Posted on Sun, Jan. 07, 2007

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Living with low expectations in the Palmetto State

SHORTLY AFTER midnight, at the weary outset of Friday morning, a heavy-set woman stood outside the elaborate revolving doors of the Palmetto Health Richland emergency department, smoking a cigarette.

She tilted her head at the sound of a distant siren, the volume and Doppler effect indicating its rapid approach.

“Here they come again,” she said with resignation. “They bring in another one, we go to the back of the line.”

I was standing nearby, preferring the mists of the night to the unwholesome miasma of the packed waiting room. A few moments earlier, I had used the last few drops of energy in my PDA to post this brief comment on my blog (hey, as a distraction it beats ragged old copies of People):

I’m standing outside a hospital ER at 11:52 p.m., waiting for MY turn to go in and see my daughter, hoping they’ve started the IV that I’m pretty sure she needs (you know how it is in a state that refuses to adequately fund mental health or other essential services — if you have an emergency, you’ll be treated in a hallway if you’re lucky enough to get treated at all)....

In the hallway, she could only have one visitor at a time. She eventually got into a room, receiving about four liters of fluid, and got stronger. I’ve got no complaints at this point about her treatment — certainly not against Palmetto Richland. The crowding at Lexington Medical had been worse. It was the worst I’d ever seen it, and with five mostly grown kids, I’ve seen it a few times. So we were at Richland.

It’s not the fault of either hospital. It’s just a fact of life in South Carolina. Like the woman with the cigarette, we’ve come to accept it. Go to an emergency room on a typical evening, and if you’re not bleeding out your eyeballs, you’ll generally have a long wait. My experience tells me that if, for instance, you need some stitches and a tetanus shot but don’t have anything life-threatening, you should not be surprised to wait as long as four hours. It’s not always that long, but you’re no longer surprised if it is.

(My daughter was “lucky” in that she obviously needed quick treatment for dehydration caused by a two-day stomach bug.)

I don’t know, specifically, what caused the backlogs of Friday’s wee hours. I suppose if I had about a month and could get around the HIPAA privacy rules and track down every patient and interview them, I could give you a reliable answer.

But I do know that there is a constant, underlying condition in this state that causes ER waiting rooms to overflow whenever other human variables — a rash of wrecks on a slippery night, a stomach virus going around — collide with it: Hospital beds are occupied by the mentally ill, who are often found on the streets, off their meds, and police have no other place to put them, their jail cells being full of actual criminals.

The variables may be hard to pin down in a specific instance, but that one constant is not.

“It’ll happen the same way tomorrow night and the night after that,” says Thornton Kirby, president and CEO of the S.C. Hospital Association. But there are two constants, not one, he reminded me. The second is the fact that so many uninsured people go to the emergency room for their basic medical care, not just when they’re in crisis. As the sign behind the desk at the Richland ER proclaims, in both English and Spanish, the hospital is forbidden by law to turn you away if you need medical care. Regardless of your ability to pay, the medicos have to do what they can for you.

That second constant is a national problem, although the responsibility for it is shared by the states, via Medicaid funding and administration. The first one seems to be particularly acute in South Carolina. It’s related to the underfunding of the state Department of Mental Health over the last few years. People with brain problems who formerly would have received greater attention and care from the state now wander our cities, seriously strung out, a danger to themselves and others.

So eventually they end up in an ER — quite likely at a comprehensive indigent care facility such as Richland — where they wait for someone to figure out something else to do with them. That can take a while.

So the rest of us, when we have a situation that won’t wait until regular doctors open shop in the morning, find ourselves waiting much of the night, and accepting it, because that’s the way things are in South Carolina.

We accept it the way we accept people whizzing past us at 90 miles an hour on the interstate (or faster, in the case of the lieutenant governor), secure in the knowledge that they will not be ticketed. There simply aren’t nearly enough troopers on the road to enforce the speed limits, and everybody who didn’t just fall out of the stupid tree knows it. This is because the folks who make up our state budget haven’t stepped up to pay for such enforcement.

But hey, rest assured that when a loud minority of homeowners whose McMansions are appreciating too rapidly squeal about it, our state lawmakers take quick action to slash their taxes radically — by raising the sales tax on all of us, but refusing as usual to reform the overall tax system comprehensively, to make it fair and effective for a change.

They can’t assess the state’s actual needs, set priorities and address them, but they can surely lubricate a squeaky wheel in one quick hurry — just in time for elections, in fact.

With our elected followers set to come back and do their thing for another half-year starting Tuesday, I stand out in the misty night, thinking about stuff like that.

Sound off on my blog: http://blogs.thestate.com/bradwarthensblog/.