Living-Today: Issues of modern living

ER

One-third of American hospitals regularly divert ambulances to other facilities because of overstressed emergency rooms. That's according to a survey conducted for the American Hospital Association and released Monday.

About 90 percent of both trauma centers and hospitals with more than 300 beds said they have had times when their ERs were operating either at or over capacity, said AHA Executive Vice President Rick Pollack.

"Emergency departments are the ultimate safety net for many Americans, but forces are dealing blows to the foundation of this essential public service," Pollack told a news conference at the AHA's annual meeting. "The findings reveal major cracks in that foundation, cracks that can be seen in nearly every community."

Even though the survey shows rural hospitals reporting lower occurrences of diverting ambulances, that simply means the smaller facilities do not have that option available, Pollack said.

About 1,500 hospitals responded to the survey, which asked for emergency room data for the month of November 2001. The results show a 5 percent increase in the volume of ER visits from the previous year, said Carmela Coyle, AHA's senior vice president of policy. She added projections show the trend of more visits will continue in the next few years.

Urban and teaching hospitals experienced the worst diversion problems, Coyle said, with almost half of both categories reporting their emergency departments operating beyond capacity.

The issue of overcrowded ERs means more than longer ambulance rides. "Those emergency departments that are more stressed result in longer waiting times in terms of treatment," Coyle explained. "Those departments that are at or over capacity have longer waits before a patient can be moved outside the ER into another setting in the hospital."

Diversion occurs when a hospital determines its ER resources are entirely devoted to the cases it already has on hand, said Nancy Bonalumi, a registered nurse and emergency services director at PinnacleHealth in Harrisburg, Pa. "It used to be just during flu season that we'd feel the crunch," she told the gathering. "What I see now is that we divert every month, probably every week, because we're so overcrowded."

Pollack said government efforts can address some of these problems -- for example, Congress should send President Bush a bill that would devote more funds to nursing education. Lawmakers also should pass legislation to standardize wages, he said, which would help rural hospitals retain qualified people.

Several of the speakers also suggested health insurance is an important factor in the issue because it would help keep simple problems from growing into ER visits.

(Thanks to Scott R. Burnell, UPI Science News)

DOCTORS PROTEST

Hundreds of doctors closed their offices across South Texas Monday in an organized demonstration against skyrocketing malpractice insurance premiums spurred by a rising number of lawsuits in the region.

"This is making health care much more expensive and much harder to get," Dr. Antonio Cavazos said. "Some doctors are retiring early, and others are limiting their services. The public doesn't realize this."

The doctors called their action not a strike, but a "day of awareness." Most simply declined to schedule patients during the rallies. Physicians said no patients were denied care because of their unprecedented action. Emergency rooms were open at all the hospitals in the area and doctors said they would handle any urgent needs that arose during the day.

Figures released by the Bexar County Medical Society in San Antonio indicate nearly two-thirds of all Texas doctors have been sued for malpractice in the past 13 years; however, 84 out of every 100 lawsuits were dismissed as frivolous before they could be tried.

One doctor said her malpractice insurance bill has risen from $8,000 a year ago to $39,000 a year. Others said they are declining to treat new patients or dropping some areas of specialty care due to the malpractice crisis.

The idea for a one-day doctors' strike started in the Rio Grande Valley, where hundreds of doctors rallied on the steps of the Hidalgo County Courthouse in Edinburg. The valley is one of the poorest regions of the country, and has long been seen by plaintiffs' attorneys as a petitioner's heaven due to the anti-establishment attitude.

"All of this administrative mess and litigation time cuts down on the doctor's availability and does nothing to help patient care," said Dr. Don Gordon, an emergency room physician in San Antonio.

Many of the doctors warned if tort reforms were not imposed, the result would be skyrocketing bills for patients, higher insurance rates and fewer doctors available, especially in rural areas.

In Austin, Jerry Johns -- president of the Southwestern Insurance Information Service -- said the insurance industry is "very sympathetic" with the doctors' complaints but part of the problem is the propensity today to file lawsuits. "Certainly there are lawsuits that are justified, but what we feel would be part of the solution to their problem is legislation which would address the frivolity in some of the lawsuits that are filed," he said.

NUCLEAR WASTE

Nevada is just saying "no" to nuclear waste.

On Monday, Nevada Gov. Kenny Guinn announced that he was vetoing the Department of Energy's recommendation that a remote mountain north of Las Vegas become the final resting place for as much as 77,000 tons of spent nuclear fuel and other radioactive waste from power plants across the country.

"Yucca Mountain is not safe. It is not suitable," Guinn told an audience in Las Vegas prior to leaving for Washington, where he will formally file his veto at the Capitol. "We will expose the Department of Energy's dirty little secrets about Yucca Mountain."

Guinn's veto came as no surprise and will have to be overturned by Congress in order for the controversial Yucca Mountain project to move forward.

Under the provisions of the Nuclear Waste Policy Act -- which includes the establishment of a permanent national nuclear waste site -- the governor of the state selected for the dubious honor is allowed to veto the Energy Department's selection. A simple majority vote in Congress can override the veto.

The Bush administration and the energy industry see a permanent waste site as vital to allowing nuclear power plants to continue functioning and removing tons of waste that have been gathering dust at temporary storage sites across the country.

But Guinn and Nevada's congressional delegation have maintained that Nevada was selected not so much for its remote location and geological characteristics but for its lack of political clout in Washington.

Although Yucca Mountain has been on the short list of potential sites since 1987, several environmental studies still are not completed and Nevadans believe the safety issues of radioactive waste flowing into the state by truck and rail have not been adequately addressed.

"The fact that the Yucca Mountain decision was made without any analysis of the transportation risks to the 123 million Americans in states through which this dangerous waste will travel is the dirty little secret," Guinn said.

(Thanks to Hil Anderson, UPI Chief Energy Correspondent)

MAIN STREET U.S.A.

The Sept. 11 attacks did not hurt business in most of the America's older commercial districts, according to a survey released Monday by a national group working to revitalize historic downtowns.

About 74 percent of the 370 communities responding to the poll conducted by the National Trust for Historic Preservation's National Main Street Center said they experienced no significant impact on business in the aftermath of the attacks.

The findings paralleled a similar study conducted last October by the center. Both surveys showed increased retail sales and traffic in commercial districts. Attendance at special events and festivals was also up over the period, the report said.

Kennedy Smith, director of the center, said the study shows that business remains strong in the nation's revitalized downtown districts. "While challenges always remain, people and businesses continue to discover and strengthen their historic main street districts," he said. "It does not happen overnight, but over the past 22 years, main street revitalization efforts have created 227,000 jobs and 56,000 businesses and have saved 89,000 historical buildings all across the country."

Almost half of the respondents reported increased retail sales and two-thirds said they experienced increased property values. Mom-and-pop startups declined slightly during 2001, but franchise businesses increased in the communities.

Respondents said one of the great challenges they face is the increase in regional traffic and parking shortages. On the positive side, they reported progress in getting planning and zoning changes that make main street development easier.