Emergency Care

WASHINGTON -- As enrollment in health maintenance organizations soars, hospitals across the country report that HMOs are increasingly denying claims for care provided in hospital emergency rooms.Such denials create obstacles to emergency care for HMO patients or can leave them responsible for thousands of dollars in medical bills.The denials also frustrate emergency room doctors, who say the HMO practices discourage patients from seeking urgently needed care.For their part, HMOs -- in which 51 million people are now enrolled -- say their costs would run out of control if they allowed unlimited access to emergency rooms.

As a certified athletic trainer at Archbishop Spalding, T.J. Morgan considers himself fortunate. He has never had to deal with a catastrophic situation in 14 years of administering to Cavaliers student-athletes. Such situations are rare, but should he face one, Morgan, like dozens of other trainers working in high schools all over the Baltimore area, is prepared. "The educational competencies for athletic trainers are changing and there's a greater concept of emergency management, of recognizing emergency situations and being able to act accordingly," said Morgan, who is also the president of the Maryland Athletic Trainers Association.

ORLANDO, Fla. -- The nation's emergency medical system is in crisis, with crowded ERs turning away ambulances, patients waiting hours to be treated and a shortage of on-call specialists. A three-volume report published yesterday found that the system is barely able to meet daily demands, let alone the potential onslaught of patients from a disease outbreak or terrorist attack. The Institute of Medicine, which spent two years investigating the problems, found gaping holes in the "safety net" for the critically ill and injured.

In response to the coverage of a new health care facility in Columbia ("Patient First to open Columbia medical center," Aug. 5), it should be noted that urgent care centers are not equal alternatives to emergency rooms. They are options for common medical problems when a physician's office is closed or unable to provide an appointment. The fact is, the vast majority people seeking emergency care need to be there. Only 8 percent of patients are non-urgent, according to the Centers for Disease Control and Prevention, and non-urgent "doesn't mean unnecessary" by the government's definition.

Maryland ranked 10th and earned a B-minus in a state-by-state assessment of emergency medical care released today. A panel of experts appointed by the American College of Emergency Physicians evaluated emergency medical care available in each state and the District of Columbia based on 50 criteria, such as access to hospital emergency rooms and seat-belt laws. California ranked first, earning a high B. Arkansas finished last, receiving a D. The national average was a C-minus. States were given an overall grade and a ranking based on each of four categories: emergency care, quality and patient safety, public health and injury prevention, and the medical-liability environment.

Dr. Janet Neslen has a ready response to those who don't believe there's a health care crisis in the country.The county health officer might mention that 500,000 Marylanders don't have health insurance or that some elderly people have to choose between paying for medicine or buying food.But Dr. Neslen says one of the most striking examples of the inadequacy of the country's health care system is the health department's shrinking emergency-care fund.The fund was set up three years ago to provide medical care to uninsured Carroll residents in cases of pain or acute infection.

As a certified athletic trainer at Archbishop Spalding, T.J. Morgan considers himself fortunate. He has never had to deal with a catastrophic situation in 14 years of administering to Cavaliers student-athletes. Such situations are rare, but should he face one, Morgan, like dozens of other trainers working in high schools all over the Baltimore area, is prepared. "The educational competencies for athletic trainers are changing and there's a greater concept of emergency management, of recognizing emergency situations and being able to act accordingly," said Morgan, who is also the president of the Maryland Athletic Trainers Association.

In response to the coverage of a new health care facility in Columbia ("Patient First to open Columbia medical center," Aug. 5), it should be noted that urgent care centers are not equal alternatives to emergency rooms. They are options for common medical problems when a physician's office is closed or unable to provide an appointment. The fact is, the vast majority people seeking emergency care need to be there. Only 8 percent of patients are non-urgent, according to the Centers for Disease Control and Prevention, and non-urgent "doesn't mean unnecessary" by the government's definition.

You're awakened in the middle of the night by severe chest pains. You notice a lump in your right breast during your morning shower. You've had a fever and a persistent cough for the last three days.If faced with one of these or other health problems, what would you do? Should you go immediately to the emergency room? Or should you just wait and see?How you perceive symptoms strongly influences whether you'll seek emergency care for problems that aren't serious -- or whether you'll delay seeking treatment for conditions that could threaten your life.

SAN DIEGO -- House Speaker Newt Gingrich has proposed a multibillion-dollar plan in which the federal government would fully reimburse states for providing emergency medical care to illegal immigrants.The Georgia Republican said Friday the proposal could cost the federal government up to $6 billion nationwide over seven years."It is the federal government's responsibility to stop illegal aliens from coming into this country," Mr. Gingrich said, "and their failure to do so should not impose additional burdens on the states."

The Anne Arundel County Fire Department on Tuesday unveiled a 26-patient, bus-style ambulance, a vehicle for treating and transporting people in a variety of emergencies, including mass casualties, heat-related problems at large public events and evacuations of nursing homes. Depending on needs, the ambulance can hold 14 patients on stretchers or eight in wheelchairs, or 26 in its seats. Division Chief Michael E. Cox Jr. said its features include the ability to supply individually metered oxygen to 23 patients at once, as well as state-of-the-art radio capability.

Dr. Charles N. "Chaz" Schoenfeld, retired vice chairman of emergency medicine at Johns Hopkins Bayview Medical Center who was an acknowledged expert in the field of emergency medicine, died Friday of complications from cancer at his Middle River home. He was 60. Charles Nicholas Schoenfeld, the son of a career naval officer and a homemaker, was born in Boston and raised at various military posts where his father served. After graduating from Annapolis High School in 1968, he earned a bachelor's degree from the University of Maryland, College Park in 1972.

The University of Maryland Medical Center and its R Adams Cowley Shock Trauma Center today kicked off a fundraising campaign for a $160 million, nine-floor building — with former Baltimore Oriole Cal Ripken Jr. as honorary chairman. The trauma/critical care building, scheduled to open in 2013 at the northeast corner of Penn and Lombard streets, is one of the largest construction projects to get under way in Baltimore this year. The building will be the first major expansion of Shock Trauma since it opened in 1989 and will result in the creation of 300 construction jobs and hundreds more permanent jobs.

Area hospitals and hospice centers began preparing days ago for the task of getting employees into work despite a large snowstorm - and put those plans into effect Saturday. Hospitals, including Johns Hopkins and University of Maryland Medical Center, put up doctors, nurses and other essential staff in hotels or on air mattresses and cots at their own facilities. They sent out four-wheel-drive vehicles for employees who couldn't get out on their own. "Our grounds crews were cleaning the roadways around the clock," said Jean Bunker, spokeswoman for Harbor Hospital.

Maryland's world-renowned emergency medical system took a hit when a state police helicopter crashed in Prince George's County last fall, killing four people on board. Subsequent calls for change in the way Maryland operates its emergency medical system prompted an intense review of policies on transporting patients to trauma centers around the state and that has led to some needed reforms, with more to come. But the emergency medical system's service to all Marylanders should be preserved as a publicly funded and operated network for accident victims.

The U.S. is facing a shortage of physicians in the next dozen years, but the problem is even more acute in Maryland, where the situation could become severe by 2015, particularly in primary care, emergency medicine and at least a half-dozen specialties. A report released this week by the Maryland Hospital Association warns the situation will be particularly bad in the rural areas, where whole counties may be critically understaffed. Action needs to be taken soon to avert a crisis. In Caroline County, for instance, it's difficult to find a pediatric specialist or to even get an appointment with a urologist or psychiatrist 20 miles or more away in Easton.

Nearly half of the 500,000 annual deaths from heart attack could be prevented if victims received medical help within two hours of the onset of symptoms, according to a study published in the Journal of the American Medical Association.That is why the American Red Cross has published a booklet that teaches people how to respond to an emergency. "We are losing lives because people are not responding fast enough to emergencies [and] they're not providing the appropriate care while the ambulance or the Emergency Medical Services unit is on the way," says Jim Cassell, spokesman at the American Red Cross' national headquarters.

Dr. Charles N. "Chaz" Schoenfeld, retired vice chairman of emergency medicine at Johns Hopkins Bayview Medical Center who was an acknowledged expert in the field of emergency medicine, died Friday of complications from cancer at his Middle River home. He was 60. Charles Nicholas Schoenfeld, the son of a career naval officer and a homemaker, was born in Boston and raised at various military posts where his father served. After graduating from Annapolis High School in 1968, he earned a bachelor's degree from the University of Maryland, College Park in 1972.

A Baltimore fire commander has been suspended for 30 days for failing to document medical certificates for at least 22 members, including a deputy chief, three top commanders and a top union leader. In another lapse at the fire academy, 397 firefighters and paramedics - out of 1,700 - do not have licenses to drive fire trucks and other large vehicles, which union officials say forces certified drivers to shuffle from firehouse to firehouse to ensure there is adequate coverage. These new developments have heightened tensions and insecurities in a department under criticism since a February training exercise that violated safety standards, killed a recruit and led to the ouster of the training academy chief and the suspension of two other members.