Mandate stifles Gilbert emergency room - East Valley Tribune: Health

Mandate stifles Gilbert emergency room

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Posted: Friday, September 22, 2006 10:21 am | Updated: 5:09 pm, Fri Oct 7, 2011.

Patients on portable hospital beds line the hallways during peak hours at Gilbert Hospital — despite 20 large hospital rooms that remain closed and empty.

Administrators say they are being forced into the arrangement to be considered for Medicare and Medicaid certification.

“We just don’t know the rationale,” said Tim Johns, medical director and founder of the hospital. “It makes no sense.”

The situation could mean trouble when the busy flu and winter visitor season hits, administrators said.

The Centers for Medicare and Medicaid Services, which did not return calls for comment, mandated the emergency hospital have the same number of emergency room beds as inpatient beds, administrators said.

Because the hospital — which opened Feb. 3 at Power Road and Galveston Street in response to an emergency room shortage — has only six long-term inpatient beds, only six emergency department rooms can be open, as well as two additional urgent care rooms reserved for the most life-threatening situations.

Fourteen emergency department rooms have been closed, and equipment removed. Six observation beds also have been closed, unused for a week.

Nurses are prepared to pull out beds on wheels, with curtains and supplies stored underneath and on top, when more than six patients need emergency room care.

“It makes it very difficult for our staff to provide the kind of care we like to provide,” said Ronda Hawker, chief nursing officer.

Many minor emergencies now are treated while patients sit in triage chairs, she said.

On Thursday, 4-year-old Vicci Reazin was among several patients who sat on hallway beds, just outside empty patient rooms, as a doctor treated a scratch to her eye.

“To have a facility capable of taking more patients and tell them you can’t use your rooms . . . that’s wrong,” said mom Charlotte Reazin, of the San Tan Heights area in Pinal County.

Officials with the San Francisco regional and the national offices for the Centers for Medicare and Medicaid Services did not return telephone calls Thursday.

According to hospital officials, the federal agency and hospital directors have been battling over the situation for 1 1 /2 years.

Hospital CEO David Wanger said about 30 percent of the roughly 130 emergency patients seen each day use Medicare or Medicaid.

Because the hospital is not certified, it has provided about $9.8 million in care for those patients since opening, he said.

And many other health care plans rely on the Medicare and Medicaid certification when approving a hospital for care, Wanger said.

The review is expected to take place in the next few weeks, and approval could take one to two months — though Wanger said it’s unclear as to whether they can reopen the rooms.

Johns said the hospital has been able to continue its policy of patients receiving their initial doctor exam within 31 minutes, at least 91 percent of the time.

But he said he’s concerned that the approaching flu season and the return of many seasonal visitors to the area may cause an increase in need to about 180 patients each day.

That kind of surge with so few rooms could mean the hospital would be forced to set up tents in the parking lot to treat patients, Johns said.

“It becomes a disaster,” he said.

The decision runs contrary, Johns added, to another recent statement by the federal agency that prohibits the “parking” of patients in hallways by emergency medical technicians, prior to being admitted and seeing a doctor.

In addition, a recent report card of emergency room care by the American College of Emergency Physicians gave Arizona an overall D-plus grade, ranking the state 42nd nationwide, partly for its lack of adequate emergency room departments and beds.

The average wait in Maricopa County emergency rooms is more than six hours, a situation Johns said he wanted to address when he and other doctors invested in the hospital.

They plan to expand the inpatient ward in the next few years by building a four-story, 96-bed tower on adjacent land.

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