Another angle on Esmin Green’s death in the E.R. Waiting room
The surveillance video of Green collapsing and lying untended, as hospital staff at Kings County fail to respond to her collapse, is inexcusable by any stretch. And so Nancy Grace, for one, focused on the negligence. But what's largely missing from this story is the likely cause of Green's pulmonary embolism. The answer lies in a far more systematic and widespread danger in hospital care: E.R. waits. Why was Green sitting and waiting while blood pooled in her legs? Despite increasing evidence that crowded E.R.s can be hazardous to your health, hospitals have incentives to keep their E.R. patients waiting. As a result, there has been an explosion in E.R. wait times over the past few years, even for those who are the sickest.
In effect, then, E.R. boarding allows hospitals to insulate themselves from the burgeoning needs of the poor. E.R.s are safety nets: By law, we who work in them see any and all patients, regardless of their ability to pay. But as more E.R. beds are devoted to boarders, the E.R. has less space for new patients, which keeps a lid on the number of un- and underinsured. So unless you are having a heart attack and can jump the line, your emergency—though it may still be serious—may wait for so long that you give up and go home. Bad for you, good for the hospital's bottom line. E.R. boarding also tamps down nursing costs, again not to your benefit. Hospitals generally maintain strict patient-to-nurse ratios for inpatients. But many hospitals don't apply the same rules to the E.R. because they can't control the number of patients who come in that way. Sometimes the nursing ratio in the E.R. can be as high as 8-to-1. That's unacceptable in inpatient units, but just stack 'em in the E.R. hallways and suddenly it's OK.
Once again, people are dying to protect profits. What's it going to take to fix the situation? I've always said that any one of our flawed governmental systems would be fixed virtually overnight if it killed one of the Bush twins, as opposed to another "expendable" poor minority. Here's some evidence that I'm right:
In England, the National Health System now has a rule that 98 percent of patients have to spend less than four hours in the E.R.. Apparently, the son of a member of parliament spent too long in an E.R., we've heard. Esmin Green wasn't well-connected. But her death should serve as a similar prompt to fix the problem of endless waiting. (Emphasis added.)
Maybe I'm wrong and we'll fix the healthcare system before it kills the son or daughter of a prominent politician. I hope so.