At a time when the nation is on heightened terrorist alert, the American Hospital Association is tap dancing around the issue of hospital preparedness. On the one hand, the AHA says hospital emergency rooms are overcrowded because of staff shortages. On the other, it says they're not so crowded as to be unable to handle a bioterrorist emergency.
Overcrowded ERs don't mean hospitals won't treat patients in a terrorist attack, the association is telling lawmakers. But just to be on the safe side, give hospitals some more money to expand their ERs, the AHA said.
Quickly pivoting to defend itself on an issue that it has used to argue for more funding, the AHA has rebutted a congressional report that questions whether hospital ERs are ready to respond to large numbers of casualties in the event of a terrorist attack.
Prepared by the Democratic staff of the House Government Reform Committee, the Oct. 16 report is based on 130 news reports of hospitals diverting emergency patients since the beginning of 2000 because the hospitals don't have enough ER beds or personnel.
"Many areas around the nation have experienced `ambulance diversions,' which occur when officials at crowded hospitals declare they cannot safely accept incoming vehicles, causing patients to travel further distance to seek medical attention," according to the report. "The diversions are occurring under current conditions, even without the added stress of a terrorist attack."
In pushing for a $16.2 billion package of Medicare payment increases this year, the AHA cited those diversions as a glaring sign of a healthcare workforce shortage that needs to be cured through new federal spending.
But in the wake of the Sept. 11 terrorist attacks, those diversions have become a public-relations problem for the AHA as incidents of anthrax exposures have raised policymakers' concerns about bioterrorist threats and the ability of hospitals to treat large numbers of casualties (See story, p. 8).
"They know (hospitals are) closing beds. They know they're turning people away. They don't know what (hospitals) are going to do" in a disaster, said Charles Inlander, president of the People's Medical Society, a consumer group based in Allentown, Pa. "What consumers are really beginning to understand is that hospitals aren't prepared for this type of situation, period."
Nonsense, said the AHA, which argued in an Oct. 17 letter to Rep. Henry Waxman (D-Calif.), the Government Reform Committee's senior Democrat, that in a disaster ERs stop diverting ambulances and convert cafeterias and hallways into emergency space.
The AHA letter added that despite those capabilities to respond, the federal government could help by increasing funding of disaster-preparedness equipment and training.
James Bentley, the AHA's senior vice president of strategic policy planning, acknowledged that the focus on diversions may have rattled consumers' confidence in hospitals' disaster capabilities.
"We need to help people understand that we're going to care for them and we're going to care for them well, but it may not be the same characteristics as when we dictate the number of admissions we take," Bentley said.