The emergency department (ED) is the main entry point into the health care system for much of our population. Nursing shortages and understaffing affect the ED in a profound way, as patient volumes can be difficult to predict. But all patients are accepted into care no matter the capacity of the department. I felt this burden over the years, working as an registered nurse in two different Baltimore city EDs. It was commonplace for my shift team to have more patients than we could handle while at the same time being exposed to some of the most traumatic situations possible. Most of our patients were experiencing physical distress compounded by social and psychological dysfunction — all of which added to the chaos. Constant triage left my colleagues and me burnt out and suffering from compassion fatigue.
When I watched the viral video of the woman in the hospital gown being hustled out in the cold by security officers at the University of Maryland Medical Center Midtown ED, my first thought was: “Oh God, I hope I never participated in anything that awful.” I remember many instances when conflicts within the ED resulted in security staff “putting someone out” at direction of the medical staff. I ran through the possible scenarios: Perhaps the patient had been “medically cleared” and was causing a behavioral disturbance, or maybe the patient was demanding continued care or medication when there was no longer an emergency (and probably never was). Unfortunately, ED staff routinely cut people’s clothes off to quickly attach a cardiac monitor or insert an IV; there are usually no alternative clothes to provide to patients being discharged — thus, they end up only in a hospital gown. Obviously, these responses and the actions visible in the video are less than humane and stem from many years of personal and structural desensitization.
This type of ejection from a health care facility is the natural outcome of a system that over-medicalizes and ignores the social welfare of its citizens. One solution would be the creation of a single-payer health system that links patients to social services that are varied and plenty. But in our current political climate, this is a long way off. In the meantime, we must begin to heal with thoughtful redesign of how we provide care to our most vulnerable and highest needs patients.
So what did the woman wearing the hospital gown in the video really need? I don’t know anything about her circumstances or medical history, but I know many other people in her position have benefited from a human connection first and foremost: someone to look into their eyes, feel their pain and address them with kindness and empathy.
What else do they need? Probably a lot of things the ED isn’t set up to provide. A place to stay, a hot meal and some warm clothes, mental health treatment and connection to other social services in the community. Unfortunately, the only available response after they’re put out from a hospital is often to call 911 and send them back to the ED, thus continuing the vicious cycle of unmet needs. Perhaps their initial ED visits might have been prevented in the first place if these patients had access to a primary care team like mine — a clinic based, interdisciplinary team of medical, behavioral health and social services professionals. A team that offers human connection and strives to understand each patient’s medical and psychiatric conditions and provide linkage to those much-needed social services. Teams like this already exist in Baltimore and around the country, and they are part of the solution to our overtaxed ED safety net system.
In stark contrast to the despair I feel regarding the indignities conveyed by the UM Midtown video, I am delighted when the emergency response system works flawlessly. My father suffered a heart attack a few days ago while at the bank. He might not be alive if it weren’t for the incredible efficiency and coordination of the paramedics and ED staff who skillfully diagnosed and treated his heart attack in breathtaking time. I am left wondering what would be an analogous “good outcome” for the woman in the video. She might have been sent to a shelter, or provided cab or bus fare to get to a family member’s home. She might have been provided clothing, perhaps from donations to the hospital. But these short-term solutions would only have been Band-Aids on a much larger problem that can only be solved with integrated, accessible social services within the health care system.
Katherine Rediger is a nurse practitioner; her email is firstname.lastname@example.org.