Executives
at the University of Chicago Medical Center had hoped their initiative
to divert some patients from its emergency room would spark a healthy
national debate.
Now they've got one.
The nation's largest group of emergency physicians on Thursday
condemned U. of C.'s plans, saying it comes "dangerously close" to
violating federal law and calling for a congressional investigation. U.
of C.'s initiative is aimed at clearing its ER of patients with
non-urgent injuries and illnesses by redirecting them to community
hospitals and clinics.
The American College of Emergency Physicians cited the Tribune's
coverage last week of the hospital's Urban Health Initiative and of
12-year-old Dontae Adams, who was attacked by a pit bull and sent to
another hospital for surgery.
The U. of C. maintains its Urban Health Initiative is about getting
patients the right treatment at the appropriate location amid a tough
economic climate and that the plan does not violate the law.
But in an unusual attack, the emergency physicians organization said
the hospital is failing in its obligation to treat emergency patients.
The group, which represents 26,000 doctors nationwide, also expressed
"grave" concerns that U. of C.'s policy is "dangerously close to
patient dumping," a practice made illegal by the Emergency Medical
Treatment and Active Labor Act. The group also is concerned other
medical centers across the country could adopt similar strategies to
cope with long waits for emergency treatment and rising health costs
amid the deepening recession, which is what U. of C. said were the
primary drivers of its initiative.
"The medical center is reducing emergency care access to its local
community," said Dr. Nick Jouriles, president of the American College
of Emergency Physicians. "If other community, non-profit hospitals
follow this example and shift the lion's share of resources to its
high-revenue elective patients and procedures, it will leave many
emergency patients virtually out in the cold."
The emergency physicians group also raised the broader issue of whether
the U. of C. hospital has an obligation to treat all who seek care
there because it is a non-profit organization and enjoys tax-exempt
status. The medical center said that as a specialized teaching
facility, its costs are much higher than other hospitals', and that it
makes more sense to refer patients elsewhere when possible.
The academic medical center in the Hyde Park neighborhood has said 40
percent of the 80,000 patients who go to its emergency room each year
do not need to be there. These visits cost the hospital tens of
millions of dollars a year in time spent by staff and specialists whose
attention is redirected to cuts, bruises and other less critical
conditions that can be treated at community hospitals or health centers.
"Like nearly every hospital in the country, [University of Chicago]
faces challenges relating to appropriate use of our limited emergency
department resources and are seeking creative solutions," the medical
center said in a statement responding to the criticism.The U. of C.
also said the group's disapproval related to Adams' case is "unfounded."
"We regret [the group's] distortion of this case and its
mischaracterization of our efforts to responsibly address a nationwide
crisis in health care," U. of C. said.
The hospital's effort to manage patient care began with a group of
executives that included First Lady Michelle Obama, who was involved in
early efforts to educate patients on the best use of the emergency
room. The Urban Health Initiative is now run by one of President Barack Obama's closest friends, Dr. Eric Whitaker.
Under the escalated program, U. of C.'s emergency department will be
reorganized to provide more evaluations from doctors and nurses before
care is provided. In the past, U. of C. treated the patients and then
educated them about health clinics, setting appointments at doctors'
offices and community centers for follow-up care.
Other hospitals that treat large numbers of poor and uninsured say the
Obama administration should include emergency care in his health-care
reform plan, which is expected to be discussed next week in his first
address to a joint session of Congress.
"It raises a much bigger issue of how do hospitals survive in this
economic environment," said Dr. Leslie Zun, chairman of the Department
of Emergency Medicine at Mt. Sinai Hospital on Chicago's West Side.
"The Obama administration put it on their agenda to address health
care, but that's a macro issue."
Mt. Sinai executives say they treat everyone who comes for an emergency
unless a patient needs specialized care that the hospital is not
equipped to handle, such as severe burns or amputations.
The Emergency Medical Treatment and Active Labor Act requires hospitals
to provide emergency care to people regardless of insurance or Immigration
status. It's legal to transfer patients from one emergency room to a
clinic, another hospital or a government-run system like Cook County's
without treating them.
Zun pointed out that the act allows for varying degrees of medical judgment on who is admitted and who is cared for elsewhere.
"You could either do the bare minimum, which would include a medical
screening … or everything. And we have decided to do everything, which
includes lab tests and X-rays," Zun said.
Defending the medical center's treatment of Dontae Adams in a letter
published in the Tribune this week, Dr. David Song wrote that Adams'
family took him to the medical center's ER six hours after the dog
attacked him.
"The medical team concluded that closing the wound might result in a
significant risk of infection and possibly even leave this young boy
with a more severe deformity," wrote Song, director of the resident
training program at U. of C.'s Pritzker School of Medicine.
Song said the team cleaned and dressed the boy's wound before sending him home.
But Dontae's mother, Angela Adams, said neither statement is true.
"They doped my boy up and told us to move on," she said.
Adams, a medical assistant, said she went first to another hospital but
decided she couldn't wait for care there. So, she said, she dressed the
wound herself and took Dontae to the U. of C. medical center because
she believed the wound was serious, and she wanted to get the best care
possible. She estimates she waited at least three hours at U. of C.
before any medical personnel from the ER saw Dontae.
"I did not wait six hours before taking my son to the hospital," she
said. "We waited hours before anyone at the university would even see
us."
Tribune reporter Jason Grotto contributed to this report.
bjapsen@tribune.com
