Remarks to the Texas Town Hall Meeting, Austin, TX

It’s wonderful to be here in Austin today. I actually drove from Galveston to Austin yesterday evening. I like driving, and I’ve never driven Hwy 71 between Houston and Austin before that I recall. Well, it’s a lonely drive at 7:00 p.m. on Super Bowl Sunday. I was going over my remarks as I drove, and I got to wondering about the nearest Level I Trauma Center. So, when I got here, I looked up the Level I Trauma Centers –there are Level I Trauma Centers in Houston and in Austin. So……if I had needed one at the halfway point between Houston and Austin, the nearest one would have been 100 miles away. So much for the golden hour……..

This morning, we should be comfortable, knowing that there is a Level I Trauma Center less than a block away, right? Unfortunately, we are indulging in a common misperception. Most people believe – understandably – that if they’re in a serious car crash or are having severe chest pain, they can come through the doors of the ER and there will be a bed waiting, that every medical specialist and nurse they need will be available, and that we will be able to take care of them – just like they do in the television show E.R. That is not reality.

While emergency physicians and nurses are dedicated to providing the most timely and efficient care possible, the truth of the matter is – every day in hospitals across America, our hallways are lined with patients, and there are no more beds. Increasingly in many areas of the country, patients are transported to hospitals out of state because there are no neurosurgeons or Ob/Gyns in the region at all. Emergency departments are closing because half of the medical services they provide go uncompensated. Incoming ambulances carrying critically ill patients are being diverted to other hospitals farther away. Patients in emergency department waiting rooms are waiting longer than ever before – extending their pain and suffering.

One year ago, the American College of Emergency Physicians released the first National Report Card, a state-by-state comparison of the delivery of emergency care. Let me be clear – the Report Card is NOT an evaluation of specific hospitals or physicians. It is the first comprehensive analysis of state laws, policies, and funding necessary to maintain access to care, support quality of care and patient safety, prevent injuries and protect the public health.

In the spring of last year the Institute of Medicine released three comprehensive reports on emergency medicine in America. The two reports agree……we don’t have enough hospital beds; we don’t have enough emergency physicians; we don’t have enough nurses. This morning on CNN I saw a story on the bird flu in England. There was a lurid description of the destruction of thousands of birds. There was also the speculation that the virus might mutate to a form that would cause a worldwide pandemic. If a pandemic flu or disaster strikes, the majority of emergency departments across the country are not prepared to handle the influx of patients that would ultimately arrive at their doors.

Texas is not an exception to the bleak picture painted by the two national reports. In fact, Texas received a D+ in the category of “Access to Emergency Care” from ACEP’s National Report Card. The state’s spending on hospital care ranks near the bottom – 41st in the nation. Texas ranks 44th in the number of available emergency physicians and 48th in the number of nurses. Twenty-four percent of Texas residents don’t have health insurance, the highest number of uninsured people in the nation.

The data reveals that Texas has 4.45 physicians per 100,000 people. On average, there are 8,300 annual visits per emergency physicians. You can do the math: 8,000 visits X 4 doctors is 32,000 visits per 100,000 people per year. So if we look at this room, those of you on the left may go to an emergency department this year. Those of you on the right will have to wait until next year to have an emergency. Those of you in the back………..we’ll be able to see you in 2009.

Two days from today, the American College of Emergency Physicians will participate in the presentation of a new bill to Congress: The Access to Emergency Services Bill. We encourage everyone to go to the website www.acep.org and ask your representative to sponsor the bill.

I challenge the Texas legislature to respond to this D+ grade. Stop neglecting emergency care in Texas.
I challenge the Texas legislature to support and promote an increase in the number of available hospital beds.
I challenge the Texas legislature to support and promote an increase in the number of emergency physicians.
I challenge the Texas legislature to support and promote an increase in the number of emergency nurses.
Pass the laws necessary to protect the health of ALL Texans.

Outside every emergency department is a bright red light that says, “EMERGENCY”. It is a visible symbol of emergency care and a beacon of hope for the critically ill and injured. That bright light is flickering and may soon be extinguished. Where will we go then, to find emergency help in the darkness?