Emergency Care: Improvement Needed

A woman with a sick six-month-old baby is turned away from a private hospital in Houston because her husband does not have $50 for a deposit. The baby dies on the way across town to an other hospital. A New York doorman suffers a heart attack while on duty; he is refused emergency treatment at a hospital across the street because it lacks cardiac emergency equipment, and he must risk death attempting to reach another hospital.

Lumped loosely in the category of emergency care, such cases claim untold lives each year. But how can such tragedies happen in an age and a nation where severed limbs are restored, kidneys are transplanted, and "dead" hearts are restarted routinely in intensive-cardiac-care wards? Among the causes of the problem are obsolete equipment, understaffed and overcrowded hospitals, administrative ineptitude, poor judgment, and the nearly nation wide absence of an organized approach to the problem. Each of the 6,000 general hospitals in the U.S. should be at least morally bound to accept and treat any emergency case, regardless of the patient's age, ability to pay or the medical affiliation of his doctor. Hundreds of hospitals, well equipped, properly staffed and organized for the task, fulfill the responsibility. Others fail to.

Dumping the Sick. At New Yorks Coney Island Hospital recently, a combination of delayed treatment and the common practice of "dumping" emergency patients on other hospitals contributed to the deaths of two men. The emergency-room diagnosis for one was gastrointestinal hemorrhage and shock. Claiming a lack of beds, the hospital ordered the patient transferred to a larger institution. Still waiting for transfer three hours later, the man died. An other patient died after waiting six hours to be dumped. Subsequently, New York State's Investigation Commission found that on one of the patients' entry cards, the word "Transfer" had been crossed out and replaced with "Admit."

Medical regulations can also stand in the way of proper emergency treatment. When former Speaker of the House Joe Martin fell into a coma in Fort Lauderdale, Fla., last month, his doctor ordered an ambulance service to take him to a distant hospital, by passing one eight blocks away because the doctor was not affiliated there. Reported dead by the ambulance driver when he arrived, Martin, 83, was then taken to a third hospital, 15 miles away, for an autopsy. There he was officially pronounced dead on arrival. His life might have been saved had he been taken to the nearest emergency room in the first place.

In Chicago, a mistaken diagnosis in an emergency room led to the death of a 15-year-old girl last November. Sent to Cook County Hospital with a physician's note that read "Poss. acute appendicitis," the girl, mistakenly diagnosed as having VD, was given a penicillin shot and instructed to seek help at a clinic. She died of gangrenous appendicitis within 24 hours.

Any & All. Needed to correct the problem are an adequate number of emergency facilities in every community, a coordinated ambulance service with medically trained attendants, and public acceptance of a well-organized system of emergency care. For years, San Francisco has combined all three. Its five emergency-prepared hospitals admit any and all emergency cases free of charge. (Tax cost to each citizen: an estimated $1.50 per year.)

Superbly equipped and run by San Francisco's health department, the hospitals have a 14-car ambulance service manned by stewards and drivers, both with training and experience equivalent to that of registered nurses. Average time from the moment they are called to the time of admission at an emergency hospital: six to 20 minutes. San Franciscans put the service to use. Last year the five emergency hospitals treated 125,000 patients--one out of every six city residents.

Recently the Federal Government has turned its attention to the problem. Proposals to lift the quality of nationwide emergency treatment to the level of San Francisco's program have been made to the Governors of 50 states. And in his health message last month, President Johnson called on such departments as Health, Education and Welfare and Transportation to help improve emergency services.

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