Low expectations column

Living with low expectations
in the Palmetto State

By Brad Warthen
Editorial Page Editor
SHORTLY AFTER midnight, at the weary outset of Friday morning, a heavy-set woman stood outside the elaborate revolving doors of the Palmetto Health Richland emergency department, smoking a cigarette.
    She tilted her head at the sound of a distant siren, the volume and Doppler effect indicating its rapid approach.
    “Here they come again,” she said with resignation. “They bring in another one, we go to the back of the line.”
    I was standing nearby, preferring the mists of the night to the unwholesome miasma of the packed waiting room. A few moments earlier, I had used the last few drops of energy in my PDA to post this brief comment on my blog (hey, as a distraction it beats ragged old copies of People):
    I’m standing outside a hospital ER at 11:52 p.m., waiting for MY turn to go in and see my daughter, hoping they’ve started the IV that I’m pretty sure she needs (you know how it is in a state that refuses to adequately fund mental health or other essential services — if you have an emergency, you’ll be treated in a hallway if you’re lucky enough to get treated at all)….
    In the hallway, she could only have one visitor at a time. She eventually got into a room, receiving about four liters of fluid, and got stronger. I’ve got no complaints at this point about her treatment — certainly not against Palmetto Richland. The crowding at Lexington Medical had been worse. It was the worst I’d ever seen it, and with five mostly grown kids, I’ve seen it a few times. So we were at Richland.
    It’s not the fault of either hospital. It’s just a fact of life in South Carolina. Like the woman with the cigarette, we’ve come to accept it. Go to an emergency room on a typical evening, and if you’re not bleeding out your eyeballs, you’ll generally have a long wait. My experience tells me that if, for instance, you need some stitches and a tetanus shot but don’t have anything life-threatening, you should not be surprised to wait as long as four hours. It’s not always that long, but you’re no longer surprised if it is.
    (My daughter was “lucky” in that she obviously needed quick treatment for dehydration caused by a two-day stomach bug.)
    I don’t know, specifically, what caused the backlogs of Friday’s wee hours. I suppose if I had about a month and could get around the HIPAA privacy rules and track down every patient and interview them, I could give you a reliable answer.
    But I do know that there is a constant, underlying condition in this state that causes ER waiting rooms to overflow whenever other human variables — a rash of wrecks on a slippery night, a stomach virus going around — collide with it: Hospital beds are occupied by the mentally ill, who are often found on the streets, off their meds, and police have no other place to put them, their jail cells being full of actual criminals.
    The variables may be hard to pin down in a specific instance, but that one constant is not.
    “It’ll happen the same way tomorrow night and the night after that,” says Thornton Kirby, president and CEO of the S.C. Hospital Association. But there are two constants, not one, he reminded me. The second is the fact that so many uninsured people go to the emergency room for their basic medical care, not just when they’re in crisis. As the sign behind the desk at the Richland ER proclaims, in both English and Spanish, the hospital is forbidden by law to turn you away if you need medical care. Regardless of your ability to pay, the medicos have to do what they can for you.
    That second constant is a national problem, although the responsibility for it is shared by the states, via Medicaid funding and administration. The first one seems to be particularly acute in South Carolina. It’s related to the underfunding of the state Department of Mental Health over the last few years. People with brain problems who formerly would have received greater attention and care from the state now wander our cities, seriously strung out, a danger to themselves and others.
    So eventually they end up in an ER — quite likely at a comprehensive indigent care facility such as Richland — where they wait for someone to figure out something else to do with them. That can take a while.
    So the rest of us, when we have a situation that won’t wait until regular doctors open shop in the morning, find ourselves waiting much of the night, and accepting it, because that’s the way things are in South Carolina.
    We accept it the way we accept people whizzing past us at 90 miles an hour on the interstate (or faster, in the case of the lieutenant governor), secure in the knowledge that they will not be ticketed. There simply aren’t nearly enough troopers on the road to enforce the speed limits, and everybody who didn’t just fall out of the stupid tree knows it. This is because the folks who make up our state budget haven’t stepped up to pay for such enforcement.
    But hey, rest assured that when a loud minority of homeowners whose McMansions are appreciating too rapidly squeal about it, our state lawmakers take quick action to slash their taxes radically — by raising the sales tax on all of us, but refusing as usual to reform the overall tax system comprehensively, to make it fair and effective for a change.
    They can’t assess the state’s actual needs, set priorities and address them, but they can surely lubricate a squeaky wheel in one quick hurry — just in time for elections, in fact.
With our elected followers set to come back and do their thing for another half-year starting Tuesday, I stand out in the misty night, thinking about stuff like that.

5 thoughts on “Low expectations column

  1. Harold A. Maio

    “People with brain problems who formerly would have received greater attention and care from the state now wander our cities, seriously strung out, a danger to themselves and others” implies a great deal.
    Editorials are allowed to do that.
    Inside a state institution no editor could observe “attention” or “care,” it is not permitted, but we have all learned to claim it.
    And we have all read the history that denies it. Much of that history we have read in journalism, which perennially exposed the abuses, and praised “reforms,” perplexing at least this reader.

  2. Steve

    I get it, Brad. The problem is that people who have spent their lives working hard to earn the money to buy a nice house should pay more taxes so people who have made bad choices can get free medical care. That makes sense.
    Illegal alien? Sure, come take my wallet. Drug addict? Sure, why don’t you just sleep in my spare bedroom. Unmarried mother with three kids by three different fathers? Sure, come on down and take my car.
    Why shouldn’t EVERYONE pay more for the services that EVERYONE uses? Please provide us with a rational explanation of how earning more money means someone automatically should be forced to pay more for the same services. Why don’t I pay more for my food at the grocery store while we’re at it so that someone who makes less can have a steak too?
    So you had to wait a couple hours in a ER so your daughter could get an IV. Wow… that was a compelling drama. Sorry you had to be put out.
    You live in a fantasy world where you think the government can solve all the problems.
    Maybe if we removed all the government regulations that stifle hospitals we’d see better healthcare. Remember The State’s hand wringing over Lexington Medical opening a heart center? Maybe that heart center would provide the profits that would allow them to increase the staff in the ER.
    And maybe if our state legislature wasn’t full of crooked lawyers, we might get some tort reform and insurance industry reform that would allow hospitals to focus valuable resources on patient care instead of litigation avoidance. And maybe if we had a Medicare system that wasn’t fraught with fraud, waste, and bureacracy we’d see a more efficient health care system.
    Will any of that happen? Nope. It’s the system Brad Warthen loves. Government by the crooks, for the crooks, and of the crooks.

  3. Brad Warthen

    Actually, property taxes have no bearing upon this — except to the extent that the state forces local governments to support local mental health departments.
    I wasn’t really talking about that problem, though — I was talking about state funding, none of which comes from property taxes.

  4. Lee

    If our tax money was not wasted on illegal aliens, recent immigrant non-citizens, and assorted bums, there would such a surplus of “state money” that we could abolish the antiquated property taxes.

  5. Don Lloyd

    I found your description of the ER experience very compelling (Editorial of 1/7/07). I only wish that many more South Carolinians would understand how fragile our medical infrastructure has become as a result of the uninsured and the mentally ill. I serve as an Administrator for a general acute care hospital in Marion County. We certainly have more than our share of economic and social challenges here that increases the use of our ER. We do the very best that we can to provide basic medical care to an uninsured population that seems to grow exponentially each year. It is part of our mission to serve all of the citizens of our communities, regardless of their ability to pay for their services. We provided over $4 million in charity care to this population last year.
    Despite these challenges, what overwhelms and frustrates these efforts however, is the absolute disregard of our beaurocracy to deal with the plight of our mentally ill. Marions’s rural hospital has frequently declared a diversion emergency and sent emergent patients some 35 miles to the next closest hopsital because our 16-bed ER was overwhelmed with mental health patients who had no medical emergency. Many of these patients are referred to our state’s hospitals by communnity mental health clinics and law enforcement agencies.We in essence house mentally ill patients with no acute medical crisis. While housed in our ER, these patients are simply boarded and rarely recieve therapuetic mental health interventions. We frequently have mentally ill patients (served by a variety of state agencies) living in our ER for weeks while awaiting placement,a determination of eligability by a state agency, or waiting on dueling state agencies to make up their minds as to who will serve these patients. All the while, patients with true emergent medical needs must wait longer on medical treatment because limited resources are diverted to serve individuals who are in reality living in the ER.
    As a recent former State employee, I saw first hand the constant infighting of state health agencies over the management and treatment of our citizens with mental illness. To complicate matters, these very same agencies believe that our state hospitals should serve as the repository for the mentally ill. This is especially true when it is inconvenient for these agencies to do so. To add injury to insult, our state health regulators limit what we as acute care hospitals can do to house and care for these patient because we are licensed for acute care and not psychiatric care.
    Would you please inform me as to who is accountable for this mess? No one in State government seems to want to assume responsibility for resolving this issue. The usual response is pass the buck. The state agencies blame the Governor and the Legislators, and they in turn blame the agencies. Who is in charge?
    If there has ever been a compelling argument for state agency consolidation, the crisis with our mentally ill speaks volumes.

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