Hospital Surge Capacity Myth Busters

The Washington Post’s Spencer Hsu presented a two part series (parts one and two) about the House Oversight and Government Reform Committee’s hearings on Emergency Department Surge Capacity and Medicaid funding cuts. I posted about the stark picture behind the experts’ testimony a couple of days ago. Today, I’d like to elaborate a little on that and call out the fact-free BushCo loyalist testimony of Michael Leavitt, the Sec DHHS and Michael Chertoff, Sec DHS. I’ll leave you with the facts and the trends, and you can decide for yourselves what needs to be done.

Hsu reported:

Two Bush administration Cabinet members yesterday acknowledged gaps in the capability of U.S. hospitals to deal with a mass-casualty terrorist attack or other disaster, but they said a congressional effort to block pending Medicaid cuts will not fix the problem.

Testifying before the House Committee on Oversight and Government Reform, Homeland Security Secretary Michael Chertoff and Health and Human Services Secretary Michael Leavitt said lawmakers could target funds at the shortcomings more directly, such as by financing the stockpiling of hospital beds, ventilator units or medicines, if needed.

I commented:

Hsu is to be commended for the two part reporting on these hearings. Well done!

It’s important to understand a few things:

One is that the hearings were designed to specifically address a mass casualty event related to terrorism so that Chertoff from DHS would be compelled to testify about the abdication of that agency relative to assurances of providing services and timely support to healthcare. But realistically, a mass casualty event can result from a variety of problems: weather (hurricanes, tornadoes, flooding, earthquakes), communicable disease (bird flu, tuberculosis, measles, smallpox, anthrax, influenza), bioterrorism, chemical spills, toxic substances leaks, explosions, fires and all manner of other large scale accidents, disasters and hostile events.

What hospitals are screaming all across the country is that they are already at or very near full capacity on a daily routine basis. There aren’t more resources in the pipeline to be able to flex up, regardless of the need. There aren’t “extra” beds, ventilators, medications in the pharmacy, sterile supplies, nurses, physicians, support staff, etc. - all the things and people needed to care for more patients.

And in an emergency situation, realistically, those staff “at home and off duty” may not be able to get to the hospital (remember New Orleans), or they may choose not to return to work for their own and their family’s safety, as in the case of a pandemic bird flu.

To cut a major source of reimbursement is an insult to an already gasping non-system system.

Patients already clog the emergency departments across the country. Admitted patients wait hours and days on end for beds to become available - especially if they have diagnoses of multiple chronic medical problems, where reimbursement rates tend to be the lowest.

What comes through loud and clear is the BushCo loyalism of Chertoff: “not my responsibility - it’s Mike’s over at DHHS”. And the other Michael - Leavitt - spins his testimony through the sewage pipe of Republican framing: “Medicaid creates a burden on the taxpayers, and it’s only for Medicaid services. Never mind that the US doesn’t have extant bed or emergency department capacity. Never mind that graduate medical education is going to be cut off at the groin, and never you mind that there is a baseline shortage of clinically expert trauma, emergency and critical care nurses and infrastructure to care for existing need and demand. Trust me - it will be just fine in a mass casualty. I’m confident. I don’t have any facts, but I’m sure things will work out OK.”

Oh, look - here’s what Committee Chairman Henry Waxman had to say:

On Monday, we heard from leading experts that the emergency rooms in our nation’s premiere trauma centers have little or no surge capacity.

We learned from them that many Level I trauma centers do not have the capacity to respond to a terrorist bombing like the one that happened in Madrid in 2004.

And we learned that the Administration’s new Medicaid regulations are expected to make these problems worse by cutting off crucial funding.

The hearing left us with a number of important questions, which we hope to answer this morning.

Why would the Department of Health and Human Services, knowing that the nation’s emergency care system is already stretched to the breaking point, withdraw billions of federal dollars from the hospitals that provide the most comprehensive emergency care to the most seriously injured?

Why would the Department of Health and Human Services take this drastic step without first considering the impacts of its actions on emergency preparedness or consulting with the agency with lead responsibility for homeland security?

Why would the Department of Homeland Security, which is the federal agency with lead responsibility for protecting the nation against terrorist attacks, stand by while local emergency surge capacity is compromised?
The impact of the Medicaid regulations on our health care safety net is not a partisan issue. Last month, Republicans in the House joined with Democrats in passing bipartisan legislation that would postpone the regulations and give Secretary Leavitt and Secretary Chertoff an opportunity to reevaluate their implications for homeland security.

The issue we are considering today is one that concerns all Americans: how to ensure we have a robust response capacity in our emergency rooms.

If the unthinkable happens — and we’ve learned that the unthinkable can happen — lives will be lost unless emergency care is immediately available. If a major city experiences a terrorist bombing like the one that occurred in Madrid, there will be a “golden hour” that determines whether the most severely injured survive or die. The federal government’s job is to do everything possible to ensure that emergency care resources are ready during that golden hour.

Certainly, our government should not be taking actions that undermine the prospect of an effective emergency response.

Conway-Welch’s testimony is all about the effects of Medicaid cutbacks on just those things that Leavitt and Chertoff deny with wishful thinking and willful ignorance. One could make a case that they are criminally negligent and are committing fraud against the American citizenry. No wonder they testified on a separate day without any of the experts in the room. They’re naked - of facts, accuracy and good faith, and their Republican henchmen on the Committee are the only ones who will cover for them.]

The Medicaid legislation in question is H.R. 5613, the Dingell-Murphy legislation, to stop the Medicaid cuts and protect the ability of safety-net hospitals with trauma centers to maintain this critical public health function, overwhelmingly passed in the house and sent to the Senate for completion. The Congress should also enact and fully fund the National Trauma Center Stabilization Act, H.R. 5942.

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