By Dr. GREGORY SHANGOLD
Emergency departments are the backbone of Connecticut's health care safety net and its emergency care system. Our emergency departments will care for anyone seeking medical services; from the most severe trauma, to seasonal flu, to a simple laceration. Every year more and more patients seek care in Connecticut's emergency departments. This year, patients will seek care in an emergency department 1.6 million times, or 4,371 times per day.
Unfortunately, this safety net is at the breaking point.
There are multiple reasons why Connecticut's emergency care system is at this critical juncture with so many people in need of care. These high numbers result from a variety of causes, in part to a lack of availability of primary care providers. One false assumption is that emergency departments are filled with uninsured, Medicaid and non-emergency patients. A 2010 Centers for Disease Control report showed that 92 percent of emergency department visits required care within 24 hours and two-thirds of the time this care was after regular office hours. Based on the effects of Massachusetts health care reform, the need for emergency care will only increase as people are provided insurance without an adequate primary care network to provide care in an office setting.
Another myth of emergency care is that it is too expensive. However, only 2 percent of the $2.6 trillion ($47 billion) spent on medical care in 2010 was spent for emergency services. Contrast that cost with the cost of doing studies in fear of being sued, called defensive medicine. That cost is approximately $100 billion per year.
If politicians propose health care changes to reduce cost, the current dysfunctional malpractice system provides more savings opportunities than attempting to reduce emergency services.
Emergency physicians make life and death decisions, often without access to critical medical information and the ability to form a trusted doctor/patient relationship. At this time of health care reform, policymakers need to develop measures that support emergency medicine as a critical component of health care. Any reform must improve access to emergency care and the quality of emergency medical care. One key component is medical malpractice reform.
In the American College Emergency Physicians' 2009 State of Emergency Care Report, Connecticut ranked 16th worst in the nation for our medical malpractice environment. Many other states have already enacted professional liability reform in order to strengthen the emergency care safety net for their constituents.
Frivolous lawsuits and the nation's broken medical liability system are driving up the costs of health care for everyone and are leaving patients without access to physicians.
Physicians are retiring early, moving to states with lower malpractice insurance premiums, and no longer performing procedures that could risk lawsuits. They are also declining to evaluate and stabilize emergency department patients because of the high risk of litigation and the decreased likelihood of reimbursement.
Eighty-five percent of the public believes the current legal system is responsible for rising medical costs. The time is now for our state to support access to emergency care and help control cost by enacting significant and meaningful medical malpractice reform.
Currently there are two pieces of legislation being considered in Hartford. One bill, HB 5434 is a reform used in other states that will increase the burden of proof required to prove malpractice for emergency care.
A second bill, SB 243, makes it easier to file a suit against physicians. This will lead to an increase in frivolous lawsuits and ultimately drive up cost and decrease access to care.
When so many other states are starting to address the medical malpractice component of health care in an attempt to improve a faulty system, Connecticut is considering worsening the already poor environment. This is the wrong direction for our state.
Contact your legislator and encourage a vote against SB 243 and for HB 5434.
Dr. Shangold is a past president of the CT College of Emergency Physicians