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A Critical Situation For Area Hospitals
Primary-Care Needs Spill Over Into ERs

By Yamiche Alcindor
Washington Post Staff Writer
Monday, July 13, 2009

Hospital emergency departments across the region are overflowing with patients who have been battered by the recession and are increasingly using hospitals as their primary source of health care, according to local and national health officials.

At the District's Providence Hospital, emergency room visits increased by 13 percent in the past year. In Montgomery County, the number of patients seeking free care at community clinics designed to divert people from emergency rooms rose by 43 percent, many of them referred by hospitals.

The Virginia Hospital and Healthcare Association, which represents 106 community and specialty hospitals, said many of its members are at the breaking point. "Emergency rooms are being stretched to their limits," said Chris Bailey, the group's senior vice president.

A national debate is underway about how to reduce health-care costs and provide medical coverage to everyone. Diverting people from emergency rooms -- which are an inefficient and expensive way of delivering basic health care -- is a central issue, said Larry Gage, president of the National Association of Public Hospitals and Health Systems.

"The absolute number of people using emergency rooms has gone up as much as 20 to 30 percent in the last six to eight months due to the recession and people losing their jobs," he said. "The only option in their minds is going to the hospital."

To ease the strain, hospitals and community organizations are setting up primary-care clinics to serve low-income and uninsured patients at little or no cost. The Mary's Center clinic in Montgomery recently celebrated a year of treating patients who otherwise would have used the emergency room as their first option.

In the District, Howard University opened the New Freedmen's Clinic last month to provide checkups, referrals and counseling to reduce the emergency room load. Howard experienced an 11.4 percent increase in emergency room visits from 2008 to 2009.

"I'm hearing a lot of people say: 'Please help me. I lost my job,' " said Raolat Abdulai, director of Howard's free clinic. "It just shows how desperate things are right now. People really need health care."

The use of hospitals for chronic, but manageable, ailments is a long-standing problem. The poor economy, officials said, has not helped.

"Clearly, the economy has caused people to lose insurance coverage," said William Strudwick, director of the Providence's emergency department. "It's not only individuals. We see all family members. Oftentimes a person who is the head of the family loses their job, and that affects the coverage of the whole family."

Last year, Providence and the D.C. Primary Care Association launched the ED Diversion Project, which places community health workers in waiting areas to help patients obtain primary-care doctors and sign up for Medicaid and Medicare coverage.

Zoila Alvarez, who arrived in the United States three years ago from El Salvador, has been a patient at Mary's Center for a year. Before she found the clinic, she sought prenatal care and treatment for depression at hospital emergency rooms, she said.

"This place saved me," she said.

Albertha Boone, 55, of Southeast Washington, can relate. Her last visit to a primary-care doctor was in 1989, she said, even though she has asthma and high blood pressure and needs to have major knee surgery.

For years, Boone has limped into cold and chaotic emergency rooms every time she felt sick. She said she was unable to afford her prescription medication and has come to rely on over-the-counter products -- ibuprofen, lotions and heated gel packs -- to try to ease the chronic pain.

She said she has a monthly income of $1,400: $1,000 from a disability check and $400 from a part-time job as a clerical assistant. After she pays rent -- $800 -- she uses the remaining $600 to pay for utilities and buy groceries. She said that she has Medicare coverage but that it won't pay for regular doctor visits or for the knee surgery a doctor has told her she should have. So when she needs care, she will continue to go to an emergency room for treatment.

"You have to keep going," she said. "The good Lord brings you through."

Boone is exactly the type of patient health officials hope to steer into clinics that provide preventive care.

"Moving forward, we need to do more so that people are aware of clinics in their neighborhoods," said Pierre Vigilance, director of the D.C. Department of Health. "We have to make sure that these clinics are available to people when they need them."

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