Inside the busiest children’s emergency room in the country, people improvise.
Doctors jam chairs into a tiny examining room and call it an asthma treatment unit. Administrators convert a loading dock into office space. Janitors put chairs in a hallway for a makeshift waiting room.
It has been like this since 1992, when Children’s Medical Center of Dallas replaced its resident-run acute-care clinic with a full-scale emergency room.
Built to handle 28,000 patients a year, the emergency room will expand its capacity this year to 75,000, but doctors estimate they will handle 100,000 cases.
“It’s been difficult. We are almost constantly under construction,” said Dr. Robert Wiebe, medical director of the emergency room. “We just metastasize into whatever we need to be.”
Changes from policymakers may soon ease some of the traffic jam at Children’s. Last month, the state House passed a bill that would make nearly a half-million children of working poor eligible for new state-subsidized health insurance.
And in July, Medicaid recipients in Dallas County will become eligible for a managed-care system that will permit them to enroll with a health maintenance organization and, theoretically, go somewhere other than Children’s. Uninsured patients would not be affected by the conversion to Medicaid managed care.
Doctors at Children’s say their emergency department is the country’s busiest–according to a 50-hospital survey–in part because sick children are routinely treated regardless of their parents’ ability to pay. It took that function over from the Parkland Health & Hospital System in 1995.
That is one reason why the cost of what Children’s officials call charity care, which includes all non-paying patients, not just those who come through the emergency room, has more than doubled in the last five years.
That number is so large, public-health experts say, because 24 percent of Texas children–about 1.4 million–have no health insurance. Only Arizona, at 25 percent, has a higher rate of uninsured children.
Elizabeth Vasquez is one such 3-year-old. Her mother has a job that provides health insurance, but Mary Vasquez said she can’t afford the monthly premiums for her two daughters. When Elizabeth took a bad fall off a rocking horse, Vasquez brought her to Children’s.
In many ways, the girl’s case is typical. Families without health insurance are five times more likely to rely on an emergency room than a private doctor, according to the March of Dimes.
Figures for last December show that only about one in four of the patients at Children’s emergency room had a medical trauma.
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“Over and over and over again, people use the emergency room for things that could be handled by primary care,” Wiebe said.
Under the Children’s Health Insurance Program , Texas has access to $2.5 billion in federal funds over five years. The federal government will match $3 for every dollar the state spends to cover children of the working poor.
Lawmakers are wrangling over how many children to cover. And some question whether children are in need.
“I’ve had a legislator look me in the eye and say, `Show me the kids that are dying for lack of money,’ ” said Dr. Janet Squires, immediate past president of the Texas Pediatric Society, which has strongly backed CHIP.
“I can’t understand why we would not use the money that’s available,” said Squires, head of general pediatrics at Children’s.
The number of children covered by medical insurance has declined recently as employers cut health-care benefits, premiums continue to rise and an increasing number of single parents take low-paying jobs with no medical benefits.
Seventy-seven percent of Texas’ uninsured children have at least one working parent.
“These are not unemployed people. These are not people living on public assistance,” said Kenny Schuster, director of Hope for Kids, a health education organization. “They are hard-working people.”
Lack of health insurance places a strain not only on medical resources but on children themselves. Without regular checkups, they often see a doctor only when they’re seriously ill.
“The child’s sicker when they get here, but it’s really not an emergency situation,” said Julia Easley, executive director of the Coalition for North Texas Children, a 300-member advocacy group that Children’s fully underwrites.
Children’s is one of 14 national pediatric research centers recognized by the National Institutes of Health. It is the primary pediatric teaching facility for the University of Texas Southwestern Medical Center at Dallas.