Thursday, June 22, 2006; A28

The Institute of Medicine's June 14 report, "The Future of Emergency Care in the United States Health System" [front page, June 15], provides evidence that the nation's emergency departments have reached a crisis point.

Emergency department overcrowding stems from an ever-increasing number of patients, who are often uninsured. However, "overcrowded" can also mean "understaffed."

While some rural hospitals have staffing difficulties stemming from a lack of physicians specialized in emergency medicine, others have excessively long waiting times for patients because of intentional understaffing by profit-seeking corporations hiring only enough physicians to "just get by."

Until the government steps in and takes measures to eliminate the ability of corporations to split off a portion of professional revenue above and beyond fair management costs, the state of emergency care will not improve.

TOM SCALETTA

President

American Academy of Emergency Medicine

Milwaukee

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I question whether anyone preparing the Institute of Medicine's report ever spent much time in an emergency room in the Washington area. They could find a quick way to lessen the load. People who are uninsured are not necessarily stupid, and their illnesses do not necessarily merit emergency treatment. Emergency rooms are the first choice of those who do not have insurance because they know that by law the ER has to take them.

If the Institute of Medicine could figure out a way that the uninsured could be accommodated in some other manner besides access to emergency rooms, the crisis in emergency care could be reduced.

RICHARD LAMPL

Rockville