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Los Angeles Times –
Nov. 25: The emergency room at White Memorial Medical Center on Los
Angeles' Eastside was buzzing when paramedics arrived on a Friday
night with an elderly man slurring his words and complaining of
aching bones.
The nurse in the receiving bay immediately ran through standard
triage questions: "Are you diabetic? Do you have high blood
pressure? Are you allergic to any medications?" Each drew the same
response: "I don't know."
The hospital and doctors had no record of the man or his medical
history. And with their only guide a piece of crumpled paper they
found tucked into the man's pants that seemed to indicate he might
have had cancer, doctors had to order a full diagnostic work-up,
including blood tests and an EKG to check his heart.
It was another night of high-priced detective work at one of
America's urban hospitals.
"We're mostly flying blind here," said Dr. Brian Johnston, the
senior emergency room physician at White Memorial, shaking his head
at the high costs generated by the lack of records and unnecessary
testing.
Waste bedevils much of America's fragmented healthcare system,
driving up already skyrocketing costs. As health spending overwhelms
government budgets, the stakes are especially high for safety-net
institutions like White Memorial that serve the country's poorest
patients, largely at taxpayer expense.
The best safety-net systems in Denver, Dallas, New York and
elsewhere have found ways to practice medicine more efficiently,
using electronic records and integrated systems to manage care for
low-income patients and cut costly hospitalizations.
In Los Angeles, Chicago and many other cities, local healthcare
officials are now scrambling to catch up.
"There is really no system of care here," said Allen Miller, a Los
Angeles consultant who is working with private hospitals, clinics
and physicians on a potentially trailblazing initiative to link
together medical providers that care for some of Los Angeles
County's neediest patients.
Nationally, most emergency doctors reported in a recent survey by
the American College of Emergency Physicians that at least a quarter
of their patients had gotten tests that could have been avoided with
better access to medical records.
Adding to the inefficiency, White Memorial and many other hospitals
that care for low-income patients have few resources to ensure that
their patients are getting needed care once they leave the hospital.
That can lead to complications at home and costly trips back to the
emergency room. Studies show that poor patients are much more likely
to end up back in the hospital.
At a place like White Memorial, where about 85% of the patients are
on Medicaid, Medicare or some other government health insurance
program, the cost of that waste is borne directly by taxpayers.
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