Friday, September 25, 2009

Closing the Door for Taxpaying Citizens

I was up in the trauma ICU making rounds when we got the word that we were on divert for trauma due to lack of beds. Since we are the only level 1 trauma center for a huge area this is a big deal. I looked glanced at Fern the ward clerk and before I could even ask she said 18 between here and the SICU. This was the number of illegals or "undocumented" as the Feds say filling the ICUs. She then added there are 33 altogether on the trauma service. (There were three with the same name and same drivers liscence number but that is a different story.)
I would love to bring together the ACLU and our Congressmen and make them be the ones to explain to the greiving husband why his wife, mother of their three kids, school teacher and taxpaying citizen had to be sent 3 hours away while she bled to death because the Trauma Center that is payed for by her tax dollars that could have saved her life was too busy taking care of illegal immigrants. I wonder if he would feel consoled by the fact that the illeagal immigrant, drug dealing, gang banging MS13 member who took the last bed in the ICU was going to be fine as were most of the other illegals that filled the trauma service.


Andrew_M_Garland said...

Does triage operate only in the waiting room?

I would think that an "admitted" patient could be bumped back to the waiting room, or to a gurney in the hallway to take care of a critical, new case.

Throckmorton said...

Believe it or not there are federal guidelines on how many patients we can take. Where the problem arises is when the ICU's are filled as are the ORs. Then there is no where to put the patients. We try to perform what we can in what we call the critical hour. We know that if we can provide ressucitation and stop major bleeding in that hour there will be a higher chance that the patient will make it. To do this we need to have ORs available as well as the trauma teams good to go. We actually cancel scheduled cases in the ors when we dont have trauma rooms available and if necessary use the PACU (post anesthesia care units) as ICU if necessary but there is still staff and resource limitations. In this case we had all ORs were filled as well as the ICUs. We had the ED filled and had several illegals stacked in the ED trauma bay waiting to go urgently to the OR. We were already over our approved number of beds.

In regards to bumping patients back. We do do this with nonurgent cases. We will sometimes have 2 to three gurneys parked side by side, we call this yacht parking.

Oh, I hope it is alright, I used a version of your quote "we lose money on every patient but make it up in volume" in the comments section of white coats blog.

Andrew_M_Garland said...

Please reuse the quote at will. I did. The general idea floats around wherever business plans are discussed. In the last few years it has been applied to General Motors.

Many non-math people just assume that a business is supposed to lose money for the first few years, and will magically become profitable after that. The government particularly likes this model.

Of course, most businesses require setup and investment costs, but must make a profit on each unit sold, or all is bleak.

The real principle is: We charge a low price and don't make much money on each sale, but we make even more profit on higher volume.

SeaSpray said...

It must be difficult working under those conditions. I feel for the patients too.

It's just so wrong that this plays out like this.

SeaSpray said...
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