It took ambulances carrying Baton Rouge patients two minutes longer on average to arrive at an emergency room last year than it did in 2012, before two ERs closed in the city.
Exactly how these longer transport times have affected health outcomes is unclear. But a look at data collected by the East Baton Rouge Parish Emergency Medical Services Department shows that the amount of travel time to bring a patient to an emergency room has increased steadily over the past few years.
“In a true life-threatening emergency, I think time is one of the most important factors,” said Mike Chustz, EMS spokesman. “Any delay — traffic, weather, on the scene, going to the scene — any delay could have consequences.”
The long distance to an emergency room for people living in north Baton Rouge has grown into a prominent issue in recent months, garnering attention from politicians and community organizers. Residents and local leaders say they want to see a change, warning of potential health perils to some of the poorest people in the city-parish.
Local hospital leaders have downplayed any concerns about a lack of ERs in north Baton Rouge or Mid City, saying the ones in the south part of the parish and Zachary can safely provide the needed care for everybody across the region. They’ve also said they simply cannot afford to build emergency rooms and hospitals back into the areas the companies have left.
Baton Rouge General’s Mid City campus was bleeding $23.8 million before its emergency room closed in 2015, while state officials shuttered Earl K. Long Medical Center, which previously provided care for indigent patients, in 2013, saying it made more sense to move to a contract with a private hospital than rebuild the dilapidated facilities in north Baton Rouge.
EMS transport data mirrors the changes in ER options. In 2012, it took paramedics and emergency medical technicians 13 minutes and 32 seconds, on average, to drive from where they picked up a patient to the hospital. The transport time rose by 32 seconds the year the Earl K. Long Medical Center closed, transferring care of their patients to Our Lady of the Lake Regional Medical Center on Essen Lane. It increased again to reach an average of 15 minutes and 40 seconds last year, during which Baton Rouge General’s ER closed on Florida Boulevard in March.
Numbers for the first quarter of 2016 show another increase. Transportation times rose to an average of 16 minutes and 19 seconds during the first few months of this year.
Chustz said having an emergency room in north Baton Rouge should cut down on transportation times and drop times, which is how long is spent off-loading patients at hospitals. Drop times averaged 22 minutes and 25 seconds in 2015.
Hospital heads point out that most people in dire emergencies — such as trauma victims who have gotten in car wrecks, who are bleeding from gunshot wounds or who have fallen down — would skip over an emergency room in north Baton Rouge regardless. Those patients need to be taken to Our Lady of the Lake’s Trauma Center in south Baton Rouge, which has the needed array of specialists on staff at all times that other hospitals do not have for the most acute emergencies.
Still, local leaders believe some kind of emergency room will improve overall care in the north part of the city. State Sen. Regina Barrow, D-Baton Rouge, and East Baton Rouge Parish Metro Councilwoman Chauna Banks-Daniel are testing the waters to see if a company would open a freestanding emergency room in the Champion Medical Center near the Baton Rouge Metropolitan Airport.
That could be a tough task. Once an area loses hospitals and emergency care, it can be difficult to bring them back. Alan Sager, a Boston University health care policy expert, has tracked more than 1,000 hospitals across the nation going back to the 1930s.
His research shows hospitals have been more likely to close in black neighborhoods each decade.
“If you go downhill and abandon or relocate emergency rooms, operating rooms, stat imaging labs, it can be hard to re-create them,” Sager said. “If the need is there, it’s possible to re-establish services. But that requires a commitment, and it does require adequate financing.”
ER vs. trauma center
EMS data shows that its total call time — how long it takes from the moment ambulances are notified of an emergency until they drop off of a patient at the hospital and move onto the next one — has gone up by 7 percent since 2012. The department’s call volume also has increased by 12 percent since 2012.
The increases are a concerning statistic to Metro Councilman and parish mayor-president candidate John Delgado, who said it shows that the entire city-parish is affected by the lack of an emergency room in north Baton Rouge. Chustz said EMS has not increased staffing or equipment.
“Are we now going to have to put more ambulances on the street and what cost to taxpayers?” Delgado asked.
Proximity to an emergency room, rather than the level of care, is most important in four cases: when paramedics are unable to find airways and make patients breathe; when patients are in traumatic cardiac arrest; when more than 40 percent of a person’s body is burned and they have no IV or cannot breathe; and when air is escaping out of a patient’s lungs and into their chest. The Louisiana Emergency Response Network directs those patients to the nearest emergency room. A smaller emergency room might create an airway on a patient before he or she is transferred to a trauma center.
“If I had a cardiac arrest, the person’s not breathing, they have no pulse, of course I’m going to take them to the closest hospital,” Chustz said.
Whether future patients could go to a hypothetical north Baton Rouge emergency room depends on the level of care the ER would offer. For example, Chustz said the Earl K. Long center did not treat head injuries, so proximity to that hospital, when it was open, didn’t help patients with head wounds.
Chustz said the biggest benefit of having an emergency room in north Baton Rouge would be for patients who are not in need of critical care but still call ambulances. They include diabetics with blood sugar issues, people with broken bones and others who can tell that they do not feel right but are not sure what the problem is.
Our Lady of the Lake’s Trauma Center will nearly always receive the trauma calls. Among the many incidents qualifying for transport to a trauma center are adults who have fallen more than 20 feet; children who have fallen 10 feet; and people ejected from vehicles, run over by vehicles or in motorcycle crashes going more than 20 mph. People who have been shot also are typically taken to a trauma center.
“In trauma, oftentimes, you bypass,” said Paige Hargrove, Louisiana Emergency Response Network executive director. “There’s so much literature out there to support that those trauma centers have the ability to find something that others don’t.”
Our Lady of the Lake also has the city’s most robust Stroke Center — a level two — in comparison with the level-three stroke centers at Baton Rouge General, Lane Regional Medical Center in Zachary, Ochsner Medical Center and others.
Scott Wester, chief executive officer at Our Lady of the Lake, said people should realize they are getting better quality of care when they go to the Trauma Center and stroke centers as opposed to going to a closer-by hospital.
“An emergency room by itself doesn’t mean it’s going to be a better level of care,” Wester said.
Our Lady of the Lake deferred to EMS and the Louisiana Emergency Response Network on the ambulance response times issue, while officials at Lane said they did not have anything more to add when asked about them.
Every emergency room in East Baton Rouge Parish is primed to receive major heart attack victims . But other smaller hospitals — such as the West Feliciana Parish Hospital and St. Elizabeth Hospital in Gonzales — are not as well-equipped to deal with them and refer patients to bigger hospitals.
EMS is the first line of defense for emergencies in Baton Rouge, but calls also go through the private Acadian Ambulance Service, which backs up the department. Justin Cox, operations manager for Acadian Ambulance, said the data from EMS provides a better overview of the hospital closure impact because EMS is the primary ambulance provider.
Cox said changes in Acadian’s average transportation times have been nominal.
Worries about people in north Baton Rouge having to travel too far to emergency rooms have prompted numerous ideas from community leaders and organizing groups. The latest is a push to create a standalone emergency room at the Champion Medical Center in Howell Place.
The center opened in 2005 as the physician-owned Greater Baton Rouge Surgical Hospital, with 10 beds for elective surgeries. The hospital lost $6.8 million between 2007 and 2010, and when it closed in 2012, the former leader said it was not receiving enough patients.
It later became Champion Medical Center, which also does specialty surgeries, but more than 30,000 square feet of space is empty, and its Dallas-based owners at Cambridge Holdings Inc. want to lease it.
Elize Pruske, Cambridge’s vice president of leasing and development, said the medical space has been built out and is ready to move into but that they have not received much interest from the local medical community. Both Barrow and Banks-Daniel are eyeing the space to fill the health care gap, and Barrow has a bill in the current legislative session to regulate freestanding emergency rooms.
But there’s no funding and no partner in place yet.
Local hospital leaders have made it clear that they do not see building in north Baton Rouge as a viable venture.
“There was not a sustainable path forward for the Mid City ER,” said Baton Rouge General CEO Mark Slyter in a statement. “Over the last year, we have worked diligently to develop a plan that is sustainable and that allows us to continue to care for the entire Baton Rouge community.”
The unwillingness of hospitals to step forward to partner for proposed health care ideas in north Baton Rouge has frustrated north Baton Rouge political leaders.
“Based on the comments of our current hospital providers, I believe there is a clear indication that these providers are getting all the business from the north they want,” Banks-Daniel said.
Asked about hospital leaders saying they are not willing to step forward in north Baton Rouge, former state Sen. and current parish mayor-president candidate Sharon Weston Broome added, “That’s a little insensitive, to be quite frank with you.”
While several groups are exploring the possibility of standalone emergency rooms — which do exist in other parishes in the Baton Rouge region — they are viewed skeptically by some experts because they often cannot treat critical patients and are more expensive for consumers than urgent care centers.
Sager, the health care policy expert from Boston, said freestanding emergency rooms make health care more fragmented if they are not affiliated with local hospitals and if they do not have integrated medical records.
Walter Lane, a health care economics expert at the University of New Orleans, also is a critic of standalone emergency rooms. He said they often treat low acuity problems and that they cannot substitute for trauma centers or full-service hospitals.
“If they’re not attached to a hospital, those are really glorified urgent care centers,” he said. “My initial impression is they exist because if they call themselves an emergency room, they can charge more.”