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ERs, always busy, are even busier right now

Diabetic Nancy Maschinot was dehydrated from vomiting and had waited in the emergency room for more than three hours.

Maschinot, 48, went to Morton Plant Hospital one morning this week, unsure what was wrong. By 3 p.m., she was so weak she could hardly lift her head.

"I'm getting sicker by the minute," she said, her eyelids falling shut. "Three hours is a little much."

This time of year, visits to local ERs spike precipitously, driven largely by the influx of seasonal residents and the onset of cold and flu season, health officials say. Last month, ambulances transported a record-setting 10,572 patients in Pinellas County.

That's one person every four minutes.

Bay area ERs are so busy, in fact, that local ambulance operators often have to bypass the nearest hospital for one with space to treat more patients, officials say. A backlog at one emergency room can touch off a domino effect of delays at others.

"It's going through the roof," Chuck Kearns, director of Emergency Medical Services and Fire Administration, told the Pinellas County Commission this week.

The problem of overwhelmed emergency care services is playing out across the country, in part because of the aging baby boomer population. A federal study released this month found that, on average, an ambulance is diverted every minute from its original destination because of crowding.

Patients are feeling the impact.

"I haven't eaten all day and I'm fading," said Maschinot, who has health insurance but cannot afford to spend a lot of time away from the UPS store she owns. "I should have gone to the doctor earlier, but I was monitoring myself and we didn't have the money."

People are having to wait longer to see an ER doctor or get a bed assignment, health officials say. If taken by ambulance, they may be rerouted from their preferred hospital to another one that may charge their insurance differently, resulting in more out-of-pocket costs, Kearns said.

"There is a real negative effect on customer service," he said.

Most of the hospitals in Pinellas are spending more time on "bypass" status, meaning ambulances have to bypass them for other facilities, records show.

Clearwater's Morton Plant, for example, spent 251 hours on bypass from October 2005 to January 2006. During the same months the previous year, the hospital was on bypass only 155 hours.

"We have a process that is quite well-oiled and easily able to adapt to changing needs," said Jeff Barnard, the executive director of the Pinellas County Office of the Medical Director. "We're doing remarkably well compared to a lot of counties in managing a high volume of patients."

Hospital administrators can put their facilities on bypass if they see a slow-down in the emergency rooms. Or, county dispatchers may do so if an ambulance has to linger because a hospital has no room for the patient.

But diverting ambulances to available hospitals is not a bad thing, Barnard said. Rather, it ensures that paramedics turn over patients quickly, don't get stuck idling at hospitals and can respond to the next 911 call.

People demanding to be taken to their favorite hospital when it's overloaded end up slowing down ambulances throughout the county, he said.

"Simply put, we've got a fixed number of ambulances in this system (58 in Pinellas)," Barnard said.

Catharine Burt, a researcher at the National Center for Health Statistics, published a study in February on the issue of ambulance diversions.

"As the population ages and as more people go the the ER because they don't have health insurance, it could become an even bigger problem," she said.

The months of January and February put a major strain on the local emergency health care system, officials say.

It's when flu hits hardest.

This year, Florida is one of 13 states with widespread influenza, according to the federal Centers for Disease Control and Prevention. Fortunately, health officials say they haven't seen any unusual symptoms or complications from this year's flu.

"Even though we're finding some widespread activity, it's a pretty normal flu season," said state Health Department spokesman Fernando Senra.

Normal or not, it's enough to bring hospitals to their capacity or beyond.

On Tuesday at Largo Medical Center, the hospital was saddled with 280 patients - 24 more than its listed capacity.

Joann Ettien, the hospital's chief nursing officer, said administrators try not to divert patients until it is deemed absolutely necessary. By 5 p.m. that day, the emergency room was holding 10 more patients than it had beds, she said.

"I think (the numbers) show we stay open as long as we can," she said.

Hospital officials in Hillsborough County said this season always proves busier than others, but they haven't seen the kind of surge in ER visits that Pinellas has.

"We've been extremely busy, but no more or no less last month than most other months," said John Dunn, spokesman for Tampa General Hospital. "It's just a busy time. It's not due to any one particular thing."

Tampa General does occasionally divert ambulances to other hospitals when the emergency room there gets full, Dunn said. That hasn't happened any more than normal lately, he said.

St. Joseph's Hospital spokesman Will Darnall agreed. He added that flu season does contribute to the unusually busy emergency rooms right now.

"It's very busy. It's normal," Darnall said. "But normal for us is very busy."

Part of the reason emergency rooms are so stretched is because many facilities closed in the past decade as demands on those services were increasing, Burt said.

That downward trend has begun to turn around, with hospitals adding staff and bed capacities, officials say. At Bayfront Medical Center in St. Petersburg, about 20 people have been added to the ER staff in the past two years, said Tim Eixenberger, vice president of patient care.

In the meantime, health workers say people ought to expect some delays, be flexible, rely on their primary physicians when possible and consider walk-in urgent clinics in lieu of ERs.

Times staff writers Aaron Sharockman, Lisa Greene and Will Van Sant and Times researcher Angie Drobnic Holan contributed to this report.

HOSPITAL BYPASS TIME

Most of the hospitals in Pinellas are spending more time on "bypass" status, meaning ambulances have to bypass them for other facilities, records show. Clearwater's Morton Plant, for example, spent 251 hours on bypass from October 2005 to January 2006. During the same months the previous year, the hospital was on bypass only 155 hours.

Hospital Oct. 2004 Oct. 2005

to Jan. 2005 to Jan. 2006

Bayfront Medical Center 116 171

Mease Countryside 122 179

Mease Dunedin 47 68

Morton Plant 155 251

Northside 89 192

St. Anthony's 47 118

St. Petersburg General 108 228

Suncoast 36 27

Helen Ellis 6 34

Largo Medical Center 98 67

Note: The Bay Pines VA Medical Center handles less than 2 percent of the county's emergency cases.

Source: Pinellas County

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