San Diego's Emergency Room Crisis
by John Lawrence, July 11, 2019
There were 42,268 mental health visits to San Diego County emergency room hospitals in 2028 up 60% from 2008. These visits in and of themselves caused further trauma to the mentally ill. First, as anyone knows who have visited an emergency room lately, you have to wait for hours - some times for days - in the emergency room before you're given a hospital bed in a regular room. Sometimes patients have to wait for hours on a gurney just to get a bed in the emergency room. Such was the case when I hurt my back when my car was rear ended, and I was transported to the hospital by ambulance.
Lisa Halverstadt reported in Voice of San Diego in an article, "Mental Health Patients Are Pouring Into Local Emergency Rooms":
Three large local hospital systems reported to VOSD that their patients wait an average of about 20 hours to move onto more specialized inpatient beds while a separate hospital association analysis released last year suggested patients can often wait up to 36 hours for those beds.
Those waits and the frenzied environment of an ER only escalate patients’ suffering while taxing the emergency departments of hospitals dealing with an array of urgent care needs. Patients who spoke to VOSD described increased anxiety, agitation and depression as they laid in gurneys – some waiting as long as two days for an inpatient bed – and going for hours without water or food.
But this situation isn't unique to mental illness patients. People that go to emergency rooms with stroke symptoms, for example, often wait long hours to be admitted to a hospital bed without food or water. That's where a patient advocate comes in. When my late wife went to the emergency room several times with stroke symptoms, I always went with her. I was her "go to" person for everything she needed. If she was hungry or thirsty, I would track down a nurse to bring her food or water. Without me there she would never get an extra blanket if she was cold or anything else she needed. I would track down the nurse and demand it. You could buzz them on the intercom all you wanted, and they would never come. Such is the situation in hospitals. For people with mental illness, it is only more frustrating and agonizing.
Halverstadt continues:
Vincent Dimeo recalls feeling relieved as he left his friend Ann Ruhlman at Sharp Grossmont Hospital for a psychiatric evaluation in December 2017.
On their way to the hospital, Dimeo said his friend was behaving erratically and he twice had to slap her hand away she tried to scratch her right eye. Now she was safe and checked into the emergency room. Dimeo could head to work.
“They said she’d be in good hands,” Dimeo said.
About nine hours later, Ruhlman gouged out her right eye in Grossmont’s ER.
So Dimeo's mistake was not staying with her in the ER. Everyone going to the hospital in the ER or in a regular room needs someone with them, a loved one or friend, to be their advocate. Without them, you are at the mercy of the hospital staff who responds only when they please. With all due respect they are very busy, even overworked, in this glorious of all non-socialistic health care systems. My wife could wait for hours to have her bed changed since she couldn't control her bowel movements if I were not there demanding that a CNA come, clean her up and change the bed. It got to be a fight between me and the nurses.
Halverstadt continues:
Three large local hospital systems reported to VOSD that their patients wait an average of about 20 hours to move onto more specialized inpatient beds while a separate hospital association analysis released last year suggested patients can often wait up to 36 hours for those beds.
Those waits and the frenzied environment of an ER only escalate patients’ suffering while taxing the emergency departments of hospitals dealing with an array of urgent care needs. Patients who spoke to VOSD described increased anxiety, agitation and depression as they laid in gurneys – some waiting as long as two days for an inpatient bed – and going for hours without water or food.
Ruhlman’s case is especially tragic.
Hospital and legal records obtained by VOSD reveal ER staff declared Ruhlman a threat to herself after her arrival at Grossmont. After she checked in, hospital workers restrained her for about an hour after she dug her fingers into her eyes and tried to stand on the hospital gurney. ER workers ordered tests that showed Ruhlman, who has been diagnosed with schizophrenia and anxiety, had methamphetamine in her system. It was unclear whether doctors had initially decided Ruhlman needed an inpatient bed, an outcome that Ruhlman said followed other ER visits.
A few hours into her ER stay, medical workers saw Ruhlman scratching her right eye again shortly after she was released from restraints and ordered a CT scan. The scan and a separate exam documented swelling around the lower lid and an abrasion on the eye she later tore out.
Dimeo felt sick when he learned days later what had happened.
“I shouldn’t have left,” he said.
Of course he shouldn't have. Patients are left alone for hours in their ER beds. No food, no water. My wife was at the same hospital that Ruhlman was. They don't even have plans for food service in the ER. If you complain loudly enough, the nurse will sneak you a sandwich or something, but there is no provision to feed you there.
Halverstadt continues:
In a statement, Sharp Healthcare wrote that patient safety is a high priority and described Ruhlman’s case as “most unfortunate.”
“Sharp Grossmont Hospital provides high quality care and complies with all regulatory requirements specific to the use of physical and chemical restraints,” Sharp wrote in the statement. “Due to patient privacy concerns, we are unable to provide any specific details regarding care provided to patients, however it is the hospital’s policy to provide care to its patients based on clinical presentation. The acuity level of a patient determines the level of care and observation needed.”
Other patients and advocates who spoke to VOSD also described harrowing experiences in local ERs.
“I’ve had people go through the emergency room process and say, ‘I’m never doing that again. That was more traumatic than the thing that brought me to this point to begin with,’” said Michelle Routhieaux, who leads San Diego’s Depression and Bipolar Support Alliance and has accompanied patients on dozens of ER trips over the last 15 years.
Medical experts, county health officials, patients, advocates and law enforcement leaders agree that ERs can further traumatize patients who are already suffering.
Yet ERs have long been the front line of a broken mental-health system with insufficient resources for both patients in crisis and those seeking to avoid one. And in more recent years, bolstered by an explosion in Medi-Cal enrollment tied to the Affordable Care Act, patients in crisis have rushed in.
Just remember this, folks. If a loved one has to go to the ER for mental health or any other reason, stay there with them as their advocate. Otherwise, the staff will let your loved one lay there without food or water for hours, and that goes for after you're admitted to a hospital bed as well. However, there you will get regular meals. You could still lie in your own filth for hours before a CNA comes to change you if you don't have an advocate by your side. That's just the way it is in this expensive, capitalist society where money talks and shit walks. But whatever you do, don't go socialist. Seriously, Bernie Sanders has a better idea: Medicare for All and take the profit motive out of medicine.
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