Patient turn-away goes beyond the uninsured By JEFF KATZ / Aggie Staff Writer It's a Friday afternoon at the UC Davis Medical Center and the halls of the emergency room are lined with patients asking anyone in a white coat for help. Not a piece of wall space remains as gurneys take up any and all available room. Triage is packed with patients having blood drawn and the waiting room overflows past the sliding glass doors as people wait their turns. But the jam-packed ER and multiple-hour waits aren't due to a nursing shortage or outbreak of disease, according to Dr. Robert Derlet, UCDMC chief of emergency medicine. Like many hospitals throughout California, UCDMC has no room to accommodate everyone and these patients, like millions of others around the country, simply have nowhere else to go. Recently UCDMC began more strictly enforcing their 15-year-old screening process to try and eliminate the admittance of non-urgent patients from the ER. Critics initially accused the hospital of targeting the uninsured, but UCDMC officials now say the move is representative of a much larger problem the goes beyond patient dumping. "Any patient that comes to our emergency department gets that initial determination whether they have an emergency or not," Derlet said, "and that is made without any consideration of financial information." Not enough community clinics are available to accommodate the nearly 200,000 uninsured patients of Sacramento County, as capacity is often already reached at most clinics for non-urgent cases. With 42 beds at the ER, Derlet said occupancy rates usually surpass 80 patients as dozens more wait outside to be seen. Of the total amount of patients that come into the ER each day, he estimated 20 percent don't have actual emergencies, but instead have no primary doctor or source for care. UCDMC refers outpatients whose ailments are not deemed emergencies to Sacramento County clinics as well as a small number of other locations aimed at serving the uninsured and at-risk community. But Derlet says those options will only be sufficient for so long. "The county can only take care of a small percentage of the patients because they have capacity problems as well," Derlet said. "This whole situation was an inevitable change and it does need the support of the county, state and federal governments because we need them to step up to the plate and provide appropriate facilities for primary care for the uninsured." Anthony Wright, executive director of Health Access California -- a nonprofit organization working for affordable quality healthcare for all residents -- says although his group is not in favor of turning away patients at the ER, they understand the department's dilemma. "We certainly agree that there is a need for triage and a need to prioritize the folks that come into the ER so that the most urgent ones are taken care of and those with less urgent needs are waiting," Wright said. "But this is all due to the larger issue of the massive amounts of uninsured that need medical attention." Past attempts to alleviate the health care problem in California have been sparse with most proposals unsuccessful in the state Legislature. Gov. Arnold Schwarzenegger proposed a Medi-Cal reform in his 2005-2006 budget, but mentions no changes in criteria to allow an increase in resident coverage. State Senator Sheila Kuehl (D-Santa Monica) will introduce a bill later this month to create a universal health care system for all California residents. Early analysis of the proposal from Kuehl's office shows the plan would provide all Californians with a primary doctor, alleviating some of the stress placed on ERs. However, various statewide committees must consider the bill before determining its potential impact. Derlet says a change in the structure and function of the state health system is a good start, but ultimately health care reform is needed on the national level. Over-crowdedness like that at UCDMC is appearing more frequently in major cities across the country with limited local options for relief. "I worry about the future of health care over the next 10 years as more people are going to become uninsured, and more hospitals are going to exceed capacity," Derlet said. "We are the richest country in the world, and people expect to have healthcare. But those expectations are quickly fading. Healthcare is very expensive, and it is a very complex problem, but something has to be done." Attempts to contact the Sacramento County Department of Health and its facilities went unanswered. JEFF KATZ can be reached at city@californiaaggie.com. |