Cause of death: An overcrowded ER

I WORK as a registered nurse in the emergency room of an urban public hospital, and during one recent weekend, two patients died for no reason other than the fact that they were poor and uninsured.

Unfortunately, this is not an uncommon occurrence. A 2004 study by the Institute of Medicine estimated that 18,000 people died every year because of a lack of health insurance. In 1999, the same organization concluded that between 44,000 and 98,000 patients die every year due to medical errors.

It's one thing to read these statistics and be astounded by them, especially considering that we pay more per capita for health care than any other country in the world. It's another to see the impact of this system on people's lives every day.

As the number of people who lose their jobs increases, so do the number of people who lose their health insurance. Every day, I hear stories from people who had health care, but now have to turn to public hospitals for help after losing their jobs because of the current crisis. This has only added to the strain on an already strained system.

Because we are a public hospital that serves as a safety net, many other hospitals will treat patients for emergency situations, as they are required by law to do, and then refer them to us for follow-up surgery, doctor's visits and prescriptions. The clinics connected to the hospital are only able to see so many patients every day, so the overflow is sent to the ER. This means that wait times to be seen by a doctor regularly grow to unbelievable lengths.

On this recent weekend, the waiting room was so crowded that over 50 people were waiting to be "triaged" by a nurse to have their condition initially assessed. This is a recipe for disaster. Triaging is the first filter to make sure that critically ill patients get priority.

Worse, the wait time to see a doctor was over 24 hours. It's amazing to me that people will wait that long--it's not uncommon for them to just give up and come back another day.

One in five people who have jobs are uninsured--around 27 million people in all, accounting for about two-thirds of 44 million people who are without coverage in the U.S. Four in five of the uninsured come from a family where at least one person is employed.

But when you have to wait an entire day to see a doctor, taking the time to come to the hospital becomes a full-time job. It's not uncommon to see young children and infants at the hospital, not because they're sick themselves, but because their parents are, and they have no one to care for their children.

So many people don't come in when they need medical help because they can't afford to take the time off work to wait a day to see a doctor, or they cannot get someone to care for their children. This often only delays the inevitable, and they end up coming in when they have no choice because their health situation has worsened.

I can't even say how often I've asked patients how long they were suffering from whatever brought them in, and they've answered that it has been many months. Not infrequently, they have a poor prognosis only because they waited so long to come in. There's no legitimate reason that people should be forced to suffer like this.

ONE OF the patients who died this weekend had come in because he had suicidal ideas. Because of worsening economic conditions, this kind of patient is on the increase--being poor or unemployed are common causes of depression.

Since we don't have an in-patient psych facility, we hold these patients until a bed opens up at one of the publicly funded psychiatric hospitals. This process can sometimes take several days, as these institutions are consistently overcrowded.

An ER technician or nurse is assigned to watch the patients to make sure they don't harm themselves or others. This is referred to as a "one to one." But there's never a time when the ratio is actually one to one--the hospital worker assigned to these critical cases will often be responsible for six, seven or even eight patients.

Because no one was really watching this particular individual, he took an overdose of medicine and died. He was a young person who came in asking for help because some part of him still wanted to live, despite the hardship he was suffering. Our system failed him, and now, parents will have to bury their child because of this failure.

The other death was equally tragic and preventable. This person was in his 50s and came in because of chest pain. While sitting in the crowded waiting room, his family members repeatedly went to the desk to ask for help, stating that their relative was in severe pain and needed to see a doctor.

But with so many people in the waiting room, this is an all-too-common request--and people are told, sometimes callously, that nothing that can be done, and they'll just have to wait.

After 14 hours of waiting, the pain had become too much, and the family member insisted he be brought into the hospital. The patient collapsed before he reached a bed to be seen, and attempts to revive him were unsuccessful.

Because this took place after the translators had gone home for the day, one of the nurses served this purpose. She told me how the grief-stricken partner demanded from the doctors over and again: "How could this have happened? What am I supposed to tell my children?"

One could certainly place blame on the workers at the hospital who were supposed to be responsible for these two patients.

But if this seems fair on the surface, it's misplaced. Even the best health care workers, given a bad situation, make mistakes, and in an overcrowded hospital, it's a miracle that mistakes like these don't happen more often. This is little solace to the families and loved ones of the tens of thousands who die unnecessarily every year.

The statistics are staggering, even mind numbing--but every person who dies is someone's mother, father, daughter or son. Every one of these people had a life that was cut short because it isn't "good business" to provide health care to those who can't afford it. This is nothing short of mass murder taking place on a yearly basis, and it's all in the name of profit.

We can't be satisfied with the answer that is given to the patients in waiting rooms across the country. Something must be done, and we can't wait any longer.