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Emergency rooms feel impact of spike in number of uninsured

The canary ain't looking too good. That's the view of a Merced emergency room doctor who's caring for more sicker and poorer patients than ever in the health care system.

Dr. Gary Tamkin, who works in Mercy Medical Center Merced's emergency room, said that emergency rooms are the canaries in the coal mines as barometers of health care.

And those emergency departments are getting slammed with more patients and less reimbursement.The Center for Disease Control released a report this week on the number of patients using ERs across the United States — and that number has gone up and up.

The report shows that the highest visit rates are for infants under 12 months and for the elderly over age 75.

"Our volume has gone from 38,000 ER visits in 2004 to 52,000 this year," Tamkin said. There are a lot of reasons for that spike, he said, but the biggest problem is working people with no health insurance. "One out of six working Californians has no medical coverage at all," Tamkin said. On top of that, California reimburses Medi-Cal providers less than any other state.

But there's more than just insurance fueling the number of visits. Tamkin estimated that 15 percent of the nation's emergency rooms have closed their doors in the past 10 years. Mercy had two emergency rooms for years, but closed one of them in December 2002. Before that ER closed, there had been two emergency rooms in Merced since the 1920s.

Many times, patients who do have a primary care doctor can't get in to see their physician quickly. They go to the ER to get good, fast care. "About 40 percent of the patients who walk into the ER are triaged, evaluated and sent home within 62 minutes," Tamkin said.

Barbara Mullin, the emergency services department director at Mercy, said about 125 patients a day come into the ER. "A lot of them are underprivileged and don't have health care benefits," Mullin said. "Plus with the aging population, we are seeing sicker patients coming in."

Although the number of ER visits has risen, admissions to the hospital have stayed about the same. That means that people coming to the emergency room could've had their problems taken care of somewhere else.

Tamkin said that because Mercy's ER tries to get people in and out quickly, the word is out that going to the emergency room won't result in long wait times. "We are victims of our own success," he said. "It's much easier to come here than to get an appointment with their doctor."

Tamkin said the problems that face both patients and emergency rooms won't get fixed until a crisis happens.

"Eventually, the health care system will collapse," he said. "But it's going to be a long, drawn-out painful experience."And the canary is looking paler than ever.

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