Tuesday, June 2, 2009

NYC Comptroller Thompson: Hospital Emergency Rooms In Queens Are In Crisis Due to Closures and H1N1 Virus

--State, City need to take immediate action --

New York City Comptroller William C. Thompson, Jr. today charged that hospitals in Central and Eastern Queens are in a “state of crisis” as their emergency rooms confront a torrent of patients amid H1N1 virus worries and the closures of St. John’s and Mary Immaculate Hospitals.

Hospital emergency departments in much of the Borough of Queens are in crisis,” Thompson said. “A new approach is needed if we are to ensure that the Queens hospitals and all of our remaining hospitals and emergency rooms are able to provide the public with quality care.”

Thompson was joined by Queens Borough President Helen Marshall in front of Jamaica Hospital Medical Center. Jamaica Hospital is among the Queens hospitals severely affected by recent closures.

In recent years, the State Department of Health has closed four hospitals in Queens,” said Queens Borough President Helen Marshall. “Most recently, St. John’s and Mary Immaculate, which each saw approximately 50,000 emergency room visits annually, shut their doors, representing a loss of more than 400 inpatient hospital beds. In addition, emergency rooms and a trauma center were closed. Short term funding from the State was targeted for equipment and infrastructure expansions, but did not address the need for additional healthcare professionals, especially nurses. Comptroller Thompson is right when he says that emergency rooms in Queens are in crisis. I warned the Governor’s Office that the hospital system in Queens would not be able to handle a major emergency.”

The healthcare crisis in Queens has gone from bad to worse,” said Public Advocate Betsy Gotbaum. “It was troubling enough that the closing of two intensely needed hospitals could not be prevented. In January I called on the city to explore every viable option before deciding to shut down St. John’s Queens and Mary Immaculate Hospitals, a decision which could put excessive strain on surrounding hospitals and jeopardize the health and safety of New Yorkers.”

She continued: “Unfortunately, the outbreak of the H1N1 virus not only demonstrates the lack of sufficient emergency care capacity in Queens and around the city, but it has elevated the severity of the hospital crisis. I want to thank Comptroller Thompson for drawing attention to this important issue and I echo his call for immediate action to ensure that the city can provide New Yorkers with quality emergency care.”

Thompson has consistently warned about the impact of hospital closures in the region on remaining facilities. In December 2006, he issued Emergency Room Care: Will It Be There?, a report that assessed the impact of five city emergency room closures proposed by the Berger Commission. Earlier this year, he spoke out repeatedly about the need to better prepare for the closures of St. John’s and Mary Immaculate Hospitals.

The new Policy Alert, Closures of St. John’s and Mary Immaculate Hospitals Are Overwhelming Remaining Emergency Rooms; Emergence of H1N1 Virus Causing ER Crisis in Queens, found that emergency rooms are being flooded with patients, many who must now await admission, ambulance turnaround times are rising, and medical professionals are facing extraordinary challenges in their ability to provide care. Among the findings:

  • The number of emergency room patients at the surrounding hospitals soared right after St. John’s and Mary Immaculate hospitals closed earlier this year. For example, from mid-February to the end of March, there were 20 days when Jamaica Hospital’s emergency room exceeded 350 patients versus only two such days in the same period in 2008. The number of patients waiting to be admitted from the emergency room also rose dramatically in the surrounding hospitals.

  • The number of patients brought to surrounding hospitals’ emergency rooms by ambulance soared. For example, comparing January and March 2009, the number of patients arriving by ambulance at Queens Hospital Center rose 51 percent, and at North Shore University Hospital-Forest Hills by 40 percent.

  • Ambulance turnaround times – the amount of time from arrival at the emergency room until the ambulance is free to make the next call – increased significantly at Jamaica, Queens and North Shore University-Forest Hills hospitals.

  • A Queens Hospital Center emergency room doctor with more than two decades of experience told the Comptroller’s Office that he now sees 35 patients per shift compared with 20 before the two closures, that conditions at the hospital have become a “living nightmare,” and that “the state of emergency medicine in Queens is the worst I’ve seen in my career.” His observations echoed other physicians, some of whom spoke of an overwhelming added patient load.

In his Policy Alert Thompson noted that there had not been any public or inclusive discussion concerning transition plans or how the closures would affect area residents. Thompson faulted the New York State Department of Health (SDOH) and the City Department of Health and Mental Hygiene (DOHMH) for failing to acknowledge the deteriorating financial condition of Mary Immaculate and St. John’s Hospitals in a timely fashion and failing to put in place a plan to address the impact of the closures.

Thompson also noted that the SDOH allowed St. John’s and Mary Immaculate Hospitals to close without finalizing and approving a closure plan, in violation of the Department’s own requirement. Nine days before the hospitals’ emergency rooms closed, in its “Final Draft” closure plan (February 5), the operator of the closed hospitals, Caritas, revealed, “We have yet to determine that alternate resources will be in place upon the closure of Caritas.”

Noting that Elmhurst and Queens Hospital Centers could face an additional 30,000 emergency room visits and 8,000 inpatient admissions, the closure plan stated that “these hospitals may not be in a position to absorb this projected demand in the time-frame contemplated herein.”

What we are seeing now is a crisis in the hospital and healthcare system in Queens, a version of which may very well spread to other boroughs if H1N1 virus outbreaks appear in other neighborhoods,” Thompson said. “To be sure, while the timing of the H1N1 virus itself was not foreseeable, the likelihood of some event of a similar nature causing a sudden surge in demand was both foreseeable and inevitable.”

Thompson offered a number of recommendations. Among his priority items: individuals with flu symptoms should be triaged at ambulatory care facilities; the necessary resources to deal with emergencies should be activated; loans and working capital should be provided to cover expansion costs; data on emergency room utilization should be made public; hospitals should be staffed-up to meet increased demand; and, gaps in services created by the closures must be identified.

The City and State need to pull key healthcare providers and other stakeholders together immediately to share information, identify problems and develop solutions to address the current surge in demand stemming from the H1N1 virus,” Thompson said. “If the State Department of Health had begun planning in December 2006, as I suggested, it is likely that much of the current impacts in Queens could have been minimized or avoided entirely.”