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Friday, August 8, 2008

The emergency room waiting game
Updated: 08/08/2008 06:13 AM
By: Britt Godshalk

TROY, N.Y. -- Of all the instruments and gadgets in the Emergency Room there's one many patients see the very minute they walk through the door.

In a recently released report, the Center for Disease Control says that while patients waited an average 38 minutes to see a doc back in 1996, ten years later, that wait was almost an hour. That number is skewed by some extremely long waits. According to the report, half the people had waiting times of 31 minutes or less.

But at Seton Health St. Mary's in Troy, the ER has had to increase staff and beds to keep up with a rising number of patients.

“There's an increase in shortage of primary care physicians,” said Doctor Robert Holterman, Seton Health St. Mary’s Attending ER Physician. “So patients are using the emergency department as their primary care facility. Emergency departments are closing.”

“There's been about a 10 percent decrease in the number of emergency rooms in New York State as hospitals are closing over the year, in the last decade. And at the same time about a 10 percent increase in the number people who go to the ER for care,” said Daniel Sisto, President of the Healthcare Association of New York State.

Recently, patients flooded the ER at Ellis Hospital in Schenectady because they feared the former St. Clare's ER was closed after Ellis took over its management. Indeed Ellis management has said the ER at St. Clare's, now called the McClellan campus, would be downgraded to an urgent care facility at some point, but McClellan's ER is open for the foreseeable future. And in recent weeks, 12 new beds have been added at Ellis' main emergency department to help bring down wait times.

But experts say the long waits and large crowds in emergency rooms are merely symptoms of an unbalanced healthcare system in the state and in the nation.

“We're seeing the symptom of this multifaceted problem at the emergency room door,” Sisto said.

Simply, the healthcare industry now finds itself in an emergency in need of a quick remedy to turn this problem around.

“When it gets to a crisis, that's normally when society finds solution,” said Sisto. “So I think it will actually be better in five or ten years, with the investment of primary preventive care and insurance for those who don't have it.”

Quoted from Kevin March

Only if St. Clare's is under different management than it was previously.  I have received no-so-top-notch service my last few times in St. Clare's (before the merger).  I previously said that I wouldn't go back there.  My most recent visit didn't do anything to change that view for me.

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Nurses can’t bear to see what’s happening at Ellis

    I have been a nurse at St. Clare’s Hospital for 21 years. Since June I have been working at Ellis Hospital in the gastroenterology unit, because of the merger. St. Clare’s gastro unit was shut down with one week’s notice.
    To say all is not good in the unit is an understatement. It’s like a meat market. It’s all about how fast we can get the patients in and out. It is dangerous.
    At St. Clare’s we were so streamlined and the patient’s care and safety came first. Ellis will not listen to our suggestions or how much better we could do it at St. Clare’s. It’s a their-way-orthe-highway attitude. It’s frightening. Someone is going to get seriously hurt or die.
    No one in Ellis management will listen to the nurses. If we do speak up, we are punished with suspensions. It’s not only in gastro; I know nurses from every unit.
    They are all looking to get out. They are going to Saratoga Hospital and all other hospitals in the area. They are so unhappy they don’t care about losing their seniority, or a pay cut. This includes myself. If you print this letter, I will probably lose my job, but I don’t care. That’s how concerned I am about this situation.
    PATRICIA A. ARKET
    Scotia

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In 1986, Congress added anti-retaliation protections to the False Claims Act. These provisions, which did not exist previously, are contained in 31 U.S.C. Sec. 3730(h):

    Any employee who is discharged, demoted, suspended, threatened, harassed, or in any other manner discriminated against in the terms and conditions of employment by his or her employer because of lawful acts done by the employee on behalf of his employer or others in furtherance of an action under this section, including investigation for, initiation of, testimony for, or assistance in an action filed or to be filed under this section, shall be entitled to all relief necessary to make the employee whole.

The protection against retaliation extends to whistleblowers whose allegations could legitimately support a False Claims Act case even if the case is never filed. The statute of limitations for Sec. 3730(h) claims is 6 years in most jurisdictions, but is currently shorter in California and a few other locations.

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Some states have explicit statutory protections for whistleblowers. These include: California, Connecticut, Delaware, Florida, Hawaii, Louisiana, Maine, Michigan, Minnesota, Montana, New Hampshire, New Jersey, New York, North Carolina, Ohio, Oregon, Rhode Island, Tennessee, and Washington.

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Hospital whistleblowers need to be listened to

    Re Aug. 7 letter, “Nurses can’t bear to see what’s happening at Ellis”: I am struck by and loudly applaud the courage of Patricia Arket, the Ellis Hospital nurse who wrote to inform us of the disturbing conditions in that hospital.
    Six years ago my husband, Mike, died three days after donating half his liver to his brother at Mount Sinai Hospital in New York City. After his death, the New York state Department of Health found that he had received “woefully inadequate post-op care” and shut the liver transplant unit down for two years. After his death I found out that the nurses on his floor had been filing “protests of assignments” for months. After his death I found out that there was one intern taking care of 30 patients and that the nurse-to-patient ratio on the floor was 1-to-7, not the 1-to-4 New York state standard, and certainly not the 1-to-1 ratio his brother (who survived) experienced in intensive care.
    In Mike’s case, my “after his death” discoveries were too late. No one listened to the Mount Sinai nurses who filed their protests. Ms. Arket has bypassed the regulatory agencies and come directly to us, the public and potential patients at Ellis Hospital. We need to listen to her and to stand behind her should she get fired for her courage, as so often happens.
    VICKIE HUREWITZ
    Schenectady

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CAPITAL REGION
Hospitals plan for future needs
Facilities in midst of massive changes
BY CARI SCRIBNER Gazette Reporter

    Albany Medical Center launched a $360 million expansion project. Ellis Hospital has folded St. Clare’s Hospital services into their facility. Saratoga Hospital just unveiled a detailed site plan for a medical campus at Northway Exit 12 in Malta. And talks are under way for an emergency room and related services in Halfmoon.
    All the major players in local health care are charting their own courses to meet future needs, even as those needs remain difficult to defi ne.
    Some of the local changes resulted from a report by the Commission on Health Care Facilities in the 21st Century, known as the Berger Commission, a group charged with reforming New York’s health care system to improve quality and affordability. The commission cited the need to eliminate excess hospital and nursing home bed capacity, remove hospital duplication of services, modernize outdated health care facilities and provide New Yorkers with greater access to primary and preventive care. The recommendations became legal mandates in New York on Jan. 1, 2007, and were given a June 30, 2008, deadline for implementation.
    That translates into a lot of changes, in a short period of time, for the area’s health care facilities.
    “The Berger Commission told us to look at market areas and find out needs for other kinds of care, such as home-based care, longterm assisted care and alternative care,” said Claudia Hutton, spokeswoman for the state Department of Health. “We’re seeing the birth of a wider regional view that will encourage more preventative and outpatient care so people don’t need to go to a hospital. Regular care can prevent hospitalization.”
    All of the local hospitals are members of The Iroquois Healthcare Alliance, which represents 55 hospitals and health systems in 31 counties of upstate New York. With offi ces in Syracuse and Clifton Park, the alliance’s mission is to support members and their patients through education, cost-saving initiatives and business solutions.
    Like the state Health Department, IHA directors are focusing on across-the-board regional health care needs and looking ahead to changing needs down the road.
    “Everything is linked together — the number of hospital beds, emergency rooms, longterm care facilities, nursing homes — and it’s hard to answer the question of what the regional needs will be in the marketplace,” said Gary Fitzgerald, president and CEO. “We probably have enough beds now; it’s a matter of what services people need.”
    Fitzgerald acknowledged there is an inherent sense of competition as providers hurry to meet changing needs in an area with a relatively small pool of large players.
    “There is a natural rivalry, because they’re paid by the number of people they reach, and if you make a mistake and open up a facility where there already exists the same service provider, that’s a big problem,” Fitzgerald said. “The average age of physicians now is in their 50s, and there is a growing shortage of doctors, nurses and technicians. Members of our group are beginning to see that working together is the best way to make things happen.”
HOSPITAL EXPANSION
    This past February, officials at Albany Medical Center announced plans for the largest hospital expansion project in the history of Northeastern New York, a $360 million complex to be built on the main campus at New Scotland and Myrtle Avenues.
    The proposed six-story complex, which will take several years to build, will include expanded adult intensive care units, and add operating and recovery rooms, upping the medical center’s licensed bed capacity from 631 to 747. The medical center also received a commitment of $25 million in state funding for a new neonatal intensive care unit at the medical center as part of the building project.
    “Our mission is to provide fullspectrum services, research and education in 24 counties, and we’ll expand in ways that make the best sense,” Greg McGarry, Albany Medical Center spokesperson, said. “We’re following Berger recommendations to increase our profi le as a regional center.”
    Saratoga Hospital also has a project to expand, but their plan calls for locating a $350 million satellite campus in Malta with independent living units, a nursing home, and medical complex and in secondary phases, an emergency care hospital.
    Saratoga Hospital officials said they chose this direction to avoid competing with Albany Medical Center’s specialty care.
    “We’re looking at needs for general care; if we pushed for high-end procedures it would dilute the pool,” Angelo Carbone, Saratoga Hospital President and CEO said. “There’s room for both communitybased care and large, high-end hospitals in city settings. We’re taking a dispersion approach, offering the care that’s best delivered in places where people live and work.”
    Saratoga Hospital has opened urgent care walk-in sites in Wilton and Malta, and Carbone said they quickly became flooded with patients, with about 115,000 patients served annually in Wilton, and a growing number in the year-old Malta site.
    “We’re looking ahead to more managed care, because as far as hospital emergent care, you can’t determine where the growth is going to occur,” Carbone said. “People need access to walk-in care for urgent needs that don’t require a trip to the ER.”
HALFMOON PROPOSAL
    Proponents of a new hospital in Halfmoon are taking a similar community-based, rural approach, but are instead planning a full, 24-hour emergency room to treat heart attacks, strokes, and women’s health care needs including delivering babies.
    “If you live in the Town of Halfmoon or Clifton Park, your closest hospital for emergency needs is a 20-minute drive,” Kevin Dailey, project developer said. “You can’t get urgent care in the walkin places; you need beds to admit people.”
    Initially proposed in 2005, the project has seen significant delays in the zoning review process, due in part to the wetlands at the 67 acres, and also the complexity of the original proposal for a variety of medical buildings on the land, town officials said.
    But the plan could jump forward if the Town Board gives final approval to the property’s zoning change from residential to commercial/medical, as already recommended by the Planning Board. Members of the public will have a chance to weigh in at a public hearing before the Town Board on Aug. 19.
    While many residents have shown support for the project, a few people have voiced concerns about traffic, noise, and changing the rural environment by adding a hospital more frequently found in cities.
    But the largest challenge for the project is finding a sponsoring hospital to oversee the proposed Halfmoon site, required long before developers file an application for a Certificate of Need.
    Dailey said he has contacted all the area’s large health care institutions to partner with the Halfmoon project, but has been unsuccessful in those efforts.
    “We’re trying to get Saratoga Hospital to come here, but it’s a cultural bias that Halfmoon is too far south in Saratoga County,” Dailey said. “They need to look at the population in the Capital District and realize that people who can afford health care are in this area; I think many hospital administrators don’t know much about southern Saratoga County.”
    But Carbone said he believes the Northway Exit 12 campus is a better health care location for Saratoga County families, and that a Halfmoon site would be “duplicating services, weakening the system and diluting the pool of potential staff members. The Halfmoon proposal is very disruptive and potentially harmful to existing providers working hard to look into the future.”
CHANGES AT ELLIS
    In June, following Berger Commission mandates, St. Clare’s Hospital merged with Ellis Hospital in Schenectady, and officials said the Ellis emergency room was immediately maxed out, lacking sufficient beds to handle the volume.
    People with minor injuries were directed to the former St. Clare’s Hospital, now called the Ellis Hospital McClellan Campus, but a new “fast track” ambulance system is now shuttling patients to Ellis for inpatient care after they’ve been stabilized.
    Even as they work to iron out the transitions between the two Schenectady locations, Ellis Hospital officials are also eyeing the Southern Saratoga County region as the next place to enter the market.
    Ellis Hospital President Jim Connolly said their plans call for a large, urgent care walk-in facility, rather than a hospital.
    “We need a presence in Halfmoon and Clifton Park, but these towns are no more than 20 minutes from [Schenectady], so the thought of building a new hospital there doesn’t make any sense,” Connolly said. “People need an urgent care facility available 24 hours a day as an alternative to a trip to the emergency room.”
    Connolly said he has had “very preliminary talks” with Clifton Park Town Supervisor Phil Barrett, and is due to meet with Halfmoon Supervisor Mindy Wormuth in the near future.
    He also said the proposed Ellis urgent care facility would not compete with the Saratoga Hospital campus in Malta.
    “Fifteen years ago, no one really thought about growth up the Northway, but Saratoga County is clearly the most attractive area today,” Connolly said. “It was a brilliant move for [Saratoga Hospital] to go to Exit 12, and as a major exit, will pick up people to the north and south. That project doesn’t compete with our plans now and in the future; we have a different service area and I don’t see a conflict.”
    Hospital officials urge Capital Region residents to become involved in the changing face of local health care options.
    “There should be a lot of community debate around how they want their health care delivered, because it’s going to be changing very quickly,” Carbone said.

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Even as they work to iron out the transitions between the two Schenectady locations, Ellis Hospital officials are also eyeing the Southern Saratoga County region as the next place to enter the market.
    Ellis Hospital President Jim Connolly said their plans call for a large, urgent care walk-in facility, rather than a hospital.

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