Hearing of the House Committee on Oversight and Government Reform - Lack of Hospital Emergency Capacity: Will the Administration's Medicaid Regulation Make it Worse --Day Two

Statement

Hearing of the House Committee on Oversight and Government Reform - Lack of Hospital Emergency Capacity: Will the Administration's Medicaid Regulation Make it Worse --Day Two

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REP. DARRELL ISSA (R-CA): Thank you.

Governor, I'll continue along that line. With 259 trauma centers in the country, five in San Diego, four in Utah, it's very clear that in San Diego, we have as much capacity for our 2 million people in a relatively small area as Utah has in a huge area. For all practical purposes, in the case of disasters of any sort -- take Northridge earthquake -- aren't we essentially always assuming for homeland security that they're going to be in high-risk areas, while ultimately, the people of Utah or Oklahoma or Wyoming could just as easily have a huge disaster affecting thousands of people over an area that could not possibly concentrate the types of hospitals that we have in Los Angeles or San Diego? So ultimately, isn't the planning for major disasters more about the essential planning and training and ability to move people than it ever will be about having operational extra spaces in one location?

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REP. ISSA: Well, thank you, Mr. Chairman, and I certainly think that it's been good to wait a little while to go today because I think Mr. Sali's questions, although they seemed to start on a tangent, finished pretty cogently.

Mr. Secretary Chertoff, the link that you did agree exists between our inability to either stop illegal immigration or the absence of their having an alternate insurance plan that would put them into normal front-door hospital and urgent care and other places rather than an emergency room and trauma centers is a significant part of the overcrowding and the underfunding today. From your side, homeland security, you seem to very much agree that that is part of the problem that you face when looking at surge capacity today is can you get those centers freed up in time of emergency.

So my question to you is, do you feel comfortable that, even though a nonscientific, partisan telephone survey found that, lo and behold, these seven trauma centers were overcrowded on a given day, or emergency rooms, that those would be reasonably "free-uppable" for the kind of catastrophic emergencies we might have in the case of a dirty bomb or some other terrorist attack?

SEC. CHERTOFF: Well, I agree with Secretary Leavitt. My understanding, of course -- you know, the expertise really resides with his department, but it certainly makes sense to me -- my understanding is that in a true emergency, people who are in the emergency room, using it for primary care or for something less than an emergency, would be asked to leave, and many of them would. I also agree with Secretary Leavitt there is probably some point at which no emergency center, no matter how well funded, is going to be able to handle what would be a truly mass event, and that's why we have these backup systems in place.

There's no question that a catastrophic event is going to be bad. It's not going to be pleasant. But I think that we would expect the emergency room to clear out all but the priority cases in order to handle the --

REP. ISSA: I certainly agree, and certainly there are doctors who have been serving in capacities other than urgent care whose experience in surgery and other areas would quickly be brought in post-triage to do it.

Governor Leavitt, you know, the title of this hearing today, I think, is significant because it starts off and it says, quote, "The Lack of Hospital Emergency Surge Capacity: Will the Administration Medicare Regulations Make It Worse?" unquote. Yesterday, or day before yesterday, I asked the panel, who all felt that overcrowding was a problem and so on but differed on whether they could handle emergencies -- Virginia said we did handle emergencies, we believe we're well organized ever here in the District, while other areas did not.

One of the interesting things was I said, here's a billion dollars, how would you spend it? Would you spend it on training and preparation for an emergency, or how else would you spend it? To a person, the panel said I'd spend it on day-to-day routine costs; I'd simply absorb a billion dollars.

Governor, certainly you have the background to understand that a billion dollars is a lot of money, but the cost of injuries in America today is estimated to be $300 billion in medical costs. A billion, 2 billion, 3 billion -- if it is not used for preparation training, emergency facilities and planning will it, even 3 or 4 billion dollars added into the system, will it in fact increase surge capacity if it's simply spent on a daily basis?

SEC. LEAVITT: Our significant concern with monies that we give to states is that they are focused on increasing surge capacity. We have put nearly $7 billion through different departments other than Medicaid into emergency preparedness and specifically into --

REP. ISSA: Right.

SEC. LEAVITT: -- surge capacity. And I believe that if we were to just be -- if we were just to send Medicaid money, it would be absorbed into the hospital overhead --

REP. ISSA: And Governor, following up, because the time is limited -- essentially, aren't we dealing exactly with that here today, that if in fact we don't carefully make sure that these funds do not get diverted and do not cover up for problems, including illegal immigration to quote the other member, but all kinds of problems of the underinsured -- aren't we by definition making ourselves less capable if we don't take action to ensure that it goes into planning and training and preparation rather than absorbing what clearly appears to be an everyday problem in America that was neither created by September 11th, nor would be rectified by a few billion more dollars here or there?

SEC. LEAVITT: Every community needs a plan, every community needs to train, every community needs to exercise, and that's what much of our money goes to and should.

REP. ISSA: Governor, my time is short, but you did deal with the problems of illegal immigration, you dealt with the problems of your emergency rooms and the impact of the under-insured; isn't that a separate issue that we should concentrate on finding solutions for but not mix it with today's hearing on surge capacity directly related to 9/11-type events?

SEC. LEAVITT: We've dealt with three specific and different issues today: surge capacity, the impact of illegal immigration and Medicaid regulations. All three are separate, all three are important issues.

REP. ISSA: Thank you.

Thank you, Mr. Chairman.

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