Doctors and nurses warn of “breaking point” in hospital ERs

Ella Castle

A letter to the Biden administration jointly penned last week by 33 medical groups, that include the American College of Emergency Physicians (ACEP) and Emergency Nurses Association (ENA), paints a devastating picture of the ongoing crisis that is overtaking emergency departments across the country. EMT Giselle Dorgalli, second from right, looks at […]

A letter to the Biden administration jointly penned last week by 33 medical groups, that include the American College of Emergency Physicians (ACEP) and Emergency Nurses Association (ENA), paints a devastating picture of the ongoing crisis that is overtaking emergency departments across the country.

EMT Giselle Dorgalli, second from right, looks at a monitor while performing chest compression on a patient who tested positive for coronavirus in the emergency room at Providence Holy Cross Medical Center in the Mission Hills section of Los Angeles. [AP Photo/Jae C. Hong, File]

The letter was sent to President Joe Biden with a copy to Secretary Xavier Becerra of the Department of Health and Human Services and Secretary Alejandro Mayorkas of the US Department of Homeland Security.

The letter’s authors asked for a summit of health care leaders to carry out urgent collective action to address the evolving crisis, in which “Emergency departments (EDs) have been brought to a breaking point.”

There has not been a word by the Biden administration in response to the nine-page letter. In the wake of the midterm elections, prosecution of the war in Ukraine and otherwise pursuing the interests of American imperialism remain foremost on the White House’s agenda. While all its attention goes to foreign policy, all mitigation measures against the COVID pandemic have been lifted ahead of what is likely to be a devastating winter of disease and death.

After acknowledging the impact of the pandemic on the population and frontline health care workers, the letter begins by stating: “Our nation’s safety net is on the verge of breaking beyond repair; EDs are gridlocked and overwhelmed with patients waiting—waiting to be seen; waiting for admission to an inpatient bed in the hospital; waiting to be transferred to psychiatric, skilled nursing, or other specialized facilities; or, waiting simply to return to their nursing home. And this breaking point is entirely outside the control of the highly skilled emergency physicians, nurses, and other ED staff doing their best to keep everyone attended to and alive.”

As the ACEP notes, the number of patients who are being held in emergency departments awaiting care, also known as boarding, has reached a crisis level. The letter underscored that the staffing levels are dangerously low and wait times are worse now than at any other point in the pandemic. The Joint Commission has defined boarding as “the practice of holding patients in the emergency department or another temporary location after the decision to admit or transfer has been made.”

Current standards require that boarding times not exceed four hours, to avoid increased mortality and length of hospital stays. The violation of the “standard of care” is a particular problem for the poorest sections of the working class, especially those who lack health insurance or find it difficult to access their primary care practitioners. 

The ACEP wrote on its website, “Emergency care teams are strained to their limits. Demand for emergency care and services show no signs of slowing as we head straight towards this winter’s ‘triple threat’ of flu, COVID-19, and pediatric respiratory illnesses like RSV that are filling emergency departments. The influx of patients only piles more stress onto the shoulders of emergency physicians who are doing all they can to treat anyone who needs them.”

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