The House Committee on Oversight and Government Reform expressed growing concern Tuesday that hospital emergency rooms are not ready to handle a mass casualty event such as a terrorist attack using conventional explosives or a natural disaster.
There is a widening mismatch between the growing demand for emergency care and available supply, and the situation is aggravated by the Administration's Medicaid regulations on hospital emergency surge capacity, the committee said.
The Committee was warned by emergency care physicians last June that America's emergency departments were already operating at or over capacity, said Henry Waxman (D-Calif.), chairman of the Committee. "We were warned that if the nation does not address the chronic overcrowding of emergency rooms, their ability to respond to a public health disaster or terrorist attack will be severely jeopardized."
Despite the warnings, the Department of Health and Human Services (HHS) has issued three Medicaid regulations that will reduce federal funds to public and teaching hospitals by tens of billions of dollars over the next five years, Waxman said. In a November hearing, emergency physicians warned the Medicaid cuts will force a "devastating" financial hit on hospitals.
In preparation for today's hearing, the Committee majority staff conducted a survey of emergency room capacity in the cities most likely to face an attack, including Washington, D.C., New York, Los Angeles, Chicago and Houston. It also surveyed Denver and Minneapolis, where the nominating conventions will be held later this year. Thirty-four Level I trauma centers participated in the survey. Hospitals surveyed did not have sufficient ER capacity to treat a sudden influx of victims from a terrorist bombing. The hospitals had virtually no free intensive care unit beds to treat the most seriously injured casualties and did not have enough regular inpatient beds to handle the less seriously injured victims, the study found.
According to the study, the situation in Washington, D.C. and Los Angeles was "particularly dire." There was no available space in the emergency rooms at the main trauma centers serving Washington. One emergency room was operating at over 200 percent of capacity: more than half the patients receiving emergency care in the hospital had been diverted to hallways and waiting rooms for treatment. And in Los Angeles, three of the five Level I trauma centers were so overcrowded that they went "on diversion," which means they closed their doors to new patients, the study found.
"If a terrorist attack had occurred in Washington, D.C. or Los Angeles on March 25 when we did our survey, the consequences could have been catastrophic," Waxman said. "Our investigation has also revealed what appears to be a complete breakdown in communications between the Department of Homeland Security and HHS.
The most damaging of the Administration's Medicaid regulations will go into effect on May 26, and should be stopped until their true impacts can be understood, Waxman added.
Bruce Hoffman, a security studies professor at Georgetown University said hospital emergency rooms need to prepare by running test drills to be ready for not only terrorist attacks that involve weapons of mass destruction, but for suicide attacks made from homemade bombs, capable of causing "horrific" wounds.
HHS Secretary Michael Leavitt and Department of Homeland Security Secretary Michael Chertoff are expected to address the panel on Thursday.