More than 3,500 emergency physicians and nurses took their overworked, underfunded, and overcrowded woes to Congress in person on Sept. 27 at an outdoor rally at the U.S. Capitol. The west lawn of the Washington, D.C., building was dotted with white coats as physicians in their working garb waved placards stating, “No One Should Wait for Emergency Care” and “Vote to Save Emergency Care.”
The physicians and nurses were there primarily to urge Congress to pass H.R. 3875, the Access to Emergency Medical Services Act of 2005, recently introduced by Rep. Bart Gordon (D-TN) and Rep. Pete Sessions (R-TX). The bill aims to ensure Americans access to high-quality emergency care as ED visits dramatically rise and the number of EDs just as spectacularly declines. The rally was organized by the American College of Emergency Physicians and held in conjunction with its annual Scientific Assembly.
According to a new report ACEP released after the rally, ED visits in the United States increased by 26 percent over the past 10 years, while the number of EDs declined by 14 percent, causing most of the nation's 4,000 hospital EDs to operate at or over critical capacity. If passed, H.R. 3875 will provide hospitals with incentives to end boarding admitted patients and extend liability protection to on-call specialists and emergency physicians who provide EMTALA-mandated care.
The physicians and nurses aimed to put a human face on the plight of those who care for sick patients under duress. “Each of you stands between millions of Americans and no health care at all,” said ACEP President Frederick C. Blum, MD, an associate professor of emergency medicine and pediatrics at West Virginia University School of Medicine. “Ladies and gentlemen, the safety net is frayed and broken. When our emergency departments fail, they fail for everybody.”
Speaking from a podium, Dr. Blum cited the heroism of emergency physicians and nurses in caring for victims of Hurricane Katrina, as did other speakers at the rally. “They had no light, no water, and no linens. I was so proud,” he said.
Operating Over Capacity
“Katrina has just exposed what we've been saying all along,” said Peter DeBlieux, MD, the director of faculty and resident development at Louisiana State University Health Sciences Center in New Orleans. “We're already operating over capacity.”
“Each of you stands between millions of Americans and no health care at all.” - ACEP President Frederick Blum, MD
“You should be immensely proud of the job that you do.” - Dr. Peter DeBlieux
“The solution to these problems necessitates that emergency care be supported by our legislators.” - Patricia Kunz Howard, RN
Dr. DeBlieux, who applauded Representatives Gordon and Sessions for introducing the bill, told the thousands gathered at the rally that he was proud to work with first responders, physicians, and nurses in the wake of Hurricane Katrina. “Tragedies and disaster define character in individuals. You are the first line of defense, and you are the last line of defense for health care,” he said. “You show high character. You should be immensely proud of the job that you do.” He urged those present to be proud of their specialty and its commitment to providing health care under all conditions, even the most adverse.
The overcrowding plaguing the nation's EDs is a symptom of the “overburdened health care system in the United States,” said Patricia Kunz Howard, RN, PhD, CEN, the president of the Emergency Nurses Association. Overcrowded EDs “make our job harder, and make it harder for doctors, but most importantly, it affects our patients,” she said. “We all do the best we can, but is that fair to our patients? The solution to these problems necessitates that emergency care be supported by our legislators. We're doing the best we can, but we could do better.”
Rep. Gordon thanked the crowd “for what you do every day. You really are public servants.” He told the story of his healthy 4-year-old daughter, Peyton, who he said is alive today because of the emergency care she received when she was a little over a year old. Three years ago, Peyton had a convulsion. “It was the worst thing that has ever happened to me in my life,” said Rep. Gordon, struggling to maintain his composure. He described going to an ED, where Peyton was successfully treated. “What if there had been a sign on the door saying [the ED was] closed?” he asked. “What would have happened to Peyton? What would have happened to all the Peytons?”
The congressman urged the physicians and nurses at the rally to work tirelessly to help pass H.R. 3875, including contacting members of Congress from their home districts. “We need more co-sponsors,” he said. “It's easy to introduce legislation; it's hard to get it passed.” This is especially true when Congress is preoccupied with the damage from hurricanes Katrina and Rita and the Iraq war. Rep. Gordon said he wanted to convey a tip to those at the rally: Don't take no for an answer on H.R. 3875, especially if or when members of Congress asked to support it dodge the issue by saying they already support medical malpractice relief legislation. “Don't let them off the hook,” Rep. Gordon said.
Actress Maura Tierney, who received an Emmy Award nomination for her role in the NBC drama ER, also had a dramatic personal story to tell. She said her then-15-year-old brother was hit by a car 10 years ago. He was rushed to the ED at Boston City Hospital. “Today he's alive and well and 100 percent recovered from his injuries,” Ms. Tierney said. But, she asked, what if the hospital ED had been full when her brother arrived? What if he had been diverted to another hospital? What if there had been no neurosurgeon on call? Would her brother be alive and well today?
‘The Calling of Our Lives’
ACEP Board Member Angela F. Gardner, MD, an emergency physician at the Medical Center of Plano in Texas, noted that being prepared is not always possible. “You don't wake up knowing you're going to have a heart attack, stroke, or car accident, and call your [primary care physician], and make an appointment.”
She noted that 11 EDs in Atlanta were on diversion during a recent week, all at the same time. “We were not ready for Katrina. We are not ready for the health care delivery disaster that looms on our horizon,” she warned. “The levee we know for emergency care is broken; it will not stand a hard tide or a flu epidemic, much less a hurricane.
“We stand here today, every white coat a sandbag on the levee. We will not be deterred by partisanship. We will not be deterred by greed. It is the calling of our lives; it could be the saving of yours.”
Citing the myth of Pandora's box, Dr. Gardner said although the box was full of humanity's woes, hope was also in the box. She urged those at the rally to have faith that improvements could be made so the specialty can continue to give patients the best care.
ACEP partnered with the Ladies' Home Journal for the Capitol Hill rally. The October 2005 issue of the magazine contains an investigative report on problems in EDs called “Danger at the ER,” by Linda Marsa.
Diane J. Salvatore, the editor-in-chief of the Journal, said the article will bring the plight of the ED to 14 million readers, alerting them that the number of EDs in the country is shrinking and that “the shortage may be coming to a neighborhood near you.” She added that a good neighborhood ED is vital because no matter how hard people plan, they can't plan for a child who is hit by a car, a husband who suddenly clutches his chest in pain, or an elderly mother who falls to the ground.
To find out more about H.R. 3875, the Access to Emergency Medical Services Act, visit www.acep.org.