Staff, money woes stand in way of Estero ER

Before the state temporarily outlawed the construction of freestanding emergency departments, Destin opened one.

The city’s hospital had closed, and the urgent care center was not getting the job done. A stand-alone emergency department was the logical choice, said Ellen Witterstaeter, chief operating officer of Fort Walton Beach Medical Center.

The emergency room cuts down the hour-long transport time on congested roads, even though the closest hospital is only 15 miles away, she said. It also helps keep ambulances in the area where they are assigned instead of taking them out of commission for long periods of time during the commute, she said.

Sound familiar? The unincorporated community of Estero in southern Lee County is also 15 miles from a hospital in either direction, and residents have long voiced concerns about ambulances navigating the heavy traffic. They want Lee Memorial Health System to build a freestanding emergency department in Estero.

The moratorium against such facilities will expire July 1, but Lee Memorial Health System is not yet ready to get out the shovels and checkbook.

The holdup has to do with money, staffing and strict guidelines for operating the emergency departments, said Jim Nathan, chief executive officer of Lee Memorial.

It takes money to build any new facility, and emergency departments are especially tricky because they don’t tend to make much profit; some even lose money, he said.

About 33 percent of patients at Lee Memorial Hospital’s emergency department cannot pay their bill, one-fourth of patients do not have the money at Cape Coral Hospital and one in five do not pay at HealthPark Medical Center, said Karen Krieger, Lee Memorial spokeswoman.

Most patients who have trouble paying do not have insurance, despite Lee County’s low unemployment rate, Nathan said. About 25 percent of residents in Lee and Collier counties did not have health insurance in 2004, the second-highest number of uninsured residents in the state, he said.

About 70 percent of the not-for-profit health system’s business comes from Medicare and Medicaid, which physicians are continually shying away from, he said.

“We’re begging to get physicians in hospitals to see paying consults,” he said.

Then there are the staffing issues. Out-of-area physicians sometimes balk at housing prices and head back north, he said. The state also is facing a shortage of nurses, although Lee Memorial has internship programs with Edison Community College and Florida Gulf Coast University.

The biggest challenge, however, is meeting guidelines set up by the Agency for Health Care Administration for freestanding emergency rooms, Nathan said.

According to AHCA’s rules, emergency rooms that are not part of a hospital are held to the same standards as hospitals. That means a stand-alone facility must have at least one trauma room, enough space for overnight patients and a helicopter landing pad. There also must be a certain number of physicians, including specialists, on staff 24 hours per day.

If the emergency departments do not make the grade, they will automatically be bypassed by emergency medical services and fire districts that have their own rules on transporting patients.

“They have to meet certain criteria. Right now, hospitals are the only ones that meet that criteria,” said Ashley Younger, spokesperson for Lee County Emergency Medical Services.

Lee Memorial Hospital is the only trauma center between Tampa and Miami. That means a trauma patient will be taken directly there, she said.

“It doesn’t matter if Gulf Coast Hospital is two miles away,” she said.

Lee EMS has two helicopters and can transport patients to any hospital in the area within six minutes, she also said.

Emergency workers use a color-coded system to determine whether a patient can be taken to Destin Emergency Care, Witterstaeter said. The emergency department usually sees a lot of victims of fender-benders, respiratory problems and jellyfish stings, she said. The emergency room gets from 25 to 80 patients a day, depending on the season, she said.

“It’s a lot of the kind of stuff people might go to a doctor for, but (the seasonal population does not) have a doctor in this area,” she said.

Patients with cardiac problems or any traumatic injuries automatically go to the hospital emergency room, which sees about 120 patients each day, she said. The system works because the emergency department at Fort Walton Beach makes enough money to support the stand-alone facility in Destin, she said. The medical center also does not struggle to keep doctors and has been able to recruit plenty of nurses from local colleges, she said.

Lee Memorial had hoped House Bill 715, which would have extended the moratorium until the Agency for Health Care Administration could rework some of its rules governing stand-alone emergency departments, would pass during the legislative session. The bill died at the last minute during a power struggle between legislators, Nathan said.

“It makes you sick,” he said.

Lee Memorial plans to sit down with AHCA officials to see if the agency will rework some of its rules, perhaps creating standards for a facility somewhere between an urgent care center and a full-blown emergency department at a hospital, he said.

“If AHCA is not interested, then health care providers, EMS and fire departments need to get together,” he said.

The agency is interested, but such standards would have to be carefully crafted, said AHCA spokesman Robert Burns. Emergency care statewide is at the forefront of the agency’s concerns these days, he said. In the past decade, emergency room visits have risen by more than 40 percent, from 5 million patients to 7 million patients per year, he said.

AHCA Secretary Alan Levine is working with the federal government on ways to fix the emergency-care crisis, he said.

“It’s a matter of coordinating emergency rooms without breaking the piggy bank and without breaking the law,” he said.

Despite the long road ahead, there is a bright side, said Sam Levy, an Estero resident who collected about 3,000 signatures on a petition asking legislators to let the moratorium expire.

“It’s important that the legislation is dying because that means there is no opposition to the idea of freestanding emergency facilities in the state,” he said. “The question is how do you get one?”