By Angela Stewart
The Star-Ledger
NEWARK, NJ — When it comes to quality of care, New Jersey’s emergency rooms are among the best in the nation. But with the rash of hospital closures in recent years, getting access to that care is becoming increasingly difficult, a study released yesterday found.
Overall, New Jersey received a grade of C+ for its emergency care, just slightly higher than the national rating of C-, according to a state-by-state report card issued by the American College of Emergency Physicians.
“We are average, but just like for our children, we want better than average,” said Bruce Bonanno, president-elect of the state chapter of the physicians’ group.
Massachusetts, Maryland and Rhode Island ranked at the top of the list, while Arkansas, Oklahoma and New Mexico brought up the rear.
In addition to access problems, New Jersey’s litigious culture helped pull down the state’s rankings. The average liability premiums for New Jersey primary care doctors ($20,993) and specialists ($93,628) were among the highest in the nation and 30 percent above average, according to the report. Meanwhile, malpractice awards last year averaged $369,077 in New Jersey compared with $285,218 nationally.
“The medical liability environment is a long-running problem for our state,” said Betsy Ryan, president of the New Jersey Hospital Association. “The sky-high premiums for liability insurance have caused shortages in certain physician specialties, and they’ve also reduced the availability of physicians who provide on-call coverage to hospital ERs.”
The report described the nation’s overwhelmed emergency care system as a “ticking time bomb,” which could get worse as more Americans lose their jobs and their insurance coverage in the shrinking economy. Between 1996 and 2006, the nation’s emergency rooms saw a 32 percent increase in patient visits, from 90.3 million to 119.2 million, and those numbers are expected to keep going up, the report said. Recent surveys also forecast shortages of primary care doctors, which is likely to exacerbate the already serious problem of emergency room overcrowding.
“We’re clearly getting busier, diversion rates are going up and this is just the tip of the iceberg,” said Dennis McGill, chairman of emergency medicine at Somerset Medical Center and current president of the New Jersey chapter of the physicians’ group.
The closure of eight acute-care hospitals in New Jersey over the last two years has had a big impact on access, with surrounding hospitals hard-pressed to keep up with the surge. The report ranks New Jersey last in the nation when it comes to the number of emergency departments per 1 million people - just 6.6, compared with the national average of 20.
Those figures are not lost on John Spooner, 69, of Plainfield, who ended up with a long wait after taking his girlfriend to JFK Medical Center in Edison a few weeks ago. The hospital in his town, Muhlenberg, closed in August, although it still maintains a satellite emergency room for non-urgent cases.
Spooner, who knew his girlfriend would likely require a hospital stay, said they arrived at JFK around 9:30 a.m. She wasn’t admitted to a hospital room until 10 hours later.
“It was very hectic, sort of controlled chaos,” he said. “It was so crowded that people were even lined up on gurneys in hallways around the nursing station because all the holding areas were filled.”
JFK spokesman Steven Weiss said emergency room volume has been “trending upwards” since Muhlenberg’s closure, but contended JFK is dealing with the same challenges as other emergency departments.
“We are certainly looking to expand and renovate our emergency room to handle the increase,” he said.
State health officials, meanwhile, said they have purchased new software to help keep tabs on things like ambulance diversions and have been encouraging greater use of community health centers for less serious medical emergencies to alleviate overcrowding.
“It’s a complex problem, but we see this as really critical to having emergency departments used for what they were supposed to be used for,” said Eliot Fishman, director of policy for the Department of Health and Senior Services.