OPINION: Proposed South Anchorage medical facility won't be a full-service ER

Last Tuesday, at the public comment session for the Alaska Regional Hospital proposal to build an emergency medical facility in South Anchorage, I was impressed by the misconceptions surrounding this proposal. An emergency medicine physician at Alaska Regional Hospital spoke in support of the project, stating that what makes a medical facility an emergency department is the presence of an emergency medicine physician.

As a board-certified emergency medicine physician providing care for more than 20 years at Providence Emergency Department, I could not disagree more. The patients I have cared for tell the defining story of what makes a facility an emergency department. For the 40-year-old male experiencing a heart attack, the emergency department was the cardiac catheter lab, technicians and cardiologist who, within 30 minutes of the patient’s arrival, opened up a blocked blood vessel in the heart and saved his life. For the 38 weeks pregnant woman in the low-speed car accident, the emergency department was the labor and delivery nurses who detected abnormal fetal activity due to a separated placenta, and the obstetric surgeon and operating room staff who, within minutes, performed an emergent C-section, saving the mother and newborn’s lives. For the 65-year-old businessman with slurred speach, the emergency department was the stroke team, neurologist and interventional radiologist who removed the large clot from a major blood vessel in the brain, preventing permanent disability and allowing his life and work to continue. For the young mountain biker who crashed on the local trails, the emergency department was the ultrasound showing blood in the abdomen, the pharmacist who provided medications to minimize bleeding and the blood bank technicians who rapidly prepared mass transfusion of blood products to manage his ruptured spleen. And for the 30-year-old male suffering a mental crisis, the emergency department was the mental health staff, the social workers and the psychiatric observation unit that provided the safe place and support preventing his self-harm.

In the symphony of emergency medicine, the emergency physician may be the conductor, but the orchestra is the surgeons, cardiologists, neurologists, blood bank interventional radiologist, pediatric intensivists, technicians, pharmacists, labor and delivery nurses, respiratory therapists, mental health staff, social workers and a huge host of other specialty providers available on site when minutes matter. These vast resources available to the emergency physician are essential to the lifesaving role of the emergency department. As these resources are very expensive, billing in emergency departments allows for a facility fee of up to several thousand dollars for every emergency department visit.

During the public comment session, the Alaska Regional Hospital proposed building a five-bed clinic staffed with an emegency medicine physican, calling it a “hospital-based emergency department.” Because of a loophole in billing rules, this clinic would charge the exact same facility fees of an acutal emergency department without having on site a hospital, blood bank, operating rooms, surgeons, cardiologists, pharmacists or the host of other lifesaving tools essential to emergency care. While the financial return on this investment is obvious, the title and proposal have misled its supporters.

South Anchorage residents spoke during the public comment period, wanting a hospital in South Anchorage, wanting a place to treat trauma in South Anchorage, wanting emergent mental health care in South Anchorage, and wanting a destination for ambulance with emergency medicine patients in South Anchorage. Yes, South Anchorage would benefit hugely from a hospital and emergency department. But five beds and one emergency medicine physician will not, and cannot, provide these services.

Written public comment on the proposal is being accepted through Sept. 16, which interested parties can send to Alexandria.hicks@alaska.gov.

Dr. Tim Silbaugh, FACEP, is a longtime Alaskan who has provided emergency medical care at Providence Medical Center for more than 20 years.

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