Flooded with patients

Sandy Liden of Cape Girardeau has gone to the emergency room twice in the past three weeks -- both times for migraine headaches.

"They get bad," she said, rubbing her forehead at the memory. "Really bad, especially when I get them at night."

But Liden doesn't have health insurance and she doesn't have a regular family-practice physician. So she knows she went to the ER for problems that perhaps could have been handled by a private doctor.

She's not the only one who does that. Not by far. Studies released in June reported that America's emergency departments are increasingly flooded with patients. That is happening at Cape Girardeau's two hospitals, too, in large part because people who are uninsured are using ERs for basic care that could be handled by private doctors, area health-care workers said.

The report from the Institute of Medicine of the National Academies said 114 million people visited emergency rooms in 2003, up from 90.3 million a decade earlier. At Saint Francis Medical Center in Cape Girardeau, 35,000 people visited the ER in 2005. At Southeast Missouri Hospital, 39,000 patients went to the ER in 2005, up from 19,000 in 1991.

"It's basically doubled in 15 years," said Dr. Michael Kolda, Southeast's medical director of emergency services. "At any given time, we can be really strapped for room."

Both hospitals said the situation is causing longer waiting times and crowding at times and is contributing to increased health-care costs.

The reason for the climb is multifaceted, Kolda said. The demand for emergency services is increasing because of a growing aging population with increased medical needs.

Then there's the problem with the medically underinsured, he said.

"We see a lot of things that could be taken care of in a family doctor's office," he said.

People who don't have insurance or don't have enough insurance often use the ER as a place for basic care, Kolda said, for sicknesses such as colds, sore throats, runny noses, etc. To help handle those minor problems, Southeast launched its nurse-practitioner-run ER Express in 2000.

And some have pointed a finger at Gov. Matt Blunt's Medicaid cuts, which have pushed thousands of Missourians off the Medicaid rolls.

"Those cuts are causing more people to go to ERs," said Miki Gudermuth, executive director of the SEMO Alliance for Disability Independence. "Most of those people can't afford insurance. If they don't have Medicaid, they're going to go where it's free. ... Despite those cuts, it's going to affect taxpayers one way or another."

Hospitals are required by law to treat everyone, regardless of one's ability to pay. For those without insurance, the ER may seem like the only option, Gudermuth said.

But it's not, said Marcia Abernathy, a trauma nurse specialist and the director of emergency services at Saint Francis. While hospitals are not trying to discourage people from coming to the ER, she said, better -- and healthier -- ways of dealing with minor health-care issues can be found, she said.

Abernathy is co-chair of the Community Caring Council Primary Coalition, an organization formed to educate the public about the benefits of having a "medical home." The committee made up of health-care and social workers has been meeting for a year to gear up for an educational campaign.

On Friday, members of the coalition conducted a health information survey at the Salvation Army to see how many low-income residents have insurance and private doctors.

"When people are underinsured or uninsured, they have the tendency to utilize the most expensive form of medical care, which is an emergency department," Abernathy said. "So we're trying to identify who has a medical home and who doesn't."

Those who don't have a doctor tend to wait until they are very sick before seeking treatment. If they had a private doctor they would be more likely to have more regular basic care, such as check-ups and routine exams, she said.

"Managed care helps keep people from getting sick," she said. "Too often, they come to the emergency department in worse shape than they ever would have been."

And patients who are uninsured or under-insured are often some of the very same people who can't afford to pay their hospital bills. Saint Francis declined to provide its losses to unpaid bills, but Southeast last year lost more than $15 million in "bad debt," said Kent Johnson, director of patient financial services. That bad debt, in turn, is a consideration when hospitals are considering fee increases, he said.

"So it's also a factor in the increasing costs of health care," he said.

The United Way of Southeast Missouri facilitates the meetings of the Primary Care Coalition, said executive director Nancy Jernigan. Primary care was one of the four community needs identified in a 2001 assessment. The other needs were access to health care, dental and mental health care.

"People who go to ERs aren't developing relationships with their doctor or getting follow-up care," Jernigan said. "This isn't just about getting fewer people to go to the ER."

While a lack of insurance is a problem, several clinics in the area provide cost-effective primary health care, she said, including Cross Trails Medical Center, River City Clinic and Midtown Clinic.

These clinics accept most forms of insurance, Medicare and Medicaid as well as charging a sliding fee based on income for those who don't have any insurance.

The coalition has talked about getting grant money to hire a social worker to staff ERs to educate patients about health-care options. The coalition also is looking at media campaigns to educate the public.

Jernigan hopes that information gathered Friday at the Salvation Army as it provided free school supplies will provide key information that can help with the campaign.

Ultimately, Jernigan said, she doesn't know how effective any of it can be. The responsibility still rests with the individual and always will, she said.

"You can't change a person," she said. "They have to change themselves. We're hoping to point them in the right direction, to get the best information we can and try to communicate it. What they do with that information is up to them."

smoyers@semissourian.com

335-6611, extension 137