means taking a route that isn’t general practice. At the same time, generations of middle-class Americans have been brought up to believe that “general practitioner” means “shitty doctor who couldn’t make it as a specialist”, which might be fine if everyone’s a special snowflake who demands to see the best arse specialist or elbow specialist in town, but you can’t run an actual healthcare system on that basis.

  66. 66
    aimai says:

    @Tissue Thin Pseudonym (JMN): I think you think I’m making an argument that I am not making. I am not arguing for cuts to primary care, for example, or anywhere else to pay for expanded ERs. I live in MA where,thanks to early implementation of Romneycare, most people are not besieging the ER for primary care or coming in casually at all–certainly not at my local hospital where my husband was sent by his physician.

    I am simply pointing out for people who may not have had ER experience that there are several different kinds of issues for ER’s in terms of queuing, finding out where you are inthe que, being re-examined (or seen at all) once you are in the que, being stuck inside the ER once you are admitted to the ER but being sidelined for more emergency care, inability of the ER to admit you to beds given the scarcity of beds, etc..etc..etc…

    The specific problems we had, being admitted twice in 24 (not 48) hours and then admitted to a bed on a floor, were thoroughly gone over with the hospital and the hospital admitted fault to us on a number of issues. In chatting with the head of the ER about this he and I were actually in agreement about the systemic issues which included not having extra doctors at peak times and not really having any way of monitoring or paying attention to people (not us) who were not yet admitted to the ER. I’m just interested in systems–not medical care specifically–which would prevent bottlenecks in care, confusion about lines of authority w/r/t care, etc…

    I am not advocating for more money to ERs or less money to someone else but ER care is going to continue to exist because it is, in fact, a pathway into the hospital for care that has to take place in the hospital so a lot of attention needs to be paid to how you funnel people in and how long that takes. IN our case it took about twelve hours the first night, another twelve hours when we were re-admitted and then four days in hospital. The two twelve hour stints in the ER were truly brutal, physically, on both my husband (the patient) and myself. Just getting seen in an emergency shouldn’t itself be a physically demanding marathon. If it is for a lot of people, there’s something wrong with the system.

  67. 67
    pseudonymous in nc says:

    The other point to be made here is that actual healthcare systems basically underwrite the cost of emergency treatment — and often own the facilities, even when doctors operate privately — because there’s the assumption that other options exist. Emergency services are the worst possible place to bill at fee-for-service if you want an actual healthcare system.

  68. 68
    Tissue Thin Pseudonym (JMN) says:

    @aimai: Maybe I misread you, but there are a number of people on this thread who have argued that waits have to be shorter, or more time needs to be spent evaluating each person as they come in, or that the whole concept of triage is a bad idea. And most of them have failed to acknowledge that every one of their solutions involve resources that have to come from somewhere.

    The thing about triage is that there are going to be mistakes. It’s a system that inherently involves *quickly* deciding how serious someone’s condition is and given how often lengthy investigations have trouble diagnosing a problem it’s going to be a lot less than perfect. Unless we’re prepared to staff emergency rooms to the point where they can quickly handle all comers, which would involve a lot of time spent standing around waiting for patients to show up, it’s also necessary.

    And saying that patients in the waiting room should be monitored for changes in their conditions falls into the same category; it takes resources. Given that the underlying problem is that emergency rooms are understaffed, those resources will come from something else. Constantly monitoring patients is the waiting room will mean that average wait times go up because those are personnel who are not treating anyone. It might be worth doing but understand what the costs are.

    And you were the one who derided the idea that the hospital was performing a cost/benefit analysis. Well tough. That’s a necessary function of what they do. Putting it in scare quotes means you don’t really get the fact that they have to allocate resources where they think best.

  69. 69
    FlyingToaster says:

    @aimai: Howdy! (Well, I wasn’t born here.)

    All of our PCPs are MAH-affiliated, so that’s our normal first stop. The ER has improved (I remember when I was told to go to MassGeneral and my sister told to go to Brigham’s and never MAH, even though it was closer), but it’s not necessarily best for every condition — they skew old and if I’m at home I’ll take WarriorGirl to Newton-Wellesley’s ER. They’ve done a lot of work to improve the setup (the expansion helped, remarkably), but I’m nowhere near thinking they’re perfect.

  70. 70
    Cassidy says:

    @Aimai: You can overstaff all you want. Hell, you can piss and moan until you get a personal nurse knot attending to your problem. Still doesn’t solve the issue of beds. Sometimes you just gotta wait with us commoners.

  71. 71
    Cassidy says:

    Emergency rooms aren’t understaffed. They are minimally staffed. There is a difference.

  72. 72
    GHayduke (formerly lojasmo) says:

    @Violet:

    Um. as an ER nurse with six years experience, and four in triage, chest pain is priority one, and should never be left in the lobby (I have 18 years of nursing experience total)

  73. 73
    GHayduke (formerly lojasmo) says:

    @Amir Khalid:

    Probably meningitis.

  74. 74
    BobS says:

    Some people seem to be under the impression that because they’ve sought treatment in an emergency room that their affliction is an emergency. This isn’t the case. In the very busy emergency room that I work in, fewer than 10%- probably fewer than 5%- of the patients we see are emergencies in the sense of threats to life and limb. Most of the rest of the patients are more or less urgent, and the rest are there because it is now convenient for them to seek treatment for problems that have been ongoing for days, weeks, or months. Some are there because they’re drunk and the police don’t want to take the responsibility of having them in a cell- they end up taking a spot that a legitimate patient could occupy until they’re legally sober. Some are homeless folks looking for a warm place to sleep and something to eat, who present with sometimes real but frequently fictional complaints. Some are transparent drug seekers (and we don’t label every back pain patient a seeker, although you are more likely to get that label if you’re allergic to Toradol and you need your Dilaudid with Benadryl)- many of the drunks and homeless and seekers are regulars who, in some instances, I see more frequently than I do most of my friends and family. Nurses triage this mix of patients to the best of their abilities- almost always getting it right- frequently trying to squeeze the square pegs that are patients into the round holes of too few beds, a number made fewer by inpatient holds (when the hospital is full) as well as psych patients, who are frequently difficult to place in the limited number of beds our dysfunctional mental health system offers- some of them can spend days in an emergency room.

  75. 75
    Violet says:

    @GHayduke (formerly lojasmo): Yep. That’s how it should have worked. That isn’t how it worked. I don’t know exactly what she told the ER staff. Maybe she was timid in her reporting to them. Maybe they missed something. All I know is she was left waiting for hours and died from a heart attack after complaining to one of her kids before going to the ER that she had chest pains.

  76. 76
    GHayduke (formerly lojasmo) says:

    @Chickamin Slam:

    Fuck off, derp, or spatz, or whatever banned troll you are.

    ETA; or Brick Oven Boob.

  77. 77
    GHayduke (formerly lojasmo) says:

    @Roger Moore:

    in the ER faking symptoms so somebody will do something for them.

    As an ER nurse, I can only say WTF, dude?

Comments are closed.