March 16, 2001, 9:27PM http://www.chron.com/cs/CDA/printstory.hts/metropolitan/851365

Doctors say health care at crisis level, commission called for to address issue

By JO ANN ZUIGA

Copyright 2001 Houston Chronicle

Local physicians are calling for creation of a national commission including the president and Congress to try to solve what they call a nationwide crisis in emergency and general health care.

In the latest emergency room diversion here, 12 of the city's largest hospitals placed ambulances on drive-by status this week, asking to be temporarily excused from accepting emergency patients, Dr. Richard Bradley, assistant director of Houston's emergency medical services, said Friday.

Although the situation had eased Friday to only three hospitals with diversion requests, he said, the cycle will continue. "This diversion is an issue because of the lack of intensive care unit beds," Bradley said. "It's a developing crisis nationally."

Dr. Kenneth Mattox, Baylor College of Medicine vice chairman of surgery and Ben Taub Hospital's chief of staff, said, "This is not from misuse of the emergency room by the uninsured. Most of these are critical cases. Most of the community does not recognize that many times over the past year, we have been up in the middle of the night searching for a hospital with one bed available in the pediatric intensive care unit for a sick child."

The main problem, Mattox said, involves finances, since hospitals are only reimbursed 30 cents on the dollar for patients on Medicaid, Medicare and other federal and state programs.

"We have a huge shortage of medical personnel, not only nurses but technicians, clerks and other staff," he said. "This was a predictable outgrowth of managed care turning medicine into a business."

To stay within restrictions and budget, hospitals have had to cut back on care, Mattox said. "On our night shifts," he said. "we have one transportation orderly responsible for taking patients from the emergency room to the operating room to the units.

"We have one translator per shift who has to run from patient to patient, area to area. If you look at medical care as an assembly line, if the conveyor belt gets stuck at a certain point, it backs up all the others."

In letters to congressional members and President Bush last month, Mattox suggested "formation of a combined professional, congressional and presidential commission on health to address the many issues creating obstacles to access of quality health care."

So far, he said, he has received no response.

"We're now at a crisis," Mattox said. "A national health plan can help or hinder, depending on options available." Considering emergency health care a public service like the police and fire departments and garbage pickup may be a possibility, Mattox said.

"But it is incorrigible," he said, "that in the fourth largest city in the nation and the largest medical center in the world, we have to fly an injured child to Temple because no pediatric intensive care unit beds are available here."

Mattox referred to a case last month of a 5-month-old boy who suffered from blunt trauma to the head and whose mother took him to a Baytown hospital. Since no pediatric intensive care unit beds were available in the Houston-Galveston area, Austin or San Antonio, the infant was flown to Temple, where he died.

A report by the American Hospital Association also raised fears some patients may not get urgent care as fast as they need it. Emergency room visits rose 15 percent in the 1990s, reaching 99.5 million in 1999, the AHA reported.

-- Swissrose (cellier3@mindspring.com), March 17, 2001