New ER documentary The Waiting Room

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PainRack
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New ER documentary The Waiting Room

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http://abcnews.go.com/Health/waiting-ro ... GJdjY1lTYi
Eric Morgan, in his 20s and planning to get married, arrives at Highland Hospital's emergency room, shaken that he has been diagnosed with a testicular tumor that is likely cancer.

Surgeons at a private hospital have turned him away for lack of insurance but tell him it's "urgent" he get care.

Demia Bruce -- out of work for a year -- anxiously waits in the same ER with his 5-year-old daughter, her face swollen and burning with fever.

Carl Connelly has overdosed on drugs and alcohol, and Davelo Lujuan can't bear the pain of his spinal bone spurs. They, too, wait.

A provocative new documentary, "The Waiting Room," is a snapshot of Highland Hospital in Oakland, Calif., one of the nation's busiest safety-net hospitals, which is stretched to the limit with 241 patients a day, mostly uninsured, who need medical care they can't afford.

The film, directed by Peter Nicks and getting Oscar buzz, opens at the IFC Center in New York City on Wednesday, Sept. 26 and in the greater Los Angeles area at Laemmle Theaters in Santa Monica, Pasadena and Claremont on Friday, Sept. 28, before showing around the country. "The Waiting Room" will also be aired by PBS in 2013.

Nicks follows 24 hours in the lives of artists, small business owners, factory workers and unemployed parents who have been hit hard by the economy -- and hit harder still by a healthcare system that has left them out.

"Bring your breakfast, lunch and dinner -- everything honey," an African-American patient who has been waiting for days to see a doctor, tells a new arrival.
They take a number and they wait, sometimes coming back two or three days in a row. It might be months before they can get a doctor's appointment. With only one operating room, the most urgent cases go first and the rest wait. A man with a survivable gunshot wound has waited two days to be seen.

"It is the place of last resort," said Nicks, 44, whose wife is a speech therapist at Highland Hospital and came home with stories of patients' troubled lives.

"Historically, these hospitals serve the indigent, the homeless and the mentally ill -- the population on the fringe of the system," said Nicks.

But today, patients who are down on their luck also come in to have their prescriptions refilled or to be hospitalized when a disease like diabetes has escalated.

"These people are using the waiting room as their doctor because they have no continuity of care," he said. "More and more people are losing their jobs and are showing up at the public hospitals."

One Asian immigrant stopped taking his blood pressure medicine because of the cost and had a stroke.

Lujuan, a carpet layer who took a pay cut, bemoans his life as an unemployed daughter moves back home. He returns to Highland for his back pain: "I can't sleep at night -- the muscle relaxers don't work… My checking account is down. I don't know what to do."

Some of the best-trained doctors in the country, from schools like Harvard Medical, do their residencies in trauma at Highland, according to Nicks. Though the care is exemplary, these safety-net institutions are at risk for survival.

Florida's Gov. Rick Scott has waged a campaign to cut safety-net hospitals to close budget deficits. Just last March, he closed A.G. Holley hospital, a 100-bed institution in Palm Beach County specializing in tuberculosis. In April, a TB outbreak among the homeless caused 13 deaths.

Those who wait and those who work long hours to care for them cope with sickness, bureaucracy, frustration and difficult choices, but Nicks finds hope in the system. The nurse assistant who is the patient's first point of contact, Cynthia Johnson, has both compassion and humor in this overwhelming environment -- and the patience of Job.

Johnson, a cheerful African-American with pink glasses, takes pride in being able to "spell every name, no matter what country."

Some patiently wait in line and others jump the queue, losing tempers and swearing at the overburdened staff.

"Get a grip," Johnson firmly tells one aggravated man, without losing her temper. He waits.

To director Nicks, she is the "symbol of the system and what we all want in our care -- an empathetic, caring individual, who sits down next to you and says, 'How are you doing?'"
Highland Hospital Staff Have 'War Mentality'

In such a high-stress environment, it would seem logical that doctors and nurses would also burn out. But Nicks said, "We didn't see a ton of that."

"What's more revealing is that these doctors at public hospitals are a very unique group of people, a self-selecting group. They could choose to go elsewhere and make a lot more money, but they don't. It's akin to M*A*S*H*, like they are in a war -- they have that mentality."

"They love it, thrive on it," said Nicks. "You have to be wired a certain way to treat someone with empathy that smells and curses at you."

Nicks didn't want his film to be a typical "disaster documentary" like "Waiting for Superman" or "Sicko," but storytelling.

"At this moment the health care debate voices are dominated by journalists and politicians and pundits," he said. "This is the voice of the people on the front lines."

"The waiting room was a metaphor for me," he said. "What are you waiting for? It really struck me that people wanted to talk about who they were."

Nicks dispels the myth that safety-net hospitals are free. The carpet layer with bone spurs who finally sees a specialist, but earns just a little too much to qualify for Charity Care, takes home a large bill for Highland's services.
Nicks shot 175 hours of raw footage over months, but captures just a day in the life of several characters in the hospital waiting room.

He previously worked as a staff producer for ABC News, as well as for the PBS series, "Life 360."

"Some of the best scenes were not in the film," said Nicks. "In the end we wanted to make sure the patient population was represented in a diverse and accurate way."

Now he is creating an interactive digital project to continue the work of the film so people in waiting rooms across the country can share their own stories. "We want to collect cultural data that is valuable for the hospital," said Nicks.

Most of all, he said he hopes that the film will bring attention to the nation's ailing healthcare system just as the United States begins to roll out the contentious Affordable Care Act.

"I am not a policy expert and not even remotely a healthcare journalist," he said. "But what we do know from talking to people is that there is a lot going on behind the scenes … It's important to understand how the health care law affects the community and those served by the public hospitals."

As for Demia Bruce, his daughter was luckier than the son he lost at the age of 2 from a seizure. She was diagnosed with strep throat, given antibiotics and sent home.

Carl Connelly, whose drug addiction had sent him to Highland on repeated occasions, could not be released because the pastor who has given him shelter would not take him back. Connelly took up precious space in a bed that might have been given to another waiting patient.

The story of Eric Morgan, who is last seen standing alone and bewildered in the hospital parking lot, ends well, according to Nicks. Morgan was able to wade through the system and qualify for Charity Care and a $30,000 surgery revealed his tumor was not cancerous.

Morgan, who had banked sperm just in case, has since married the woman who accompanied him in such distress to Highland and they now live and work in Hawaii.

"We are all connected," said Nicks. "And we can't forget that. Insured or not, we must share the same values."
Now, the folks over at crooksandliars are linking this film to Mitt Rommey and the "they can get health care at ER" statement.

I'm sure the Americans on this board will also talk about the ailing US healthcare industry.

Fine, but I'm just stuck by one nitty statistic.
250 patients on average and this is passed on as a high volume number?

http://www.sgh.com.sg/about-us/newsroom ... aints.aspx
Last year, there were 738,000 visits at six restructured hospitals – Singapore General Hospital (SGH), Changi General Hospital (CGH), Khoo Teck Puat Hospital (KTPH), Alexandra Hospital (AH), National University Hospital (NUH) and Tan Tock Seng Hospital (TTSH).
That's an average of 336 ED visits every day. Now, I know that we're not the States, as stated in the article, half of this is for stuff like GE and requests for Medical Certificates(I'm looking at you Changi), but TTSH and SGH for example handle a good number of traffic accidents daily along as well as drunken bar fights.


Can someone give me a better picture of what kind of cases US ER faces? And their workload there?
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Re: New ER documentary The Waiting Room

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Can someone give me a better picture of what kind of cases US ER faces? And their workload there?
Your numbers were for a full-sized presumably state run general hospital. This is a small "safety net hospital". Essentially, it is a scaled up free clinic (but is not actually free, though I imagine it is subsidized by the state). It has one operating theater for example. Singapore General Hospital I imagine has more than that.

This little hospital is trying to deal with all the sick and injured people who get turned away from privately run hospitals in a major city. That is a LOT of patients.

In the general case, hospitals have the regular emergency room for things like non-critical injuries incurred outside the business hours of general practitioners (who have their own clinics) and children with late-night fevers. They also have a trauma facility for things like gunshots. Most hospitals do not handle small injuries and the sorts of things a General Practitioner deals with outside of their ER facilities. You dont schedule an appointment to have your back pain checked out at the hospital. You do so at your GPs private practice.

However, this system is built assuming that for most things, a person has a general practitioner and can get referred to specialists or surgeons (who do operate out of the hospital) if they need it. However, something like 15-20% of the US population has no such thing. As a result, the ER facilities are having to deal with patient loads they dont have the facilities to deal with.
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Re: New ER documentary The Waiting Room

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http://www.acmedctr.org/highland.cfm?M1 ... M3=1&P=104

According to this site Oakland's Highland Hospital is only a 236 bed hospital. That's about as small of a hospital as you can get and still have fairly comprehensive trauma care, though it doesn't have everything.

http://en.wikipedia.org/wiki/Tan_Tock_Seng_Hospital

According to this the biggest hospital in Singapore has 1,500 beds and handles 400 ER cases a day, most in the country. I doubt the ER is six times larger, but it will certainly be much bigger and better staffed. Importantly more beds just means more ability to get people out of the ER and having supportive care, even if they need to wait for complicated treatment, instead of waiting in chairs with nothing.

For a more typical US example, Temple University Hospital, which is smack dab in the middle of North Phily and thus gets to handle a fuck load of this cities shootings and endless serious traffic accidents, has 740 beds and handles about 320 ER cases a day. It isn't the best place but people don't wait for days with gunshot wounds.
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Re: New ER documentary The Waiting Room

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Ah I see. The issue here appears to be the relatively small size of the hospital then..

Could anyone here share their experiences in the ED then? Such as how long you waited and the situation there? One of the things that struck me was the large crowd seen in the trailer at the waiting room. Is that typical?
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Re: New ER documentary The Waiting Room

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The last time I was at the er was back in in the 90s in Idaho. From what I remember I spent about 45 minutes waiting to see a doc about stitches for a broken nose and torn up lip.
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Re: New ER documentary The Waiting Room

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PainRack wrote:Ah I see. The issue here appears to be the relatively small size of the hospital then..

Could anyone here share their experiences in the ED then? Such as how long you waited and the situation there? One of the things that struck me was the large crowd seen in the trailer at the waiting room. Is that typical?
Wow, I suppose I could, but some of this would be from 30 years back....

On a couple occasions I actually didn't wait in the ER - when I walked into an ER in Chicago one afternoon with my face swollen up and wheezing so hard I couldn't speak more than two words without gasping for breath the triage nurse took one look at me as I choked out "food allergy" and signaled two big dudes, who then lifted me bodily onto a gurney and wheeled me into an immediate beehive of treatment. That is one thing to be clear about - if you really do have an obvious, immediately life-threatening problem you will be sent to the front of the line and seen immediately. I've seen that happen on a couple occasions.

I had one occasion where the wait was about 20 minutes, which was the lowest wait time other than the first instance I related, but in that case I'd been seen by a GP who decided I needed to be admitted to the hospital NOW, but because it was outside normal business hours the only way to do that was via the ER. So he called ahead and told them I was coming, it was (very surprisingly) not a particularly busy time, and the wait was mainly the delay in finding a bed for me in the hospital.

I'm trying to remember how long my spouse had to wait when he had the pancreatitis - it was less than a half an hour, I suspect the constant vomiting and the whacky vitals at triage factored into that.

Think my longest wait personally was when I dislocated and sprained my knee, about six hours. I'd gotten to the front of the line after only a couple hours when a father ran into the ER with his young son who had a bathtowel clamp over his face and one eye, said towel saturated with blood and dripping it onto the floor. At which point the bleeding kid bumped me out of my slot and I went back to waiting. Granted, my knee injury, while painful, was not life threatening and really could wait, although someone did come by periodically to check on me very briefly. They do try to keep an eye out for folks in the waiting room who are "crashing" unexpectedly.

Even in upscale areas with adequate facilities and while possessing good health insurance one should be prepared to wait, oh, I'd guess about 2-4 hours in an ER unless you're actively dying: heart attack, spurting quantities of blood, seizing violently, detached body parts, etc. Strokes are starting to be seen in that category though it still happens that stroke patients get stashed in a corner for hours at a time by folks who haven't gotten the message that yes, you can do something to mitigate the damage if you treat early enough.

I've seen ER's that were nearly empty and no one was waiting, everyone could be seen immediately, maybe twice in my life. I've seen them totally chaotic, crazy, exhausted kids sleeping on the floor, people puking into the bushes just outside the door (if not into the potted plants/trash cans inside), people bleeding, etc. maybe twice in my life. More often it's between the two extremes. True emergencies are seen immediately or nearly so, with a lot of folks with problems ranging from serious (broken bones, gunshot wounds not immediately life-threatening, serious gashes, very sick with something or other) to minor (no insurance so bring kid with ear infection to the ER because no one can sleep with the kid yelling and crying in pain all night). The less serious the problem the longer you wait. Yes, 4-8 hours, 12 hours... people do wait that long, particularly in overburdened urban areas, when the problem is something better seen by a GP but they don't have access to one due to lack of insurance.
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Re: New ER documentary The Waiting Room

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I think I should make this clear.

Relax,I don't need to be convinced of the concept of triage and even economy of scale. I can easily google it and know that the average 4 hour n 5 min ER wait in 2007 is significantly superior to the then waiting times in Singapore. I not here to lambast the US healthcare industry or claim superiority. I was just intrigued by the two clips shown and dug up some official data,but I need the human perspective to place that in context.

Some things are just OOC situations. Like the time I read this nursing blog and she claimed administering rituximab was a nursing intensive procedure that needed her whole attention. HA!

Try running rituximab, two patients on blood support, one more on iv antibiotics and taking care of their elimination needs at the same time!.......


Although in retrospect,don't. Constant shit like that is probably why I'm burnt out and non functional now.


And without knowing the technical details behind my story, you can only garner the impression that it was exhausting work,but you can't fully comprehend it.

Which is why I started this thread. The clips aroused some questions which the official data can elaborate upon, but I needed some human perspective to place it in context. Such as the idea of a small safety net hospital n etc....

I could of course watch the docu in full but I don't think its out yet in stores:d
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