Witnesses on Friday at a hearing of the House Oversight and Government Reform Committee said that U.S. emergency departments are overcrowded, understaffed and unprepared for large natural disasters or terrorist attacks, CQ HealthBeat reports. According to CQ HealthBeat, witnesses testified that, despite a number of reports that have highlighted the problems in EDs, "federal agencies charged with overseeing the nation's emergency health care system have done little to ease the burden."

William Schwab, chief of the Trauma and Surgical Division at the University of Pennsylvania Medical Center, said, "While the demands on emergency and trauma care have grown dramatically, the capacity to handle such demands has not kept pace." Schwab added, "There has been perhaps some transient coverage in the media, several dissemination meetings in various parts of the U.S., but no response has come from our government. Despite efforts by all constituents, little seems likely to be done to begin to manage the biggest crisis in American health care."

Rep. Elijah Cummings (D-Md.), who chaired the hearing, said that HHS "appears to be ignoring the mounting emergency care crisis," despite the billions of dollars spent on biodefense and flu pandemic preparedness. Cummings added that HHS has "not made a serious effort to identify the scope of the problem and which communities are most affected."

Questions for CMS
Cummings was "clearly irritated" that CMS administrator Leslie Norwalk failed to attend the hearing, CQ HealthBeat reports. CMS spokesperson Jeff Nelligan said that the agency asked the committee to reschedule the hearing, adding that the committee refused the request. He said, "However, we have provided written answers to several questions for which CMS input was sought."

Committee Chair Henry Waxman (D-Calif.) on Friday sent additional questions to Norwalk about the actions that CMS has taken to address the practice of boarding, in which hospitals admit ED patients when no rooms are available and leave them in hallways for extended periods of time, and diversion, in which hospitals reroute ambulances because their EDs have reached capacity. Waxman asked Norwalk to respond by June 29 (Carey, CQ HealthBeat, 6/22).

ACEP Report
In related news, a report released on Sunday by the American College of Emergency Physicians issued a grade of C- to the U.S. emergency care system and issued grades of C or lower to the systems in 80% of states, CongressDaily reports.

Rep. Tom Davis (R-Va.) said, "Our public health infrastructure, particularly emergency medical response capacity, is still not ready for prime time."

The report recommended an increase in the number of health care facilities in small communities, improvements in information-sharing among hospitals and government agencies and the enactment of a universal health insurance proposal that includes coverage for primary care (Leonatti, CongressDaily, 6/24).

C-SPAN video of the hearing is available online.

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