Our Er Circus

Fancy doing something out of the ordinary this weekend? For a look into how “the other half” lives, park yourself over at the greatest show in town: under the big top at the lovely, luxurious University of New Mexico Hospital emergency room. It will be a show you won't soon forget. Good as any traveling three-ring cable reality show. Blood, guts, poverty, drug addiction, an occasional brawl. As the kids say, “it’s sick.”

And the colors! Mostly deep reds and browns—Native Americans and Hispanics. It's a slice of America. And admission is free. The only catch is that if you actually want to be seen, you’d better plan on waiting longer than the average line for a ride at Disneyland. Unless, of course, you have a life-threatening gunshot wound. Then you might be seen in just a couple of hours.

Welcome to the circus that is emergency health care in New Mexico. Our beloved state received a D-plus and ranks 43^rd in the country for its emergency medical care system, according to a national report card recently released by the American College of Emergency Physicians.

The high number of uninsured residents and the state's poor spending on health care torpedoed the state’s score. The state's lack of nurses (it ranked 47^th among states for number of nurses) didn't help. This shortage might help explain the state's short supply of staffed hospital beds. These problems contribute to emergency department overcrowding by forcing admitted emergency patients to wait hours and sometimes days until an inpatient bed becomes available.

I have seen and heard about the problems firsthand. My sister is an emergency room nurse at UNM Hospital. She moved back to New Mexico a couple years ago after serving as an Army nurse in Europe. She's pretty feisty and energetic and thought an ER at a public hospital would give her just the excitement she desired. Eighteen months later, she's burning out. She loves her job, but like most ER personnel, she is increasingly fed-up with the high-wire act that is the UNM emergency room.

Along with several of her colleagues, she presented a petition to the hospital's management decrying the problem of overcapacity facilities, from admission to treatment. More than 120 emergency room nurses, doctors and others signed the petition.

According to UNM hospital staff, it can take days for patients to be moved to a room from the ER and nurses must care for those patients while handling traumas and emergencies.

In a recent interview, one UNM emergency room staffer said he averaged 12 to 20 admitted patients who had been in the ER for days awaiting hospital beds. Nurses said at one point more than 35 patients had been admitted and were awaiting beds. They said the record stay in the emergency room was more than five days. Patients were lined up like battle survivors in hallways throughout the ER. The emergency room is designed to evaluate and stabilize patients. Its total capacity, including stretchers, beds and chairs, is about 55 patients.

In a recent news report, one nurse said she worked 12 hours in the emergency room on Saturday and 16 on Sunday. At one point, she was responsible for 12 patients, she said. Other floors have one nurse for every four seriously ill patients. This is unacceptable and dangerous.

Adding to the crisis, another major local emergency room with more than 30,000 patients a year will close this year. Worried yet? Here's a closing act. The proposed federal budget eliminates funding for Indian health clinics. Guess where those patients will likely end up for both emergency and nonemergency care.

How is it that in a major American city with an average income higher than anywhere else in the state, the largest trauma center looks like something you might find in Baghdad?

Benign neglect. Despite pleas for help from a few public officials, doctors and social justice groups, the three-ring circus that is emergency health care in Albuquerque remains a sideshow for most local leaders.

Sure, there's no shortage of problems facing the community. Public education—yep, there’s lots of work to do there. Crime—we have more than our share. Jobs—we could use a few more of them. But civilized emergency health care is a disgrace in Albuquerque.

Who are the people under the UNM ER Big Top? Mostly poor. Mostly Native American and Hispanic. Mostly rural. Mostly blue collar. Mostly drug-induced or drug-addicted. They are “the other” New Mexico. “The other” Albuquerque.

Before we all take a big jump, there is a bright side. New Mexico has a good supply of board-certified emergency physicians, and its future supply looks good, too. We have an above-average number of emergency-medicine residents who will likely stay to practice medicine in the state. The state ranked above-average in emergency-medicine residents per one-million people (16^th), and in the percentage of its population with access to enhanced 9-1-1 services (19^th).

It’s time to make emergency health care the top issue for local and state policy-makers. More nurses. More acute care beds. Health care access for more New Mexicans. These are big challenges. But we must face them courageously. The circus of disgrace that is emergency health care in New Mexico must end. Send in the clowns.