Japanese Woman Dies Being Refused Care After Visiting 30 Hospitals--- Could This Happen in America?

An 89-year-old woman died after an ambulance crew spent two hours trying 30 hospitals before finding one that would accept her for treatment, Japanese officials said Friday.

The woman's family called an ambulance early Tuesday morning after she became ill with vomiting and diarrhea, said Hideto Matsumoto


You might think this is not possible in the USA, but you might be wrong. Many hospitals all over the country right now are on what we call ER Diversion. ER Diversion means a hospital will divert every ambulance either because they cannot provide sufficient services or there are no open beds available. How can a hospital in this advanced 20th century not have adequate services. Easily as the on call specialist saga is reaching a critical point. Many specialists such as Neurosurgeons, Trauma surgeons, Cardiologists are in short supply secondary to simply decreased numbers or a refusal to take hospital call. Hospital call represents the bane of their existence as it interrupts family time, increases their medical liabilty in our "lawsuit for everything society," not to mention the millions of dollars in non-reimbursed care. I can tell you I work in a major city and Neuro diversion is more common than back pain and finding an oncall specialist, is like finding ancient ruins in the backyard. Transfers for specialist care can require calls to up 15 different hospitals up to 2 hours away. Incidents like the one in Japan have happened before in the US, maybe not the extreme above, but a similar event is inevitable if the on call specialists catastrophe is not addressed urgently.

Why You Wait At The Emergency Department? ED Visit Part II The registration and triage process

You have just been registered for your ED visit. This means your entire financial history, including your SS#, birthday, credit card number, maybe even your favorite cereal has been recorded into the hospital data system. Why you ask?, because your friendly neighborhood hospital, wants you to "show them the money. " They want to be paid. In era of ever escalating non-reimbursed care, an ED survival can depend on securing this info to ensure payment. It is required before anything official can get done, including blood work, xrays, ct scans. Many ED's have "quick registration" teams that will descend upon you like a special forces ops squad for your information. If you want this process to be expedited pretend you are at security at the airport. Have your documents ready.

Now you are ready to meet the gatekeeper aka the triage nurse. Be nice to the triage nurse. Wait a second, let me emphasize this BE NICE TO THE TRIAGE NURSE!!! She or he controls all entry into the Kingdom of the ER. You do not want to get on this person's wrong side. Dont try using the Trojan horse aka an EMS ambulance to enter for a frivoulous complaint. Ambulances are for true emergencies like strokes and heart attacks, not for runny nose, your run of the mill sore throat or for a convenient taxi service. Triage nurses have usually been doing this job for thousands of years, you do not want feign an illness, they can sniff it out 300 miles away. Most triage is done by nurses, but many cutting edge ED's are now utilizing physicians and allied health professionals like nurse practitioners or physician assistants to decompress overcrowding. If you have an illness requiring immediate attention, you will be taken to a room, if not you will be booted to the waiting room. See the next blog for "Waiting Room Drama."

ERINSIDER

ED Advice. What is going to happen during my ED visit? PART I

You have a complaint, something that is bothering you, it may be life- threatening like a heart attack or something benign like an ingrown toenail. I want to to give you some advice for surviving your ED visit literally and figuratively.

Expect to wait, wait, wait and wait more!!!

This is not Burger King, you will not "have it you way". You can be nice. You can curse and scream, definitely not recommended, you will wait longer. You can throw yourself on the floor, this does not always work either. Decreasing ED wait time is a priority at most ED's but there are multiple factors that prevent this from happening. Here are some of the reasons that you are going to wait:

ED overcrowding is at an all time high. The ED is the only place in medicine that you must accept all comers. Unlike private offices, where a doctor can refuse a visit because you have no insurance, the provider doesn't like you or your scheduling your 22nd appointment in 1 month for abdominal pain that your doctor has no answer for. The ED is required to see you. This prevents sick people from mistakenly being sent away(EMTALA) but it also allows many to abuse the system. So when your 40 year uncle with a beer belly, that eats bacon for breakfast, lunch and dinner shows up with his heart attack, he has to wait to be "triaged" or assessed because Tonya the vicodin pain seeking drug addict is complaining of her perpetual back pain despite a negative MRI. Thomas the homeless guy from the shelter six blocks away, wants a place sleep, but complains of chest pain and an elephant sitting on his chest। Finally Sandra the 90 year old demented lady feels like talking about her 30 year old hand pain from rheumatoid arthritis and mentions by the way she fell down the stairs 3 weeks ago and hit her head। Hence we have the triage system.

Your chief complaint is recorded, the "vital signs" blood pressure, heart rate, temperature, oxygen saturation, are taken and then you are categorized। It is done a million different ways, but basically your placed in 1 of three categories। Emergent, semi-emergent and non-emergent। At well organized departments, triage will happen right away but at others that are disorganized or just simply overwhelmed by sheer numbers, the wait to be triaged can be up to 60 minutes. Now the real wait begins. You may wait in a room, in a hallway, in a chair inside the department, or in the dreaded waiting room that can range from urine stained seats to plasma TV's and cappuchino machines. If your fortunate enough to have your faculties during your visit, my advice come prepared. Many of you prepare to go to a baseball game. You bring a jacket, a hidden sandwich if your cheap, paper towels, whatever. Bring some of your favorite stuff with you, ie food, water, harry potter, xxl, psp, nintendo DS, because as I said before, waiting is common, you will need distraction. The average wait 2-12 hours,yeah 2- 12 hours. Most ED are trying to decrease their wait time to 30 minutes. Return for my next blog ED visit part II and I will let you why "this is impossible." and more about your emergency room journey.