State's medical ‘non-emergency' list is ill-advised – and dangerous

What is a medical “emergency”?

Chest pain? No. Kidney stones? No. Congestive heart failure? No. Severe abdominal pain? No. Difficulty breathing? Again, no, according to the state of Washington.

In an effort to cut $72 million from the budget, the state has decided that these conditions – along with 700 more – are not true “emergencies” and will not be covered for Medicaid patients who exceed three visits to the emergency room for such conditions.

We are all faced with tough choices – especially with the budget problems facing all of us. Programs are being cut. Sacrifices are being made. And tough choices are happening every day.

But the tough choices should not come at the expense of quality patient care and at the expense of patient safety, especially for the most vulnerable among us – children, the elderly and the poor.

A mother should not have to choose whether or not to seek care for a child who cannot breathe from asthma. A pregnant woman who wakes in the middle of the night hemorrhaging should not have to question whether she is having a “real” emergency. Yet these are the tough choices the state of Washington is foisting upon Medicaid patients in the state.

This legislatively enacted policy unfairly targets children and the most vulnerable in our state. Children represent nearly two-thirds of the Medicaid patients in Washington. The proposed plan would significantly impact them.

Patients and parents may decide against seeking needed emergency care in fear of using one of their three allowable visits. This could worsen their health and leave conditions untreated – an especially risky scenario for babies, children and people with chronic conditions such as diabetes.

However, I suppose we can take comfort in the fact that the state made death an exception. If a patient dies from one of these “non-emergencies,” the family will not be billed for the ER visit.

As an emergency room physician in Tacoma, I am outraged and disheartened by the state’s plan to limit emergency room visits by Medicaid patients for what the state deems are non-emergent conditions.

Physicians and health care experts disagree strongly with the “list” – the state’s erroneous classification of true emergencies as non-emergencies. Such a policy is dangerous and could result in seriously jeopardizing the health of people who need emergency care.

Physicians, who treat patients every day, have been trying to work with the state to fix these errors. Unfortunately the list remains over-reaching and dangerous for patients.

As physicians, we are not blind to the budget difficulties facing our state and to the fact that cuts must be made. However, we are passionately opposed to doing so on the backs of our patients, at the expense of quality patient care and sacrificing patient safety.

Dr. Nathaniel Schlicher is associate medical director at St. Joseph Medical Center in Tacoma, a practicing emergency physician at the University of Washington Medical Center and a health care attorney in Tacoma.