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Long waits for rooms leaving patients in ER hallways for hours. Could new state law worsen problem?

Paul Sisson, The San Diego Union-Tribune on

Published in News & Features

Bill Dixon, 80, lay on a bed between two white fabric dividers in the hallway of the emergency department at Scripps Memorial Hospital Encinitas Friday, one of 14 patients waiting for an emergency bed to open up.

He had been there for two hours, having come in from his Solana Beach home with chest pain and dizziness, comfortable with the attention he was getting from medical staff, but taken aback by his surroundings.

"This is really not acceptable from a patient perspective," the Solana Beach resident said. "There's really no privacy."

On Friday, all 38 of the hospital's emergency department rooms were full of patients, and 20 of them had already been admitted for overnight stays, but no beds were available in the main hospital, forcing them to hold up in emergency rooms.

It is a medical malaise the industry calls "boarding," a phenomenon that local experts say could be exacerbated by a new state law that would broaden the set of circumstances when residents may be detained by law enforcement and brought to local emergency departments for evaluation. Because the new law expands the current definition of "gravely disabled" to include those "unable to provide for their personal safety or necessary medical care," it is widely expected to most directly affect the unhoused.

Called Senate Bill 43, the new law, set to take effect Jan. 1, will be the subject of a county hearing Tuesday at which supervisors will debate delaying its implementation for one year. Some argue that taking more time would allow better planning to minimize impact on already crowded ERs while others, including the mayor of San Diego, argue that such a delay would be cruel to the thousands of people living on city streets who need help now.


Hospitals are stepping into the debate in a more vocal way than they usually do, warning that they simply do not have any extra capacity, especially during the busy winter months, which typically bring many additional patients sick with respiratory illnesses into their waiting rooms.

While local data on the overall prevalence of boarding, and its crowding effects on emergency room hallways, was not immediately available, this is a nationally recognized phenomenon.

The American College of Emergency Physicians recently called boarding in emergency departments a "national public health crisis," releasing poll results that indicate "almost half of adults (43%) would delay or avoid going to the emergency department if they knew that they, or a loved one with a severe illness or injury, could face extreme delays associated with boarding."

It is clear that not every hospital in San Diego is experiencing severe patient backups to the same extent that Scripps Encinitas has been. Larger Scripps facilities in Hillcrest and La Jolla were doing better with the issue last week. But at the same time, the problem has recently been so intense in some locations that it has spurred action. UC San Diego Health, for example, recently announced it had purchased Alvarado Hospital in La Mesa out of concern that its emergency departments had become clogged with overflow patients lodging for far too long in emergency hallways, converted waiting areas and even a re-purposed conference room.


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