Minorities, the elderly, and low-income people suffer the most when local emergency rooms close, according to a new study published this week. Longer distances to emergency rooms and protracted wait times increase a patient’s likelihood of dying by five percent, a trio of researchers from Harvard Medical School, the University of California, San Francisco, and the Ecologic Institute concluded.
The research team collected data from the California State Office of Statewide Planning and Development to measure the impact of 48 emergency room closures in the state between 1999 and 2000. In that period, more than 16 million Californians — a quarter of whom hailed from neighborhoods affected by emergency room closures — were admitted to hospitals. Deaths as a result of heart attacks and strokes also increased by more than 10 percent for those who had to travel further and wait longer for emergency medical care, researchers found.
“Disproportionate numbers of emergency department closures may be driving up inpatient mortality in communities and hospitals with more minority, Medicaid and low-income patients,” the group’s spokesperson said in the Los Angeles Times this week. “Our findings regarding the ripple effect of closures on surrounding communities suggest that it may be time to reassess the extent to which market forces are allowed to dictate ED closures and access.”
Oftentimes, medical facilities shutter in areas heavily populated with blacks, Latinos, or low-income residents, according to the National Institute of Health. That ultimately leaves those populations with less access to the care they need. A 2006 Institute of Medicine report cited patient waits of up to 24 hours for bed assignments and the divergence of ambulances away from emergency rooms at a rate of one vehicle per minute. A 2007 study in the Official Journal of the Society for Academic Emergency Medicine also found that children living more than a mile from emergency care facilities often utilized its services 11 percent less often than children in other groups.
A succession of emergency room and clinic closures has created what medical experts call “medical deserts,” or areas where medical services aren’t within close distance. In Detroit for example, more than 30 hospitals have closed in the last 50 years, leaving only four emergency care facilities to serve more than 700,000 people. In New York, the shuttering of more than two dozen neighborhood hospitals placed a strain on medical professionals and spurred legislation that would require hospital administrators to have a minimum number of nurses on call.
Some lawmakers are getting fed up with this dynamic. Last year, Vidant Pungo Hospital, a 49-bed facility based in a rural town by the name of Belhaven, N.C., announced it would close its doors because it could no longer afford to serve its working-class clientele. In response, Belhaven mayor Adam O’Neal walked from the small North Carolina town to Washington, D.C. — a distance of nearly 300 miles — as a show of solidarity with people who often face the dilemma of longer journeys to the emergency room after facility closures. In a press release, Neal drew parallels between hospital closures and a refusal by elected officials to expand Medicaid in their states. A host of other states — including Tennessee, Georgia, and Alabama — face similar problems.
“[North Carolina’s] refusal to accept expansion is taking 2 billion dollars a year out of our state’s healthcare system,” said Neal in the press release. “Americans need to realize the rural healthcare struggles across our country. In the last year, more rural hospitals have closed than in the previous 15 years. Every hospital closure means deaths!”