Hearing of the House Oversight and Government Reform Committee - The Lack of Hospital Emergency Surge Capacity
Hearing of the House Oversight and Government Reform Committee - The Lack of Hospital Emergency Surge Capacity
BREAK IN TRANSCRIPT
REP. DARRELL ISSA (R-CA): Thank you, Mr. Chairman, for holding this hearing. I ask that my entire opening statement be put in the record.
REP. WAXMAN: Without objection.
REP. ISSA: Mr. Chairman, I'm troubled with today's hearing for one reason. I think there's a legitimate problem, overcrowding of our emergency rooms. That overcrowding comes from a combination of illegal immigration, legal immigration, and a pattern of going to emergency rooms when, in fact, urgent care would be a better alternative.
I think it's part of a bigger problem we particularly in California face, that we have, in fact, a large amount of uninsured. But they're not uninsured. They're insured at the emergency room. That overcrowding needs to be dealt with. And I trust that on a bipartisan basis, in good time, we will deal with the challenges created by illegal immigration, individuals who, either because of that or because they lack insurance, are choosing the emergency room over more effective and efficient delivery systems.
Having said that, I particularly am concerned that a partisan, amateur survey was done in order to justify or politicize today's hearing. It's very clear, both by the ranking member's opening statement and by the facts that we will clearly see here today, that a survey of emergency rooms done by Democrat staff for the purpose of getting the answer they wanted, which is, of course, we're overcrowded at the emergency room, is self-serving and unfortunately short- sighted.
The number of beds that could be made available in a hospital. The number of health care professionals -- doctors, nurses and the like, that could be brought to bear within a period of time, would have been part of any effective analysis of what the surge capacity could be; the number of patients who, although in the hospital, could be removed to other facilities of lesser capability to make room for severely injured people.
Although this would not change the fact that if we had a Madrid- type occurrence, even in a city like Los Angeles 2,000 severely- injured people would strain our capacity in the first few hours, and undoubtedly -- undoubtedly -- just like a two hundred car pile-up on the 405, we would have loss of life that we would not have in a lesser occurrence.
I do believe that the challenges of Medicare and Medicaid, in dealing we escalating costs -- and particularly for California, the cost of reimbursement, which has not been sufficient, needs to be looked at. I hope that we can work on a bipartisan basis to deal with these problems. I hope that today's hearings will, in fact, cause us all to understand the causes and the cures for overcrowding of our emergency room.
However, I must reiterate that the federal response for this type of emergency needs to be to pay to train, and to pay to test for these kinds of emergencies. That's the appropriate area for the federal government to deal with, in addition to providing certain lifesaving resources such as mass antibiotics like Cipro, and, of course, small pox and other vaccinations in the case of an attack.
These are the federal responses that were agreed to after 9/11 on a bipartisan basis, and I would trust that, at the minimum, we would not allow an issue such as how much is reimbursed to California on a day-to-day basis to get in the way of making sure that we fully fund those items which would not, and could not be funded locally or by states.
Mr. Chairman, I look forward to today's hearing. You have a distinguished panel that I believe can do a great deal to have us understand the problem. With that, I yield back.
BREAK IN TRANSCRIPT
REP. ISSA: Thank you, Mr. Chairman. And I ask unanimous consent to submit eight documents into the record that reflect the commonwealth of Virginia's emergency response preparedness, both alone and in conjunction with the rest of the national capital region.
REP. WAXMAN: We'll review the documents before we're willing to give unanimous consent, and we'll see if we can get the unanimous consent.
REP. ISSA: So you're reserving an objection?
REP. WAXMAN: I object until I get a chance to review the documents.
REP. WATSON: Mr. Chairman, can we see the documents too? I don't want to vote unless I know what it is.
REP. ISSA: Mr. Chairman, here are the documents.
Dr. Lewis, before I ended the last round, I was just going to comment that in your own statement, you had said that you had surge capacity. You could bring in people that you wouldn't otherwise have, but it would put you into the red. And I'm not going to further elaborate because of the shortness of time.
But if you have 48 beds and you don't fill them and 14 people stay boarded, to me it sounds like you were unwilling to go into the red in order to board those people, that you did have 48 capacity, assuming those higher-cost resources were available, but you chose -- your hospital chose not to do it that day.
Dr. Kaplowitz, I'm very intrigued by your testimony, these documents that are pending going into the record. If I understand you correctly, if there were a significant crash or something on the orange line or blue line today, representing dozens or even maybe 100 significant injuries, you would be prepared to put together the resources to take care of that. Is that correct?
DR. KAPLOWITZ: We would be working very closely with the District of Columbia and Maryland in terms of appropriate distribution of patients, working through EMS as well as the hospital. We'd activate our northern Virginia coordinating hospital, which is at Nova Fairfax, and do the best we can for optimal distribution of patients.
I can't tell you what would happen. First of all, that could be anywhere.
REP. ISSA: Sure. I understand, on a given day, that you can't answer. But in general -- and we'll go back to Virginia Tech. Virginia Tech was an example of the worst of all worlds, a place you didn't expect it, a weather condition that wasn't cooperative, and hospitals that generally were not prepared. And yet the response, looking back, you were able to rise, using resources, as you could transport people and/or -- people one direction or the other. Is that correct?
DR. KAPLOWITZ: Virginia Tech was not truly a mass-casualty event. It stressed rural hospitals. And we were prepared to pull in people. However, no hospital was pushed beyond what they were capable of doing and it wasn't hundreds of people at the same time.
REP. ISSA: Right.
And Doctor, I know it's always unfair to do hypotheticals. But in general, the amount of times that America's going to be attacked en masse by a dirty bomb, chemical attack or aircraft from the sky, compared to the amount of time in which an airplane crashes as it's landing in Iowa -- a DC-10; the blue line does have an electrical failure and people are damaged or burned; a gasoline truck on the 405 jackknifes and bursts into flames; a fire in a refinery such as Long Beach; a widespread hurricane or tornado that injures many -- aren't all of these dramatically more likely -- and I'll be self-serving and say since it happens every year in America -- every single year one or more of these, actually, almost all of them happen at least once or twice a year -- mass causalities occur every year in America.
Isn't it true that, in fact, if we take the war on terror, the likelihood of another attack like 9/11 completely out of the scenario, that the need is greater in frequency and even likelihood of dozens or hundreds of people needing care, isn't it greater based on these -- and I'll throw in just one more just for good measure, Dr. Lewis -- an earthquake in Northridge?
DR. MEREDITH: Yes, it is. And we're not ready to deal with that.
REP. ISSA: Okay.
DR. MEREDITH: Whether you survive an injury in America today on Interstate 40 from Wilmington, North Carolina to Barstow, California depends on where you get hurt and how well the trauma system is organized between those two points.
REP. ISSA: And Dr. Kaplowitz, I'm particularly intrigued, because you seem to be positive in saying that at least within the resources available, Northern Virginia and Virginia in general has done a good job of being prepared. And I'm particularly concerned, because I'm a Californian, and it appears as though California feels they're not prepared.
Could you comment further on why you feel fairly prepared within the resources available?
DR. KAPLOWITZ: Preparedness is all relative. We've put a great many things in place to go beyond where we were on 9/11. I can't tell you how we would handle hundreds -- you know, whether people would be happy with how we handled hundreds. We would have a plan, a communications system.
REP. ISSA: One final question for the panel.
If I had a $1 billion sitting in the center of this room and I gave it to you for preparation, training for these mass events or I spread it around the country to staff up or reimburse Medicaid, which would you rather have that $1 billion go to -- assuming there was only one pile of $1 billion available today?
DR. KAPLOWITZ: I would like to see our emergency departments and our capability able to function on a daily basis, because much as I've talked about surge, I also agree that if we don't do a better job on handling emergencies on a daily basis, we're going to be at a disadvantage when there is a mass causality event.
We have to be able to empty our emergency rooms more rapidly, because that's going to be even more important in an emergency event. Again, I'm positive in terms of what we've put in place and the kinds of communications; however, I recognize full well the stresses on our emergency system on a daily basis and we can't ignore that. They're interrelated.
REP. ISSA: Mr. Chairman, I'd appreciate it if the others could answer for the record which way they would spend the money -- or if you'd like to give them additional time.
REP. WAXMAN: Whichever of you want to respond.
Yes, Dr. Lewis.
DR. LEWIS: I agree, absolutely, with what Dr. Kaplowitz said.
But in addition, I'd like to point out that even if one chose to spend the $1 billion on training and equipment and things that would only be used in those very unusual events that you pointed out, one of the key decisions is whether we want to be prepared for the most likely of those catastrophic events, or whether we want to instead be prepared for the least likely -- meaning bio terrorism or nerve agents.
MS. WELSH: I would take the $1 billion and apply it to the public health infrastructure in our country. That is critical to any kind of a response in any kind of a disaster. And we are in grave danger of really crumbling public health infrastructure in our country.
DR. MEREDITH: You could fund the federal infrastructure to support the states to develop trauma systems for $20 million or $10 million -- million -- "m" million dollars. You know, you'll drop that on the way to work in the morning. So that should be done.
The next piece is -- just to your question, Representative Issa -- can we plan to surge on a daily basis and always be ready nationwide? I don't think that's doable or the smart way to do it. But I do think we are not ready on a daily basis to do what we have to do every day, and that frightens me immensely, because we're not prepared for a bomb in a cafe or the mall or a bus falling off a bridge, because we don't have the capacity on an every day basis.
MR. HOFFMAN: This isn't exactly my expertise, but I would say that I agree completely with Dr. Lewis's statement.
And I would point out that as unlikely as a terrorist attack may or may not be in the future of the United States, I think that the American people would expect that years after 9/11, we would be prepared adequately to respond to any kind of threat like that.
BREAK IN TRANSCRIPT
Source