Hearing of the House Oversight and Government Reform Committee - The Lack of Hospital Emergency Surge Capacity
Hearing of the House Oversight and Government Reform Committee - The Lack of Hospital Emergency Surge Capacity
BREAK IN TRANSCRIPT
DEL. ELEANOR HOLMES NORTON (D-D.C.): Thank you, Mr. Chairman.
And I must say, because I represent this city, I'm especially grateful that you've brought some sunlight to this really urgent problem as we face Medicaid cuts.
I want to note that I have constituents from Anacostia High School who would be very much affected if, in fact, there was such an event here.
Mr. Chairman, since 9/11, I've been trying to get funds out for what are called ER One. It was to be a demonstration here. People came from hospitals all over the country to see how we did it here and then to see if they could replicate it. And essentially, it would add to the Metropolitan Hospital Center a surge capacity and a way to quickly add on that capacity.
I want to -- my concern, I will say to the panel, is that you have a mix of residents here. So if you try to separate out who you're talking about -- undocumented, poor who overuse, of course, emergency rooms from the ordinary emergency -- you're going to have a hard time, which is why this ER One notion was to try to say that this is the place close to the capital to send victims. We have a burn center, for example, there. They brought people there from Virginia after 9/11.
On top of 600,000 people who live here, we've got 200,000 federal workers and other workers who just come in every day and go out, creating a potential for a true catastrophic situation. They won't be able to get out on the roads. Some of them will try to get out if they're hurt. So the point is to let them know quickly what the place is to go.
Now, Virginia -- and Dr. Kaplowitz, you've testified about what Virginia's trying to do with money it has and that caught my attention. Placing key -- according to your testimony -- key supplies and medications in various places -- of course, Virginia went through 9/11; and trying to deal with surge in its various hospitals.
I'd like to ask you -- and that inclines me to look at how much in Medicaid funds Virginia would lose to see whether Medicaid funds were implicated. And I learned that Virginia -- and when we talk about Virginia, Maryland, the District of Columbia, we're talking about one place, virtually, except that if the event occurred here, unlike the Pentagon, if the event occurred here in this crowded space and people went to various hospitals, you would only make the situation worse, which is why we're working on the ER One. The administration has supported it. We've not been able to get it through appropriations, even though there's some considerable support for it.
Virginia would lose 93 million (dollars) in federal Medicaid funds over the next five years.
I'm trying to discern what impact the loss of federal Medicaid funds would have on the surge capacity they're trying to create out of whole cloth.
DR. KAPLOWITZ: I've been thinking about that, knowing I was going to be here today. I know you've heard from Dr. Sheldon Retchin, who spoke about the impact on the VCU Health System. Again, if we lose the -- much of the capability to handle emergencies on a daily basis, it's going to definitely put us at a disadvantage. I know full well how much Level 1 trauma centers depend on Medicaid funding in general, not only for trauma care, but in general, whether it's the VCU health system or INOVA Fairfax. And I'm very, very concerned of the impact it's going to have on the ability of those facilities to function not only in an emergency, but on a daily basis. And they do work together. It's hard to expect the facility to add surge if they're so stressed on a daily basis.
Nonetheless, we are planning for surge capability, surge beds for an emergency, no matter what the situation is on a daily basis. We have to plan for the emergency and recognize that there are stresses on a daily basis. I know there's going to be enormous impact on a number of facilities, especially our Level 1 trauma centers, on a daily basis. It will impact their ability to surge in emergencies. That's not going to stop us from continuing to plan for that large event, looking at distribution of patients and hoping facilities respond appropriately.
DEL. NORTON: And those the ones -- the Level 1 trauma centers are the ones that, because they are the hospitals that have the greatest capacity, tend to be the ones that are overcrowded?
DR. KAPLOWITZ: Absolutely.
There's one other point there that's not related to Medicaid funding but related to surge, and that is the concern that hospitals have of the funding they're going to receive after an emergency. I bring this up because it's a major issue when hospitals are talking about surging in emergencies. Most hospitals and most health care is private, and there's been a lot of discussion and stress about what kind of reimbursement they would get in responding to emergencies. They're going to respond, but are they going to be dramatically hurt financially?
DEL. NORTON: Well, you know, Dr. Kaplowitz -- you know, following 9/11, it was easier to get funds out after the fact, and this is what is so frustrating to me because in the face of a capacity (sic) and we're living in a country that doesn't prepare for anything -- you know, money went out. But preparing for this -- such an event is very bothersome. I am concerned.
I'd like, finally, to ask this. When -- if in fact, these patients are distributed to the trauma centers, wherever they are and -- in a place like the District of Columbia, rather than to have a place that is specially outfitted to deal with traumas, if you would tell me how a emergency room is supposed to decide how to quickly separate the traumas that come, let us say, from the District of Columbia, the other people who have serious emergency problems who come in, the people who shouldn't be in the emergency room but perhaps should be referred -- I mean, I'm worried about the chaos of just sending everybody to trauma centers in the first place.
Dr. Meredith, did you have a --
DR. MEREDITH: Well --
REP. WAXMAN: The gentlelady's time has expired, but we'll get an answer to the question.
DR. MEREDITH: The trauma system itself is designed to do that exact question. It's -- a lot of work has been done to define what kind of patient is the trauma patient and how should they move. And that -- those questions are answered. There are about 230 Level 1 trauma centers and about 320 Level 2 trauma centers. So it talk -- we're talking about saving 550-ish -- maybe between that and 600 hospitals that are the core of a safety net of -- for patients in the country by the --
DEL. NORTON: Well, thank you.
But Mr. Chairman, I want to just say I'm very concerned that if people simply go to the hospital closest to them as opposed to the hospital that in fact has been most prepared to handle --
DR. MEREDITH: Right.
DEL. NORTON: -- the surge from the event --
DR. MEREDITH: Right.
DEL. NORTON: -- all of the placement that Virginia is trying to do, for example, a little bit everywhere without Medicaid funds will not serve us well in the event of a truly major capacity (sic), if I may say so. Virginia was not the kind of event that we in the District of Columbia are most afraid of following 9/11.
REP. WAXMAN: Thank you --
DEL. NORTON: We can handle that one.
BREAK IN TRANSCRIPT
Source