Emergency doctors seek help from Congress in liability fight

Washington -- Thousands of physicians from around the country recently gathered at the Capitol to rally in support of a bill that promises to ease some of the financial pressures socking emergency departments.

"The health care system is sick, and there is no greater symptom than this nation's overcrowded emergency departments," said Frederick C. Blum, MD, president of the American College of Emergency Physicians.

The problems are many, including a dramatic rise in liability premiums that has made it more difficult for emergency departments to maintain financial viability. Add to that rising health care costs, which have hurt access to primary care services, and therefore increased case loads at emergency departments, he said.

The legislation would provide some relief from the liability crisis by bringing emergency physicians and nurses under the umbrella of the Federal Tort Claims Act, which established a fund to pay litigation costs. The act originally was created to cover the cost of lawsuits against government employees but later was expanded to full-time staff physicians serving federally qualified health centers. The bill would extend that coverage to emergency department staff when caring for uninsured patients.

"Factors such as the nation's medical liability crisis have placed a great strain on ERs nationwide," said Duane M. Cady, MD, chair of the AMA Board of Trustees, which is reviewing the new legislation.

"The Senate must pass national medical liability reforms for all physicians so that they can continue to provide care for patients in need," he added. In July, the House passed a tort reform measure that would cap noneconomic damages at $250,000.

Rep. Bart Gordon (D, Tenn.), the emergency department relief bill's co-sponsor, said his measure was not meant as a substitute for comprehensive liability reform but as a rapid response to the current crisis. It's important to pass both, he said at the rally.

The American College of Emergency Physicians released a report showing that Americans made 114 million visits to emergency departments in 2003, a 26% increase from 1993. At the same time, the total number of departments decreased by 14%.

The result is that the nation's 4,000 hospital emergency departments are being overwhelmed. Even in the absence of a natural disaster or other catastrophic event, the majority of them are running at or over critical capacity, according to the report.

"If you look at what happened after Katrina, we don't have surge capacity," said Gordon Wheeler, spokesman for ACEP.

Crowded emergency departments also are beginning to impact community physicians around them, said Chris Slusher, MD, from Manchester, N.H., where he works in the urgent appointment department of the Dartmouth-Hitchcock Medical Center.

Due to a scarcity of hospital beds, wait times at the emergency department have continued to lengthen. Many who have medical emergencies but want to avoid waiting for care in the ED are now seeking it elsewhere in the community, he said.

"Traditionally, everything has been dumped on the emergency department, and now the levees are overflowing," Dr. Slusher said.

Nowhere else to go

Capacity problems are caused in part by a growing uninsured population that is straining the health care system and has hit emergency departments especially hard, Wheeler said.

About 15% of emergency patients are uninsured, said a study last year in the Annals of Emergency Medicine. Federal law bars emergency departments from turning patients away.

"Congress has told us that we have to take care of the uninsured. But they didn't say who is going to pay for that," said internist Barbara Ellzey, MD, of St. Louis, where she helps staff local emergency departments. The ACEP-backed legislation, introduced in the House by Gordon and Rep. Pete Sessions (R, Texas), would go a long way to alleviate that cost, she said.

The bill would make the federal government pay emergency physicians an extra 10% for the care they provide to Medicare patients. Although the measure has not been officially priced out, a rough estimate put the cost of that provision at $180 million, Wheeler said.

The extra money is similar to disproportionate share hospital payments, which offset uncompensated care hospitals provide to indigent and other uninsured populations.

The legislation also would require the secretary of the Dept. of Health and Human Services to create standards and incentives for hospitals to speed up the process of admitting patients from the emergency department.