Democrats Warn About Hospital Capacity

"Other"

05/06/2008

By Spencer S. Hsu and Mary Beth Sheridan
Washington Post
Tuesday, May 6, 2008


Hospitals in seven major U.S. cities would be overwhelmed if any of the cities were struck by a terrorist attack on the scale of the 2004 train bombings in Madrid, and shortages of emergency room capacity and intensive care beds will grow worse if Bush administration Medicaid changes are implemented, House Democrats charged yesterday.

In a survey by the House Committee on Oversight and Government Reform, more than half of 34 hospitals in five U.S. cities deemed at greatest risk of attack and two cities that will host this summer's national political conventions said they had no emergency room treatment space available to accept severely injured patients.

The March 11, 2004, bombings in Spain killed 191 people, injured more than 2,000 and sent as many as 270 patients to a single hospital within three hours. In New York City, only 56 Level 1 emergency room treatment beds were available on the afternoon the House survey was conducted, Tuesday, March 25. The six other cities had fewer beds available.

"America's emergency departments are already operating over capacity," said the committee chairman, Rep. Henry A. Waxman (D-Calif.). Despite warnings, he added, the Department of Health and Human Services "has issued three Medicaid regulations that will reduce federal funds to public and teaching hospitals by tens of billions of dollars over the next five years."

Rep. Christopher Shays (Conn.), the senior Republican on the panel, said he agreed that changes are needed to the administration's Medicaid plan but cautioned that making them would not create adequate hospital "surge capacity" by itself. "Stabilizing Medicaid payment policies alone won't guarantee readiness against bombs or epidemics any more than the annual cost-of-living raises assure people they're safe against inflation or a recession," he said. "It's a factor, to be sure, but not the sole . . . element to worry about."

Rep. Darrell Issa (R-Calif.) said Democrats were exploiting long-known hospital capacity problems to score political points in a debate over Medicaid's future. "I am particularly concerned that a partisan, amateur survey was done to justify and politicize today's hearing," he said.

President Bush has threatened to veto legislation passed by the House last month that would impose a one-year moratorium on Medicaid reimbursement changes sought by HHS. States argue the changes would shift costs of the program to them, but the White House argues that states are padding their overall budgets with the reimbursements.

Planned changes to the program, which provides medical insurance for the poor, would eliminate reimbursement for residents and interns at teaching hospitals and payments to public hospitals. The Congressional Budget Office says the moves would reduce federal spending by about $17.8 billion over five years.

Jay Wayne Meredith, chairman of the general surgery department at Wake Forest University Baptist Medical Center, testified yesterday that the changes would cost his hospital $36 million, on top of $4.5 million it spends on its trauma center and $13 million to care for the uninsured. "We will go under," he said, warning that the hospital would have to kill its trauma center. "I just beg you, stop the Medicaid cuts."

In the committee's survey, Washington and Los Angeles hospitals were especially strained. Three of five Los Angeles hospitals were diverting ambulances to other hospitals on March 25. Two Washington hospitals that responded to the survey reported no available beds.

Washington Hospital Center was operating at 286 percent of capacity, making it the single most overcrowded hospital surveyed. Hospital officials and Republican aides said the statistics are misleading because emergency room space and inpatient beds would be cleared in an actual emergency. Other cities surveyed were Chicago, Houston, Denver and Minneapolis.

"Given the increased financial stress on our nation's health system in general -- and urban hospitals in particular -- any degradation of our existing capabilities will pose major challenges to our nation's readiness for an attack," testified Bruce Hoffman, a terrorism analyst at Georgetown University. He said the opposite approach is needed: strengthening preparedness for conventional suicide bombings.