State gets failing grade for emergency services

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By Angye Morrison

Report cards are in for Florida’s emergency care system, and it looks like the state might need to go to bed without its supper.

The state received an F and ranked 50th in the nation for its population’s lack of access to emergency care, according to the National Report Card on the State of Emergency Medicine, issued by the American College of Emergency Physicians earlier this month. Also contributing to the low ranking was the large population of uninsured Florida residents, few psychiatric beds and a low number of physicians who will accept Medicare.

The state received a C- overall, the same grade given to the nation as a whole.

The good news is that Florida received high marks for developing systems to ensure quality and patient safety, and for significantly improving its ability to prepare for disasters.

The report card includes five categories: access to emergency care, quality and patient safety environment, medical liability environment, public health and injury prevention, and disaster preparedness. The state ranks 50th, 10th, 27th, 37th and 10th, respectively, in those categories.

“Florida has made significant progress in preparing for disasters and improving our quality of care, but our biggest challenges are making sure people have access to physicians and to emergency care,” said Dr. Ernest Page, president of the Florida College of Emergency Physicians. “Our state also has a poor record of vaccination for our large, elderly population, as well as a low Medicaid reimbursement rate.”

The state has a large number of uninsured people – 21.9 percent of all adults and 18.9 percent of children – and a severe shortage of primary care physicians. Florida also faces an emergency medicine workforce shortage.

But Page said there is good news as well.

“Florida has reporting requirements for adverse events and hospital-based infections and is working on a stroke (care system),” he said. “Our state also maintains a statewide trauma registry and provides funding for quality improvement of the EMS system and an EMS medical director.”

Dr. Nick Jouriles, president of ACEP, said the weakened economy, combined with a failing health care system, means the number of people needing emergency health care is rapidly increasing.

“The role of emergency care has never been more critical to this nation, which is why emergency patients must become a priority for health care reform. We are urging President-elect Barack Obama and the new Congrress to strengthen emergency departments, because they are a health care safety net for us all,” Jouriles said.

Although there is no doubt that communities all over the state are feeling the sting of inadequate access to emergency care, there is perhaps no other county feeling it more than Gadsden County. Gadsden Community Hospital closed in November 2005, leaving residents without access to 24-hour emergency services.

Since that time, residents have relied on Gadsden County Emergency Medical Services to transport them to hospitals in Tallahassee, a trip that can take up to 45 minutes.

In 2007, Gadsden County EMS ambulances made 7,400 trips to Tallahassee hospitals at a cost, to the county, of $2 million. That number was expected to climb to about 8,000 trips in 2008.

In an effort to alleviate this problem and reopen the hospital, a half-cent sales tax was placed on the August 2008 ballot, which was overwhelmingly passed by voters. The process has been stalled in recent months due to disputes between the county and contractors, as well as debate as to whether the hospital will open at the expected time this June.

In recent weeks, Gadsden County commissioners voted in favor of a four-bed hospital, instead of the 25-bed facility voters passed in August, with the stipulation to add more beds during the next five years, provided there are available funds to do so.

If the hospital cannot be completed by the June deadline, James McLemore, Florida Agency for Healthcare Administration health services and facilities consultant supervisor, said the state has a fast track program that the county could take advantage of and possibly have a certificate of need leading to a new license in less than a year. The county could start that process as early as February 2009 and if the June deadline is missed, a parallel process would have already begun.

The county would also continue to pursue the process of seeking an extension for the license through the Legislature during the 2009 session.

Gadsden County commissioners recently awarded the construction contract to Childers Construction Company,, the only company to bid on the project during the second round of bids. The accepted bid was for $8.45 million, and Childers officials have said they expect to meet the June deadline. Work has begun on the project.

Continuing on without emergency medical care could lead to tragedy, said Sherry VanLandingam, chair of the Gadsden Community Health Council Inc.

“Every day without access to 24-hour emergency medical care is a day our lives and the lives of our loved ones are in jeopardy. Minutes count in an emergency. A trip to Tallahassee can take as much as 45 minutes. That could be 40 minutes too long if you’re having a heart attack or stroke,” she said.

But not having a facility in the county has already led to tragedy.

Gadsden County Commissioner Brenda Holt, who represents District 4, lost her son due to a heart valve malfunction when he was 28 years old. She has spoken about riding right past the closed hospital in an ambulance headed to Tallahassee while her son was fighting for his life.

“We passed right by (the hospital). We don’t know if he could have been saved. I don’t want anyone to suffer what I went through. This building should have been open with the best medical equipment,” she said, adding that commissioners are doing everything possible to get the hospital open and running profitably.