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Hooked on heroin, she sat 2 days in an ER. Hospitals say you pay for this stay, too. – Charlotte Observer

A 25-year-old Gaston County woman who is addicted to heroin waited two days in a hospitals emergency department, in a psychiatric observation room with no bed.

She needed help for her drug addiction, her family says, but local treatment centers were full.

They dont have any place to put them. Theyre so packed, says the womans grandmother.

Instead, the woman was taken to an emergency room by police last month, under a judges order to involuntarily commit her. The womans family says she had threatened to kill herself and theyve been concerned about her health and behavior after learning shes been using heroin for several years.

The ER, according to the family, was the only option.

A growing opioid and heroin epidemic has escalated a problem that health care professionals have been raising concerns about for years: North Carolina has inadequate services for people with mental and behavioral health diseases.

Doctors in North Carolina confirm theres an increasing demand for help and patients are turning to emergency rooms an expensive and ineffective place for treatment.

Often, patients wait days a process called boarding. Hospitals say it takes a toll on their budgets and leaves fewer beds available for other people who need the emergency room.

Most ERs cant provide full substance abuse or psychiatric health treatment. Instead, they can assess patients and offer some medical care then work to transfer patients to specialized treatment centers.

But, when the treatment centers are full, hospitals end up keeping patients inside emergency room departments.

Recently, the North Carolina Hospital Association reported 30 to 80 percent of emergency beds are used for boarding. The result is higher costs for all patients and delays for patients who are in a mental or behavioral health crisis.

For privacy reasons, the Observer is not publishing the name of the Gaston County patient or her grandmother.

Her family says they grew concerned in the past year about changes in the womans behavior. Then, they learned she had started using heroin while she was in college in western North Carolina a few years ago. After graduating from college, she got a job but she stayed hooked on heroin, her grandmother said.

Heroin is an opioid, a class of drugs that now kills more people in North Carolina each year than car wrecks.

This familys experience of a long stay inside an ER and difficulty finding a treatment bed is a common one in North Carolina.

After calling state and local lawmakers to complain about bed shortage, the 70-year-old grandmother called the Observer in late June as her granddaughter waited inside CaroMont Hospitals emergency psychiatric unit in Gastonia.

There, two rooms, separated by gender, house three recliners each for patients. Theres no medical equipment inside and no other furniture, except for an encased television with no wires exposed. Patients may use a wireless phone and are supervised by hospital staff at a nursing station.

This is where the young woman stayed for 48 hours, her grandmother said. Hospitals are required to accept patients in mental health or drug abuse crisis and perform psychiatric evaluation.

CaroMont Hospitals average patient boarding time is four days the same as the states average for adults who are waiting for a transfer to one of North Carolinas three state-run psychiatric hospitals. For a transfer to a taxpayer-supported treatment center, the average statewide wait is 2.5 days.

We will have patients present to our (emergency department) because they have nowhere else to go, said Dr. Tom Davis, chief medical officer for CaroMont.

It is truly a public health crisis and it is really complicated … Our society in general has not funded or put an emphasis on helping to treat and manage mental health problems.

CaroMonts ER sees nearly 90,000 patients a year. When mental and behavioral patients at the ER dont have acute physical medical problems, they can wait in rooms called psychiatric suites.

Davis and other hospital officials said they couldnt talk about the specific case of any patient. When boarding, the hospital prioritizes the patients safety and medical needs, he said. And, if a patient needs follow-up care but not inpatient treatment, hospitals discharge them with a treatment plan.

Patient boarding and gaps in health care services for mental and behavioral health patients are problems nationwide.

But North Carolina, compared to other states, sees nearly twice the rate of psychiatric patients who resort to the ER each year, says Martha Whitecotton, senior vice president for behavioral health services at Carolinas HealthCare System in Charlotte. Carolinas has an emergency room that exclusively serves patients in behavioral health crisis and its often full.

On average, the boarding time at a Carolinas HealthCare emergency room or another facility in the system is about 17 hours.

But we definitely have patients who are there much longer, Whitecotton said, including children and geriatric patients because of fewer beds for those populations.

In Charlotte, both Carolinas HealthCare System and Novant Health told the Observer they board up to 40 patients daily, with some fluctuation, including those who go to the ER in crisis, with mental health and substance abuse issues.

At Novant, the average boarding time varies by location from 10 hours in Huntersville to close to 17 hours at Presbyterian Medical Center in Charlotte.

Many hospitals in the state including Novant, Carolinas and CaroMont are trying to cut down on the boarding wait times by using telemedicine services that include psychiatric consultations by phone and video.

Each time boarding happens, hospitals stand to lose thousands of dollars.

Its draining the system, said Julia Wacker, vice president for community and behavioral health with the North Carolina Hospital Foundation. Its counterproductive in every way.

Nearly 80 percent of mental health and substance abuse patients in North Carolina are covered by Medicaid or dont have insurance, which means tax dollars pay for some of their costs and hospitals absorb the rest.

Hospitals lose money by the hour when they board uninsured and Medicaid or Medicare patients because expenses past the first day of their stay cant be fully reimbursed. Some experts estimate this type of boarding costs about $100 an hour, per patient.

These extended stays in the ER burden hospital budgets, and those costs are being shifted to other patients and payers.

Some doctors and health care administrators say boarding is happening at higher rates because North Carolina doesnt have enough treatment and psychiatric beds. Others say patients are turning to the ER because preventative care for mental health disease and drug addiction is too expensive or inaccessible. Data shows about half of the states counties dont have enough psychiatric doctors.

The stakes are high, with nearly 1,100 opioid deaths annually in North Carolina a death rate higher than murder rates in the state. That figure from 2015 is a 73 percent spike compared to opioid deaths in the state 10 years ago.

Over the same time period, the wait for treatment beds and the number of patients resorting to the emergency room for mental and behavioral health care has gone up fourfold, the hospital association reports.

North Carolinas Department of Health and Human Services is trying to alleviate the boarding problem and related opioid crisis on several fronts. This year, the department introduced new criteria for the groups that manage mental and behavioral health care, and it plans to impose penalties and fees if services arent improved.

Adding beds would reduce some ER boarding but one research project performed in North Carolina suggests the state would need to effectively double the amount of beds it currently has to just ensure patients arent waiting more than 24 hours in a hospital for a transfer a potential solution that would take years to build out and millions of dollars not currently allocated.

Partners Behavioral Health Management is trying to reduce the problem of boarding at ER rooms, said Dr. Michael Forrester, a psychologist and the chief clinical officer. Partners operates in eight N.C. counties, including Gaston, Iredell and Catawba. Its one of seven regional entities that receive state and federal tax dollars to act as a managed care organization for mental and behavioral health needs.

These regional organizations have special care centers for patients who are in mental health or drug addiction crisis, as an alternative to the ER, as well as offering individualized outpatient treatment.

DHHS says many of its solutions for emergency room boarding are routed through Partners and the other regional organizations. One pilot program is running now in 13 N.C. counties, with the aim of diverting patients in behavioral health crisis away from ERs and on to specialty facilities.

A better approach to getting patients the right kind of health care outside of an ER is key, says Billy West, executive director at Daymark Recovery Services, a growing mental health and substance abuse treatment provider, with 32 clinics in North Carolina.

Whether a person is in a mental health crisis, involuntarily committed through court or is personally ready to start drug addiction treatment, West says, doctors and health care providers want to act quickly in that window of time to help a patient. Boarding delays access to long-term health solutions, West said, and may contribute to a dangerous and expensive cycle.

Some statewide statistics suggest this may be happening already.

More than one quarter of Medicaid patients who use an ER for mental and behavioral health issues return to an emergency room the same year with the same problems, North Carolina DHHS statistics show. Of those, nearly 13 percent were return ER visitors within a months time.

In the young womans case in Gastonia, her family worries shell be one of these statistics. After being discharged last month, the woman followed up on outpatient treatment as prescribed by the hospital, says her grandmother, but more waiting may be in the future.

The local outpatient treatment facility shes enrolled in has some wait times for appointments the young woman will need, her grandmother told the Observer Tuesday.

Ill do anything, says the grandmother, who adopted her granddaughter around her first birthday. I want to get her good help now.

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Hooked on heroin, she sat 2 days in an ER. Hospitals say you pay for this stay, too. – Charlotte Observer

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Anthem asks Missourians to think twice before going to the emergency room – KCUR

Anthem Blue Cross Blue Shield, one of Missouris largest insurers, no longer covers emergency room visits that it deems unnecessary.

The policy aims to save costs and direct low-risk patients to primary care physicians and urgent care clinics. But doctors say patients may avoid going to a hospital when they really need it, if they fear a large bill.

Theyre forcing the lay public to make a medical determination, said Dr. Doug Char, a Washington University emergency physician. Theyre basically telling people you have to decide if this chest pain youre having is indigestion or a heart attack.

An emergency room is the most expensive place to see a doctor, and insurers are balking at the cost. Between 15 percent and 30 percent of emergency room visits in the St. Louis region are avoidable, according to a study by the nonprofit Midwest Health Initiative. Missouri hospitals charge an average of $372 for emergency room visits for minor issues, but some charge as much as $1,300, according to data compiled by the Missouri Hospital Association.

“Most non-emergent medical conditions can be easily treated at retail clinics, urgent care clinics or 24/7 telehealth services,” Anthem’s Missouri spokesperson, Scott Golden, wrote in an email. “The review by an Anthem medical director will take into consideration the presenting symptoms that brought the member to the emergency room as well as the diagnosis.”

In mid-May, Anthem sent letters to Missouri enrollees to alert them that from June 1, it would no longer cover emergency room services for non-emergencies. In such cases, people who have health insurance could still be stuck with the full cost of their visit, if the insurer determines that their symptoms did not reach the level of requiring emergency care.

Anthem enforces the same guidelines in Kentucky, and put the rule in place for Georgia policyholders this month. Its officials say there are several exceptions, such as if a patient is under 14, the visit occurs on a Sunday or there are no urgent-care centers within 15 miles.

The American College of Emergency Physicians raised a red flag when Anthem sent out a spreadsheet of 1,908 conditions that it may not deem worthy of coverage in an emergency room. Some of the listed symptoms could indicate a life-threatening emergency, said Dr. Jonathan Heidt, president of Missouris ACEP chapter.

To have them under that threat of not having their bills paid if theyre wrong about what their diagnosis is, its really going to harm patients in the long run, Heidt said. Our patients have a right to seek emergency care.

The doctors argue that Anthems policy, and similar rules set up by state Medicaid programs, violate the federal Affordable Care Acts prudent layperson standard. The rule asserts that a person with average knowledge of health and medicine should be able to anticipate serious impairment to his or her health in an emergency, and that laws should not assume that a person will know more than that. Anthem contends that it reviews claims using this standard already.

Though Anthem began enforcing the Missouri rule at the beginning of June, patients who visit the emergency room for non-emergencies likely will receive bills in the coming months. Heidt said that if Anthem does not reconsider its policy, ACEP may weigh legal action against the insurer.

Were still a little bit early for that,” Heidt said. “But at this time, all of our options are on the table.

According to the Missouri Department of Insurance, Financial Institutions & Professional Registration, the rule is based on previously filed language that was approved by the regulator. Other plans have similar provisions.

“If a consumer believes a claim has been improperly denied, or has questions about how a claim has been handled by their insurer, they can contact the Department’s Consumer Affairs Hotline at 800-726-7390 or they can file a complaint online,” said Grady Martin, the agency’s director of administration.

Follow Durrie on Twitter: @durrieB

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Anthem asks Missourians to think twice before going to the emergency room – KCUR

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Anthem asks Missourians to think twice before going to the … – St. Louis Public Radio

Anthem Blue Cross Blue Shield, one of Missouris largest insurers, no longer covers emergency room visits that it deems unnecessary.

The policy aims to save costs and direct low-risk patients to primary care physicians and urgent care clinics. But doctors say patients may avoid going to a hospital when they really need it, if they fear a large bill.

Theyre forcing the lay public to make a medical determination, said Dr. Doug Char, a Washington University emergency physician. Theyre basically telling people you have to decide if this chest pain youre having is indigestion or a heart attack.

An emergency room is the most expensive place to see a doctor, and insurers are balking at the cost. Between 15 percent and 30 percent of emergency room visits in the St. Louis region are avoidable, according to a study by the nonprofit Midwest Health Initiative. Missouri hospitals charge an average of $372 for emergency room visits for minor issues, but some charge as much as $1,300, according to data compiled by the Missouri Hospital Association.

“Most non-emergent medical conditions can be easily treated at retail clinics, urgent care clinics or 24/7 telehealth services,” Anthem’s Missouri spokesperson, Scott Golden, wrote in an email. “The review by an Anthem medical director will take into consideration the presenting symptoms that brought the member to the emergency room as well as the diagnosis.”

In mid-May, Anthem sent letters to Missouri enrollees to alert them that from June 1, it would no longer cover emergency room services for non-emergencies. In such cases, people who have health insurance could still be stuck with the full cost of their visit, if the insurer determines that their symptoms did not reach the level of requiring emergency care.

Anthem enforces the same guidelines in Kentucky, and put the rule in place for Georgia policyholders this month. Its officials say there are several exceptions, such as if a patient is under 14, the visit occurs on a Sunday or there are no urgent-care centers within 15 miles.

The American College of Emergency Physicians raised a red flag when Anthem sent out a spreadsheet of 1,908 conditions that it may not deem worthy of coverage in an emergency room. Some of the listed symptoms could indicate a life-threatening emergency, said Dr. Jonathan Heidt, president of Missouris ACEP chapter.

To have them under that threat of not having their bills paid if theyre wrong about what their diagnosis is, its really going to harm patients in the long run, Heidt said. Our patients have a right to seek emergency care.

The doctors argue that Anthems policy, and similar rules set up by state Medicaid programs, violate the federal Affordable Care Acts prudent layperson standard. The rule asserts that a person with average knowledge of health and medicine should be able to anticipate serious impairment to his or her health in an emergency, and that laws should not assume that a person will know more than that. Anthem contends that it reviews claims using this standard already.

Though Anthem began enforcing the Missouri rule at the beginning of June, patients who visit the emergency room for non-emergencies likely will receive bills in the coming months. Heidt said that if Anthem does not reconsider its policy, ACEP may weigh legal action against the insurer.

Were still a little bit early for that,” Heidt said. “But at this time, all of our options are on the table.

According to the Missouri Department of Insurance, Financial Institutions & Professional Registration, the rule is based on previously filed language that was approved by the regulator. Other plans have similar provisions.

“If a consumer believes a claim has been improperly denied, or has questions about how a claim has been handled by their insurer, they can contact the Department’s Consumer Affairs Hotline at 800-726-7390 or they can file a complaint online,” said Grady Martin, the agency’s director of administration.

Follow Durrie on Twitter: @durrieB

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Anthem asks Missourians to think twice before going to the … – St. Louis Public Radio

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Belleville OKs Clara Maass emergency room expansion – NorthJersey.com

A rendering of the proposed Emergency Department renovations at Clara Maass Medical Center in Belleville.(Photo: Mollie Shauger/NorthJersey.com)

The Belleville Zoning Board of Adjustment has given its go-ahead for Clara Maass Medical Center to expand its Emergency Services department.

As previously reported, the hospital was seeking approval for a 1,400-square-foot addition and renovations to its Emergency Department and an 8,000-square-foot courtyard between the ER and a recently built Intensive Care Unit. The application included four variances.

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Domenic Segalla, the chief operating officer and chief financial officer of Clara Maass, appeared before the board on Thursday, July 6, to explain the reasons for the upgrades. Segallasaid Clara Maass is looking to expand the current Emergency Room by adding more space and to segregate pediatrics andbehavioral health treatment areas. Right now, the two areas are commingled, he said.

“Our whole goal isto createand help to expand and create a need that is here for the community, and how do we serve that need. We feel very strongly that right now we don’t have the capacity to provide this need for the community,” Segalla said.

“We’ve spend a lot of time over the last sixmonths trying to become as efficient as we can, and even thoughwe’ve made a lot of progress, it’s still a small setting for the volume we continue to see,” he added.

The hospital sees about 20,000 pediatric visits a year, and about 10,000 behavioral health visits, he said.

As a result of the the Affordable Care Act, more patients are being treated in an outpatient setting, he noted, and some with behavioral health issues don’t necessarily need to be admitted to the hospital.

Clara Maass intends to addmore observation beds for these patients tobe treated and cared for in a safer and more efficient way, but not necessarily admitted to the hospital, he explained.

Also, these treatmentareashave special requirements in that they cannot contain furnishings and other items that a patient could potentially use for committing suicide, he said.

A map shows where the additional construction would occur at Clara Maass.(Photo: Mollie Shauger/NorthJersey.com)

The expansion would also include the addition of 10 pediatric treatment rooms on top of 13, for patients to be examined,he said.

The Zoning Boardbecame hung up on the aspect of parking, as the hospital had proposed eliminating a small number of spaces to enhancethe drop-off area to the Emergency Department.

Board ChairA.J. Del Guercio and Vice ChairWilliam Villanoexpressedconcernthat patients in distress or those who have physical ailments may not be able to walk from another lot 250 feet away from the ER.

The application had proposed a loss of 16 parking spaces overall. However the applicants agreed to provide four additional parking spots at the drop-off area, and to reserve seven in a nearby employee lot for Emergency Room visitors, and not to refuse other ER visitors from parking in the lot.

Email: gray@northjersey.com

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Belleville OKs Clara Maass emergency room expansion – NorthJersey.com

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Anthem asks Missourians to think twice before going to the emergency room – St. Louis American

(St. Louis Public Radio) – Anthem Blue Cross Blue Shield, one of Missouris largest insurers, no longer covers emergency room visits that it deems unnecessary.

The policy aims to save costs and direct low-risk patients to primary care physicians and urgent care clinics. But doctors say patients may avoid going to a hospital when they really need it, if they fear a large bill.

Theyre forcing the lay public to make a medical determination, said Dr. Doug Char, a Washington University emergency physician. Theyre basically telling people you have to decide if this chest pain youre having is indigestion or a heart attack.

An emergency room is the most expensive place to see a doctor, and insurers are balking at the cost. Between 15 percent and 30 percent of emergency room visits in the St. Louis region are avoidable, according to a study by the nonprofit Midwest Health Initiative. Missouri hospitals charge an average of $372 for emergency room visits for minor issues, but some charge as much as $1,300, according to data compiled by the Missouri Hospital Association.

“Most non-emergent medical conditions can be easily treated at retail clinics, urgent care clinics of 24/7 telehealth services,” Anthem’s Missouri spokesperson, Scott Golden, wrote in an email. “The review by an Anthem medical director will take into consideration the presenting symptoms that brought the member to the emergency room as well as the diagnosis.”

In mid-May, Anthem sent letters to Missouri enrollees to alert them that from June 1, it would no longer cover emergency room services for non-emergencies. In such cases, people who have health insurance could still be stuck with the full cost of their visit, if the insurer determines that their symptoms did not reach the level of requiring emergency care.

Anthem enforces the same guidelines in Kentucky, and put the rule in place for Georgia policyholders this month. Its officials say there are several exceptions, such as if a patient is under 14, the visit occurs on a Sunday or there are no urgent-care centers within 15 miles.

The American College of Emergency Physicians raised a red flag when Anthem sent out a spreadsheet of 1,908 conditions that it may not deem not worthy of coverage in an emergency room. Some of the listed symptoms could indicate a life-threatening emergency, said Dr. Jonathan Heidt, president of Missouris ACEP chapter.

To have them under that threat of not having their bills paid if theyre wrong about what their diagnosis is, its really going to harm patients in the long run, Heidt said. Our patients have a right to seek emergency care.

The doctors argue that Anthems policy, and similar rules set up by state Medicaid programs, violate the federal Affordable Care Acts prudent layperson standard. The rule asserts that a person with average knowledge of health and medicine should be able to anticipate serious impairment to his or her health in an emergency, and that laws should not assume that a person will know more than that. Anthem contends that it reviews claims using this standard already.

Though Anthem began enforcing the Missouri rule at the beginning of June, patients who visit the emergency room for non-emergencies likely will receive bills in the coming months. Heidt said that if Anthem does not reconsider its policy, ACEP may weigh legal action against the insurer.

Were still a little bit early for that,” Heidt said. “But at this time, all of our options are on the table.

According to the Missouri Department of Insurance, Financial Institutions & Professional Registration, the rule is based on previously filed language that was approved by the regulator. Other plans have similar provisions.

“If a consumer believes a claim has been improperly denied, or has questions about how a claim has been handled by their insurer, they can contact the Department’s Consumer Affairs Hotline at 800-726-7390 or they can file a complaint online,” said Grady Martin, the agency’s director of administration.

Republished with permission of St. Louis Public Radio: http://news.stlpublicradio.org/post/anthem-asks-missourians-think-twice-going-emergency-room

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Anthem asks Missourians to think twice before going to the emergency room – St. Louis American

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Entry to Leesburg hospital ER moving as part of $27 million expansion – Orlando Sentinel

LEESBURG The entrance to Leesburg Regional Medical Centers emergency room, which will grow in size as part of a $27 million expansion, will close Thursday as part of the construction, hospital officials said.

Starting then, patients will be required to access to the ER through the hospitals main entrance, officials said. Signage and extra security will be in place to help guide patients and family members. Additional parking spaces have been added to the east and west lots to accommodate patients and visitors.

The expansion will increase the hospitals east side by almost 48,000 square feet of space, adding 24 beds to the ER and including a fast-track unit to handle pediatric patients, three or four trauma-sized rooms for critical-care treatment, a spacious waiting room and an atrium-like lobby.

Its the first increase in the ERs capacity since it was built more than 50 years ago, according to Don Henderson, president and CEO of Central Florida Health, LRMCs nonprofit parent company. The expansion is due to be completed in spring of 2018.

jfallstrom@orlandosentinel.com or 352-742-5916

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Entry to Leesburg hospital ER moving as part of $27 million expansion – Orlando Sentinel

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Summer months bring rise in emergency room visits – Florida Times-Union

Summertime in Florida brings warm weather, beach trips and outdoor activities as children are out of school and families enjoy vacations.

All can be fun, but also have inherent risks and increases in injuries.

Close to 20 percent of adults and more than 17 percent of children every year visit an emergency room.

About 27 percent of visits are in the summer months, according to the Centers for Disease Control and Prevention.

In Florida, we are faced with a unique set of problems that can result in drownings from rip currents in the ocean to heat-related illnesses and dangerous sunburns.

Some other common injuries and illnesses seen in emergency rooms in the summer include motor vehicle accidents, watersports-related injuries, snake bites, shark bites, bug bites, spinal injuries and other traumatic injuries.

But there are many ways to stay safe while enjoying all the fun summer has to offer.

Wear sunscreen that is SPF 30 or higher and reapply frequently

Limit your time in the extreme heat and direct sun and wear sun protective clothing

The suns rays are most harmful between 10 a.m. and 4 p.m. If youre out during these times, seek shade under a tree, shelter or an umbrella.

Stay hydrated throughout the day

Learn CPR and other life-saving techniques

Be sure to wear your seatbelt at all times

In the summer, the temperature inside a parked car can reach 140 degrees. Never leave a child or a pet inside a parked car even if the windows are cracked or the car is parked in the shade.

Water safety is also essential. The CDC reports that from 2005 to 2014 there were an average of 3,536 fatal unintentional drownings (non-boating related) annually in the United States about ten deaths per day. An additional 332 people died each year from drowning in boating-related incidents.

Drowning is the leading cause of death among children between 1 and 4 and the second leading injury-related cause of death in older children, with nearly 800 children drowning each year nationally, according to Safe Kids Northeast Florida, led by THE PLAYERS Center for Child Health at Wolfson Childrens Hospital. More than half are under age 5.

More than 5,000 children nationally are seen in emergency rooms for injuries from near-drowning incidents.

According to Safe Kids Northeast Florida, studies show that although 90 percent of parents say they supervise their children while swimming, many acknowledge that they engage in other distracting activities at the same time like talking, eating, reading or taking care of another child. Even a near-drowning can have lifelong consequences.

With all the water activities in Florida, its important to also know that Floridas drowning death rate of children ages 1 to 4 has historically been the highest in the nation.

Children need to be watched carefully and at a close distance while also avoiding any distractions. Use life jackets when boating and ensure that yourself and children know basic swimming skills. If you have a pool, be sure it is fenced off and safeguards are in place to protect children from getting inside unsupervised.

When it comes to the outdoors, children and adults also need to be careful where they walk and play because they may come face-to-face with critters, including snakes.

Summer is snake season and Florida is especially dangerous with several poisonous snakes commonly roaming the area.

Avoid high-brush areas and if you see a snake, do not approach or pick it up.

If you are bitten, seek help immediately. Do not apply a tourniquet and do not attempt to suck venom from the wound. Often times, people try to capture and bring in the snake when they go to the emergency room. But that is actually more dangerous and does not help with treatment. Instead, remember the snakes color and shape to describe to medical personnel.

The key to summer fun is to just be cautious and take necessary precautions to keep you and your family safe.

Brandi Gilchrist, MD, is board-certified as an emergency medical specialist. She is medical director of Baptist Emergency at Town Center and assistant medical director of the emergency department at Baptist Medical Center Beaches, 1350 13th Avenue South, Jacksonville Beach, FL 32250.

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My Night in the Emergency Room – Aish

I was in my kitchen following directions for a new muffin recipe when the immersion blender got stuffed with the dried ingredients, clogging the sharp blades. For a second I thought to myself, let me unplug the machine, but somehow I didnt.

I know. Big mistake.

I put my finger in to scoop out the thickened flour and before I knew it the machine went swirling. I screamed out for my husband to call Hatzalah, the emergency volunteer corp. Grabbing a towel, I wrapped it tightly around my finger. We ran outside, my hand lifted, pointed to the sky.

A few moments later we heard the sound of sirens. My husband and I climbed into the ambulance. I was afraid to look and turned away as my finger was examined. No doubt about it, I needed to get to a hospital. I kept giving my husband a brave smile but the truth is, I had no idea about how much damage was done. I was frightened and scared. And yes, it was painful.

The Hatzalah volunteers raced us to a nearby hospital. They brought us in to the emergency room and reassured us that all will be all right.

All around me there were people waiting to be helped. Police were clustered around a room where they were guarding a crime victim with a gunshot wound. Some lay moaning on their stretchers. This is going to be a really long night, I thought to myself.

The Hatzalah crew took care of getting me checked in and quickly returned with news.

The doctor on call tonight is a wonderful plastic surgeon. Hes part of the local community and guess what his specialty is? Hands!

I was overwhelmed with gratitude.

I cant believe it, my husband added. I know him. We grew up together and went to the same shul as kids.

Even more unbelievable because the shul is in Sao Paulo, Brazil.

I was settled on a stretcher still holding up my heavily bandaged finger while we waited for the doctor who was treating another patient.

My husband began pacing. Is the pain terrible? he asked.

Its ok. I gave a thin smile.

So many thoughts were going through my head. Why didnt I just unplug that machine? What was I thinking? Who knows what this will involve? And wow, does this ever hurt!

Then I remembered something my mother taught me years ago. When Joseph was sold by his brothers and taken down to Egypt, he was put into a caravan. Normally, there would be smelly tar taken as the caravans cargo but to spare Joseph the awful stench, God arranged that on this journey there would be fragrant spices instead. When Joseph would smell the spices hed realize that he was not forgotten. This would be a personal sign to him. Even in the midst of his pain and suffering, he was receiving a comforting message from Above.

At this moment I truly got it.

In the midst of your pain, look for a sign and seek a token of something good. Try to smell the sweet spices and youll get through your challenge feeling loved despite the pain.

Here we are in this emergency room, I said to my husband. Its the middle of the night, were both exhausted and I have no idea how this will turn out. But with it all, I feel comforted. The doctor here is a plastic surgeon hand specialist whom you grew up with! What are the odds? I am smelling the sweet spices. I am feeling the Almighty watching over me.

A short while later the doctor treated me and thank God I my hand will heal without lasting damage. We were finally ready to return home.

It had been a difficult day. That morning we had stood in the cemetery for the unveiling of my beloved mother, Rebbetzin Esther Jungreis. Prayers were recited and tears were shed. Even though the distance from that tragic moment of loss grows wider, the searing pain remains. I yearn for another conversation, another laugh, another Shabbos meal shared, another blessing that will never be.

But if we can hold onto the lessons that a parent has given us, then the soul is forever with us, guiding us, inspiring us, and infusing us with strength. That is the parents legacy.

That night my mothers words echoed to me in the night, bringing me comfort and soothing my soul.

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Emergency room patients shouldn’t have to worry about coverage – STLtoday.com

In the wake of Anthem Blue Cross/Blue Shield notifying Missouri plan participants that non-urgent emergency room visits would no longer be covered, the Post-Dispatch published an article (June 23) asserting that St. Louis residents use the ER too often for unnecessary care. Unfortunately, there were serious methodological flaws in their study. This policy from Blue Cross/Blue Shield may violate federal law regarding the national “prudent layperson” standard.

This standard requires insurance coverage be based on a patients symptoms, not final diagnosis. Anyone seeking emergency care suffering from symptoms that appear to be an emergency should not be denied coverage.

Burning in the chest may be heartburn; however as emergency physicians, we know not infrequently it actually ends up being a heart attack.

If you have an Anthem Blue Cross/Blue Shield health insurance plan in Missouri, be aware that nearly 2,000 diagnoses which the company consider to be non-urgent would not be covered in the emergency room. Heart disease, cancer, asthma, stroke, diabetes, influenza and pneumonia are among the top eight causes of death in the United States. All of these illnesses can cause life-threatening conditions that require emergency care.

Missouri participants need to fight for their right to have access to emergency care as protected by the “prudent layperson” standard.

Patients should be able to seek emergency care immediately without wondering if insurance will cover the ER visit. The vast majority of patients who come to the emergency department seek care appropriately.

Dr. Kristen Mueller St. Louis

Member, Missouri College of Emergency Physicians

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Anthem asks Missourians to think twice before going to the emergency room – KBIA

Anthem Blue Cross Blue Shield, one of Missouris largest insurers, no longer covers emergency room visits that it deems unnecessary.

The policy aims to save costs and direct low-risk patients to primary care physicians and urgent care clinics. But doctors say patients may avoid going to a hospital when they really need it, if they fear a large bill.

Theyre forcing the lay public to make a medical determination, said Dr. Doug Char, a Washington University emergency physician. Theyre basically telling people you have to decide if this chest pain youre having is indigestion or a heart attack.

An emergency room is the most expensive place to see a doctor, and insurers are balking at the cost. Between 15 percent and 30 percent of emergency room visits in the St. Louis region are avoidable, according to a study by the nonprofit Midwest Health Initiative. Missouri hospitals charge an average of $372 for emergency room visits for minor issues, but some charge as much as $1,300, according to data compiled by the Missouri Hospital Association.

“Most non-emergent medical conditions can be easily treated at retail clinics, urgent care clinics of 24/7 telehealth services,” Anthem’s Missouri spokesperson, Scott Golden, wrote in an email. “The review by an Anthem medical director will take into consideration the presenting symptoms that brought the member to the emergency room as well as the diagnosis.”

In mid-May, Anthem sent letters to Missouri enrollees to alert them that from June 1, it would no longer cover emergency room services for non-emergencies. In such cases, people who have health insurance could still be stuck with the full cost of their visit, if the insurer determines that their symptoms did not reach the level of requiring emergency care.

Anthem enforces the same guidelines in Kentucky, and put the rule in place for Georgia policyholders this month. Its officials say there are several exceptions, such as if a patient is under 14, the visit occurs on a Sunday or there are no urgent-care centers within 15 miles.

The American College of Emergency Physicians raised a red flag when Anthem sent out a spreadsheet of 1,908 conditions that it may not deem not worthy of coverage in an emergency room. Some of the listed symptoms could indicate a life-threatening emergency, said Dr. Jonathan Heidt, president of Missouris ACEP chapter.

To have them under that threat of not having their bills paid if theyre wrong about what their diagnosis is, its really going to harm patients in the long run, Heidt said. Our patients have a right to seek emergency care.

The doctors argue that Anthems policy, and similar rules set up by state Medicaid programs, violate the federal Affordable Care Acts prudent layperson standard. The rule asserts that a person with average knowledge of health and medicine should be able to anticipate serious impairment to his or her health in an emergency, and that laws should not assume that a person will know more than that. Anthem contends that it reviews claims using this standard already.

Though Anthem began enforcing the Missouri rule at the beginning of June, patients who visit the emergency room for non-emergencies likely will receive bills in the coming months. Heidt said that if Anthem does not reconsider its policy, ACEP may weigh legal action against the insurer.

Were still a little bit early for that,” Heidt said. “But at this time, all of our options are on the table.

According to the Missouri Department of Insurance, Financial Institutions & Professional Registration, the rule is based on previously filed language that was approved by the regulator. Other plans have similar provisions.

“If a consumer believes a claim has been improperly denied, or has questions about how a claim has been handled by their insurer, they can contact the Department’s Consumer Affairs Hotline at 800-726-7390 or they can file a complaint online,” said Grady Martin, the agency’s director of administration.

Follow Durrie on Twitter: @durrieB

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