Health

As ER Wait Times Grow, More Patients Leave Against Medical Advice

Published

6 years ago

May 29, 2019

Emergency room patients increasingly leave California hospitals against medical advice, and experts say crowded ERs are likely to blame.

About 352,000 California ER visits in 2017 ended when patients left after seeing a doctor but before their medical care was complete. That’s up by 57%, or 128,000 incidents, from 2012, according to data from the Office of Statewide Health Planning and Development.

Another 322,000 would-be patients left the emergency room without seeing a doctor, up from 315,000 such episodes in 2012.

Several hospital administrators said overcrowding is a likely culprit for the trend. California emergency room trips grew by almost 20%, or 2.4 million, from 2012 to 2017.

Moreover, ER wait times also increased for many during that time period: In 2017, the median ER wait time for patients before admission as inpatients to California hospitals was 336 minutes — or more than 5½ hours.

That is up 15 minutes from 2012, according to the federal Centers for Medicare & Medicaid Services. The median wait time for those discharged without admission to the hospital dropped 12 minutes over that period, but still clocked in at more than 2½ hours in 2017.

California wait times remain higher than the national average. In 2017, the median length of a stay in the ER before inpatient admission nationwide was 80 minutes shorter than the median stay in California. Four states — Maryland, New York, New Jersey and Delaware — had even longer median wait times.

The growth in patients leaving California ERs prematurely was faster than the growth in overall ER encounters. About 2.4% of ER trips in 2017 ended with patients leaving the ER against medical advice or abruptly discontinuing care after seeing a doctor, compared with 1.8% in 2012.

“Most patients are sick but not critically ill,” said Dr. Steven Polevoi, medical director of the emergency department at UCSF Helen Diller Medical Center at Parnassus Heights. “Emergency care doesn’t equal fast care all of the time.”

When a patient leaves the ER after seeing a doctor but before the doctor clears them to leave, the Office of Statewide Health Planning and Development classifies that encounter as “leaving against medical advice or discontinued care.” The definition includes encounters in which a doctor carefully explains the risks to the patient and has the patient sign a form, but also instances in which the patient simply discontinues care and bolts out the door.

Patients leaving the emergency room too soon “are deliberately putting themselves at more risk for morbidity and even mortality,” Polevoi said — a point echoed by other physicians.

Dr. Veronica Vasquez-Montez, emergency room medical director at Good Samaritan Hospital in Los Angeles, said she sometimes finds herself having “tough conversations” with sick patients intent on leaving the ER, often citing pressing responsibilities.

“If you die from this,” she tells them, “you are good to no one you are caring for.”

One of her recent patients was at high risk for a major stroke but insisted he needed to leave the ER to take care of his pet.

“Guess what he came back for? A major stroke,” said Vasquez-Montez, also a clinical assistant professor at the University of Southern California’s Keck School of Medicine.

Compared with all ER patients, those leaving against medical advice were more likely to be men; people ages 20 to 39; and uninsured or on Medi-Cal, the government insurance program for the poor, state figures show. They were also more likely to complain primarily of non-specific symptoms such as chest pain or a cough.

Fresno, Shasta, Yuba, Kern, San Bernardino and Tulare counties had the highest proportion of ER encounters in 2017 that ended with patients leaving against medical advice or abruptly discontinuing care. Each of those counties recorded more than 4% of ER patients leaving too soon, state figures show.

From 2012 to 2017, the number of emergency room encounters in Fresno County increased by almost 95,000, or 37%. At Fresno’s Community Regional Medical Center, about 9% of ER encounters ended with a patient leaving too soon, more than three times the statewide rate.

Community Regional Medical Center is one of the busiest hospitals in the state. It recently instituted a “Provider at Triage” program that puts caregivers in the lobby area with patients, said Dr. Jeffrey Thomas, the hospital’s chief medical and quality officer. The hospital’s internal data now show fewer than 2% of patients leaving against medical advice or abruptly discontinuing care.

“When patients bring themselves into the ED, they are seen in about 5 minutes by a qualified registered nurse and, on average, are seen by a provider within 30 minutes of arrival,” Thomas said in a statement.

Phillip Reese is a data reporting specialist and an assistant professor of journalism at California State University-Sacramento.

Phillip Reese, Kaiser Health News

Posts by Phillip Reese, Kaiser Health News

Activism

Oakland NAACP President Stands on the Frontlines for Equity

With education as a cornerstone, Adams emphasized the importance of youth having access to quality kindergarten through 12th-grade education along with college or vocational programming beyond high school. “I feel that it’s so important for our children to get a good education in K-12th grade, along with the colleges of their choice, especially with the HBCU’s (Historically Black Colleges and Universities).”

Published

3 days ago

January 7, 2025

Oakland Post

NAACP Oakland President Cynthia Adams. Photo Courtesy of Cynthia Adams.

By Carla Thomas

For Cynthia Adams, president of the Oakland chapter of the NAACP, fighting for the rights of Black people comes naturally. With southern roots in Arkansas, Adams experienced firsthand the injustice and unfairness of racism.

“Growing up in the Jim Crow South, I experienced the unfair treatment of people of color and how faith can inspire communities to bring about positive and long-lasting change,” said Adams. Adams says a combination of her family and faith has kept her strong in the face of adversity and inspired her life’s work of advocacy.

Adams chose education as a career path — and a means to achieve equity and overcome racism. She earned her bachelor’s degree at the University of Arkansas at Pine Bluff and later received an advanced degree from California State East Bay.

Adams’ experience as an Oakland Unified School District (OUSD) recorder, a counselor, a researcher, and a college recruiter has allowed her to be laser-focused on youth. She also served as the chairperson for the Oakland NAACP youth.

“The mission of the National Association for the Advancement of Colored People is to ensure the political, educational, social, and economic equality of rights of all persons and to eliminate race-based discrimination. We want to ensure our citizens have equal rights and opportunities without discrimination based on race.”

As a partner with the State of California’s Stop the Hate campaign, Adams says the initiative is a step in the right direction. “It’s great that our governor and state created the Stop the Hate campaign and provides resources for victims of racism and other hate crimes,” said Adams. “The racism toward Black people has increased and our children are being targeted,” she continued.

“We, at the Oakland branch, created a declaration on racism that will amplify the needs of our community to combat racism,” continued Adams. “That declaration was adopted nationally.”

Bridging communities and collaborating is also a strategy for moving society toward justice, according to Adams.

“Through the NAACP, we build connections between communities and advocate for the rights of historically marginalized and oppressed individuals,” said Adams. “Collective action is the only way to advance civil rights and promote social equity.”

By taking stands on supporting former Oakland Police Chief LeRonne Armstrong to supporting the recall of a mayor faced with a scandal that brought negative national press to the city of Oakland, Adams has always demanded more for her people, and better for Oakland, the city she calls home.

She expressed pride in the national organization’s announcement of a $200 million fund designed to empower Black funders nationwide. “We all know the health of a community begins with economics,” said Adams.

Adams says that strengthening Black businesses automatically sustains a community. “We’ve also got to educate our community on opportunities and teach our children critical thinking so that they can provide the next generation of solutions for society,” said Adams.

Oakland Post

Posts by Oakland Post

Activism

January Is Mental Wellness Month

Mental illness affects people differently. Children ages 6-17 are three times more likely to repeat a grade if they have mental, emotional, developmental, or behavioral problems. Those with severe mental illness have a life span of 10 to 25 years shorter than the general population. 64% of jail inmates have a mental illness compared to 21.6% of the general adult population.

Published

4 days ago

January 6, 2025

Oakland Post

iStock,

By Scott Knight

January is a time to recharge and recover from the holidays. It is also National Mental Wellness Month, which recognizes the importance of mental health and aims to reduce the stigma associated with mental illness.

According to the National Institutes of Health, 57.8 million adults lived with some form of mental illness in 2023. The severity varies from person to person. Understanding mental health statistics in the U.S. can raise awareness and garner support for those in need.

Anxiety disorders are the most common form of mental illness and women are more likely than men to experience depression. 17% of adolescents ages 12-17 experienced a major depressive episode. And 33.5% of adults with living with a mental illness also has a substance use disorder.

The Substance Abuse and Mental Health Services Administration (SAMHSA) collects data on substance use and mental health. Their 2023 National Survey on Drug Use and Health reported that multiracial people had the highest rate of mental illness at 36.7%, followed by Whites (24%), American Indian/Alaskan natives (23.5%), Hispanics (20.6%), Blacks (19.4%), and Asians (18.1%).

National Mental Wellness Month involves highlighting the resources available to equip individuals with the capacity to cope with life’s difficulties; have healthy relationships and take care of their mental well-being before issues arise.

Wellbeingtrust.org tells us that having a purpose in life offers many benefits, including being happier, living longer, sleeping better, and improved heart health. To find that purpose explore your interests, volunteer, consider what you love to do, talk to friends and family, and try new experiences.

The National Alliance on Mental Illness reports that 46% of people who die by suicide had a known mental illness.

The Jason Foundation is a valuable resource if you feel that a friend or loved one is struggling with a mental illness. JFI is dedicated to the awareness and prevention of suicide through educational programs that equip youth, parents, educators, and the community with the tools and resources to identify and assist those who may be struggling mentally.

Visit www.jasonfoundation.com to learn how to make a difference and find the closest Jason Foundation Affiliate Office.

About the Author

Scott Knight is the Education Specialist at the Jason Foundation.

Oakland Post

Posts by Oakland Post

Activism

2024 in Review: 7 Questions for Former Assemblymember Chris Holden

While in office, Holden championed efforts to improve education outcomes for students and advocated for social and racial justice. Legislation he wrote or sponsored also focused on, innovation in transportation, protecting developmental disability service providers and improving public health, more broadly.

Published

4 days ago

January 6, 2025

Oakland Post

Hon. Chris Holden. File photo.

By Edward Henderson, California Black Media

In 2012, Assemblymember Chris Holden was first elected to the California State Assembly representing the 41^st District in the San Gabriel Valley.

He was re-elected to that position for the following four terms.

Holden, a graduate of San Diego State University, lives in Pasadena with his wife, Melanie, and children Nicholas, Alexander, Austin, Mariah and Noah. Holden is the son of former State Senator and LA City Councilmember Nate Holden.

Before he closed out his final year of service in the Assembly, California Black Media (CBM) spoke with Holden. He reflected on his accomplishments this year and his goals moving forward.

Looking back at 2024, what stands out to you as your most important achievement and why? 

A project I’ve been working on for well over 36 years — the light rail system — made its way into Pasadena from downtown LA. Now it’s making its way through the San Gabriel Valley to Pomona.

How did your leadership and investments contribute to improving the lives of Black Californians? 

Having an opportunity to represent a multi-ethnic and diverse district is exciting, but to be able to bring a voice for a lived African American experience from the San Gabriel Valley is very important.

What frustrated you the most over the last year?

I still am frustrated that we aren’t seeing the kind of progress on affordable housing to allow underrepresented communities to be able to afford to live in the community that they grew up in.

What inspired you the most over the last year?

There has been a lot of movement around reparations through community engagement. Dr. Shirley Weber put forth the bill to establish a reparations task force and that task force met for a number of years. Two members of our caucus served on it, Sen. Steven Bradford and Assemblymember Reggie Jones-Sawyer. A thousand-page report and a hundred recommendations or more came out of that. And now we’re in the process of finding ways to implement some of those recommendations. It’s going to be a longer process, but I’m hopeful because California, once again, is on the front end of taking on a really challenging issue.

What is one lesson you learned in 2024 that will inform your decision-making next year?

Always be mindful how quickly the winds can change. We’ve gone from 10 years of having budget surpluses to this year having a $45 billion deficit.

In one word, what is the biggest challenge Black Californians face?

Inequality.

What is the goal you want to achieve most in 2025?

Well, I won’t be in the legislature in 2025, but I love public policy. I’d like to find myself in a position where I’m continuing to have an influence on how public policy is shaped and formed. I’m just looking forward to being a vital voice going into next year in a different role. It will also be an opportunity to lay a foundation to take another run, possibly for a seat on the LA County Board of Supervisors in 2028.