The Busiest Emergency Room in America

Originally found at centrist blog The Motley Moose

If I asked you to guess where the busiest ER in the country was, what places would immediately come to mind?

New York City? Nope- but not a bad guess. Lincoln Medical and Mental Health Center in the Bronx processes approximately 400 triage cases a day, but it's not even close to the busiest. How about Los Angeles? Close, but no; though USC Medical Center has an average of 500 admissions come through their triage unit a day.

Wow. Tough question, huh? I'll give you a clue. Examination rooms are converted horse stalls, made into "rooms" by creating walls out of ropes, sheets, and clothing pins. There are sometimes thousands of people in the ER waiting area at a time. Here's a picture of the waiting area:

Give up?

It's nestled in the Appalachian mountains in Wise, Virginia, where Virginia, Kentucky, Tennesse, and West Virginia meet.  This emergency room has over two thousand triage patient encounters a day, dealing with everything from root canals and diabetic complications, to pregnancies and mental health issues.  This is also the only emergency room in the United States where all care provided is a hundred percent free of cost.  Some people drive from as far away as Ohio and Alabama just to be able to get free medical care, and it's often the only medical attention they've received in years.

What's the catch?

The catch is this emergency room is first come, first served basis -- and it's only open for two and a half days every year. Some people spend the night in their cars just to be able to get an appointment -- and thousands are still turned away.

And heck, that was last summer.  You remember last summer, don't you? When all we suffered from was a "mental" economic recession?  This year promises to be a lot more fun.

Of the 46-million Americans in the United States that do not have health insurance, about one in every 20 live in this small section of our country.  Appalachia, for all it's natural beauty, is home to some of the most debilitating poverty in the United States.  That's why every July, the Remote Area Medical Volunteer Corps, in conjunction with the University of Virginia, holds a two-and-a-half day rural area medical clinic in Wise, Virginia.  The Remote Area Medical Volunteer Corps is a non-profit organization based out of Knoxville, Tennessee; since 1985, they've been running similar clinics in needy places all over the world -- Guyana, South America...and Virginia.

Over the course of these two and a half days, the Virginia/Kentucky State Fairgrounds become a world-class medical facility with a full range of medical services available in ear, nose, and throat (ENT); endocrinology; audiology; obstetrics/gynecology; nephrology; mammography; gastroenterology; HIV/infectious disease; and primary care.  A fully functional pharmacy and lab is available on site.  For the first time last year, patients had access to ultrasound exams, which were performed by two University of Virginia sonographers.  If a diagnosis can't be made on site, videoconferencing equipment is set up to consult with clinical teams three hundred miles away in Charlottesville, Virginia.

This is the same clinic that, as some of you may remember, one-time Democratic Presidential candidate John Edwards visited while campaigning in Appalachia in 2007. Surveying the scene, he remarked:

How can we live with this in America?  This is not OK.

Well, John, you're right; this isn't okay. But it's the way things are, and it'll only get worse before it gets better.

Last year, over 80 patients received free hearing aids they wouldn't have been otherwise able to afford.  Hundreds of mammograms were provided to patients who had gone years since receiving their last one, if ever.  Over 2,000 individual prescriptions were filled, with the knowledge that once the patients ran out of medicine, they wouldn't be able to get anymore.

One of the most "popular" procedures is elective tooth extraction.  That's right -- people choose to have their teeth pulled.  Why?  Because they understand this clinic is the only time they'll have access to dental care; even many of those with full health-care insurance don't have dental insurance.  And rather than risk the teeth degrading over time, they elect to have unhealthy-but-salvagable teeth pulled entirely, in order to save themselves the discomfort or financial burden down the road. Of course, financial reasons are hardly the only motives behind these kinds of decisions, as anyone who has tried to navigate through southwest Virginia will tell you.

Last year, over 200 doctors, nurses, medical and nursing students, and other health care professionals from the University of Virginia donated their time to staff this clinic, and the UVA Health System donated approximately $400,000 a day in equipment, supplies, and pharmecutecals -- and that's not counting the contributions of the Remote Area Medical Volunteer Corps or the dozens of other Commonwealth and nationally-based volunteer organizations that donated time and money towards the success of this program.  The entire event involves over 1300 volunteers and up to $10 million in contributions.

In recognition of those who sleep outside or in their vehicles to keep their spots in line, free coffee and bagels are handed out overnight, both nights of the event. The health care professionals work long into the night, trying to cram a year's worth of medical care in one long weekend.  Regardless, on Sunday afternoon there are still several hundred people still in line, waiting to be seen, some who have been waiting since the first day of the clinic.

Sadly, it looks like the folks who need this help the most are going to be the ones who suffer the most.  Included in the $2.9 billion budget cut signed into law by Governor Kaine was over $24 million aimed at the University of Virginia alone, or approximately 15% of its operating budget. This was tough, of course, but necessary to even have a chance at balancing the state budget. Thankfully, the University has enough of an endowment to enable them to honor their commitments to help operate the clinic this summer.  However, they are only one contributor out of many. The majority of the funding for the Remote Area Medical clinics comes from individual donors- people like you and me- and those individual donors are the ones hurting the most from this economic crisis.

Well, I shouldn't say that; we're hurting, sure, but most of us are getting by. The people who come to the Remote Area Medical clinic are many times worse off than most of us, because many have never had proper medical care. I could expound on this for hours, but nobody here needs me to wax poetic on the plight of these people, or how the recession is affecting them more severely than ever before. Even in the best of years, as noted above, there are many hundreds of people who wait in line for two-and-a-half days to get a modicum of medical care, and are turned away. Every volunteer who can no longer afford to donate their time, and every dollar taken away from providing supplies and medicine has a cascading effect.

But talk is cheap. If you are able, please, donate to the Remote Medical Area organization- or, even better, if you've got some free time this July 24th-26th, and are a medical professional of any kinda, come down to Wise and volunteer your time.

Any help is better than none; any help will help us make up the difference in what has been lost already. And it will have a real effect on people who had nothing well before this economic crisis.

Thank you, and God bless.

Tags: health insurance, Remote Area Medical clinic, University of Virginia (all tags)




this diary is incredibly heart-wrenching and important.  highly rec'd.

by canadian gal 2009-03-16 04:15PM | 0 recs
Open Letter To President Obama From MA. Physicians ticles.cfm?ID=18398

February 18, 2009

Honorable Barack Obama, President
The White House
1600 Pennsylvania Ave NW
Washington, DC 20500

Dear President Obama,

We applaud your commitment to enact legislation that will improve health care in the United States.  Health care continues to be a critical issue for workers at the bargaining table and -- as the crisis in the auto industry shows -- without a real solution responsible employers lose their competitive edge while employees suffer.

The undersigned labor leaders from Massachusetts, ask that you pursue a strong agenda for national, universal, publicly-funded health care as the best solution to address out-of-control health care costs and unacceptable levels of health care disparities.

The best way to achieve your goals of universality, quality, and cost effectiveness is a national program based on improving and expanding Medicare to cover everyone.  This would be accomplished by passing HR 676, the "Medicare for all" legislation.

Although much-touted by some policy makers in Washington, the Massachusetts Plan has failed to address our concerns about costs and disparities and in some cases, has even made them worse.

The chief problem with the Massachusetts plan is that it leaves private insurance companies at the center of the system through an individual mandate and expensive public subsidies supported by taxes for plans that still don't provide enough coverage.

The law is too expensive for many individuals forced to buy health insurance.  It has failed to control costs and it has cost the state far more than initially projected.  As a result, many critical health care facilities that serve low-income communities are facing huge cuts, while health care premiums continue to rise by double digits year after year.  The Massachusetts Plan is widely recognized as unsustainable and now that we are facing an economic crisis, it is even more problematic.

As John Sweeney, President of the AFL-CIO has said, "Who would have thought that Massachusetts ...would take a page out of the Newt Gingrich playbook for health care reform?  Forcing uninsured workers to purchase health care coverage or face higher taxes and fines is the cornerstone of Mr. Gingrich's health care reform proposals.  And it is unconscionable that Massachusetts has adopted this misguided individual mandate."

We are part of a growing number of labor leaders in the labor movement who support HR 676, the "Medicare for All" bill, that is very similar to previous efforts sponsored by our own Senator Edward Kennedy.  We believe that, given the lessons of Massachusetts, this approach is the most fiscally prudent and morally imperative direction for successful health care reform.

We thank you in advance for your commitment to health care reform and look forward to working with you to make it a reality.


Pauline Arguin, President, UE Local 204, Esterline Ind., Haskon Div., Taunton, MA

Cliff Alzes, President, IAMAW Local 2654, Gloucester, MA

Barbara Beckwith and Charles Coe, Co-chairs, National Writers Union / UAW, Boston Chapter

Alex Brown, Vice President, IUE-CWA Local 201, Lynn, MA

Myles Calvey, Business Manager, IBEW Local 2222, Dorchester, MA

Jeff Crosby, President, North Shore Labor Council, AFL-CIO, Lynn, MA

Russ Davis, Director, Massachusetts Jobs with Justice, Boston, MA

Wilfred "Willie" Desnoyers, President, UAW MA State CAP Council

Sandy Eaton, Chair, Mass Nurses Association Region 5, Canton, MA

James Foley, Business Rep., IAMAW District 15, Boston, MA

Christine Folsom, Chair, Mass Nurses Association Region 1, Northampton, MA

Paul Georges, President, Merrimack Valley Central Labor Council, AFL-CIO, Lowell, MA

Mark Govoni, V.P. & Political Director, UFCW Local 1445, Dedham, MA

Fiore Grassetti, President Hampshire Franklin Labor Council, AFL-CIO, Northampton, MA

Donna Johnson, President, University Staff Association/MTA, UMass Amherst, MA

Donald Keith, President, UE Local 269, Erving Paper Co., Erving MA

John Kelly, President, IBEW Local 2321, North Andover, MA

Peter Knowlton, District President, UE Northeast Region, Taunton, MA

Stephen Lewis, Treasurer, SEIU Local 509, Watertown, MA

Bill Lynch, President, UE Local 262, Boston, MA

Kathy Melish, President, UAW Local 1596, Canton, MA

Dick Monks, Vice-President, IUOE Local 877, Norwood, MA

Joseph Montagna, Business Agent, AEEF-CWA Local 1300, WGBH, Somerville, MA

Carl Olsen, Pres., UE Local 248, Mattapoisett, MA

Ron Patenaude, President of UAW Local 2322, Holyoke, MA

Randall Phillis, President, Massachusetts Society of Professor/MTA, Amherst, MA

Beth Piknick, President, Mass Nurses Association, Canton, MA

James Pimental, Reg. VP, Southeastern Mass. CLC and Secr-Treas, Southeastern Mass. Building Trades Council

Julie Pinkham, Exec. Dir., Mass Nurses Association, Canton, MA

Frank Rigiero, National Business Agent, American Postal Workers Union, AFL-CIO, Worcester, MA

Cynthia Rodrigues, President Greater Southeastern Massachusetts Labor Council, AFL-CIO, New Bedford, MA

Lynne Starbard, Chair, Mass Nurses Association Region 2, Worcester, MA

Ed Starr, Business Mgr., IBEW Local 2321, North Andover, MA

Stephanie Stevens, Chair, Mass Nurses Association Region 3, Sandwich, MA

Richard Stutman, President, Boston Teachers Union, AFT, Boston, MA

Paul Toner, Vice President, Mass Teachers Association, Boston, MA

Daniel B. Totten, President, Boston Newspaper Guild, TNG-CWA Local 31245

Don Trementozzi, President, CWA Local 1400, Boston, MA

Gael Wakefield, President, UE Local 274: Franklin County, Greenfield, MA

Anne Wass, President, Mass Teachers Association, Boston, MA

Jon Weissman, Secr-Treas, Pioneer Valley Labor Council, AFL-CIO, Springfield, MA

Brian Zahn, Chair, Mass Nurses Assoc. Region 4, Peabody, MA

cc: Senator Edward Kennedy
   Senator John Kerry
   Massachusetts Congressional delegation

* Affiliations are listed for identification purposes only.

by architek 2009-03-16 06:34PM | 0 recs
Glad to see you are finally understanding

how important this is ragekage.

We can't wait till 2019 for "more efficiency"

by architek 2009-03-16 06:39PM | 0 recs
Re: rage...

i second that emotion, thanks for this work.

by National Nurses Movement 2009-03-17 09:07AM | 0 recs
rage scholarship

Incredible reporting Rage, we need public health care more than anything else we need, aside from food.  What optimistic people are our citizens, I could imagine nearly any other nation rioting with under such a system of health care.  Health care is a civil right, a human right, and we'll get no where lecturing china when we tolerate our weakest and most vulnerable being treated worse than our livestock, well, we don't slaughter our poor, except for that part worse.  

by anna shane 2009-03-16 05:06PM | 0 recs
Where is health care a civil right?

Its not. It should be, but this is America.

You have to go to Canada to find a civilized "right" to health care.

by architek 2009-03-16 06:36PM | 0 recs
We have a President who LOOKS DIFFERENT!!!

Does that mean that he doesn't have to BE different?

(Isn't that a stroke of genius, or what?)

Hard to say yet, huh?

by architek 2009-03-16 06:43PM | 0 recs
Re: We have a President who LOOKS DIFFERENT!!!

oh, he's different, for one he's an adult, and if he makes mistakes, he'll still be trying to get things right.  He has a philosophy, bottom up, that sometimes clashes with his other one, of being practical and level-headed.  He needs to know what we want, and so we have to tell him.  when it's clear that 60 percent of Americans want at least the choice of enrolling in a public health plan, he'll make a speech and if our legislators want to be reelected, they'll go along.  

by anna shane 2009-03-17 08:07AM | 0 recs
The "public plan"

Why aim low?

Other polls have shown majority support for moving to a guaranteed healthcare system, like the "single-payer" systems in Europe.

The problem with a public option is that it either preserves or increases the role of insurance companies in the delivery of care...which are the very same corporations who built the system that denied all these people medicine.  Why should they be rewarded now with a bailout?

by National Nurses Movement 2009-03-17 09:02AM | 0 recs
Re: The "public plan"

I agree, but Barack doesn't, and he was clear about that in the primary.  Hillary didn't even propose single payer and that's what each of them claim to prefer, and I believe them. I assume that it's a path they think we need to be on, and the first part is to make private insurance less profitable.  Hey, I don't like not having single payer, never have had, and if it's as slow as it seems, it won't happen in my lifetime, unless I stop smoking anyway.  Right now health care is private enterprise, sans medicare and veterans health insurance.  Taking it back completely is likely too complex to do in one fell swoop without disrupted health care in the process. They aren't just going to give it back, they'll wreck if first.  Just look at the way banks are dealing with the mortgage melt-down, I mean, the banks are being completely irresponsible, no reason to think health care insurers won't break things on the way out either.  

by anna shane 2009-03-18 07:53AM | 0 recs
The magic of the marketplace!

Debtors prisons or organ sales

Thats what we are headed towards. The average person has $200,000 in organs, corneas and skin grafts which could go a long way towards paying those defaulted medical bills.

In the past, many Americans were indentured servants.

We may return to that situation.

Another alternative is to legalize prostitution in cases where people had medical or mortgage bills to repay.

Or states could contract out with countries like Nauru (soon to be below sea level!) or China to take care of their homeless indebted poor at a group rate. They could work off their debts "rebuilding Tibet".

Of course, the work is very, very, very dangerous.

But it IS gainful work.

Mars colonization is another option that seems to be in consideration. (Rents are low but the air and water bills are expensive.)

Oh, the magic of the marketplace!

by architek 2009-03-19 04:52AM | 0 recs
Bottom up = bend over?

We did get fooled again. Because people can't afford him. Face it, in ten years, America will be an amusement park for the rich only, or a Third World nation with nukes.

Enrolling in a public health plan that doesn't work will only porlong the agony. I knew from the beginning that Obama was owned because of the plan he put forward which was a sham. Whats to believe that anything else will be any different. We dont have decades to waste. That seems to be the strategy, a delaying and stonewalling tactic. The Dems and the GOP seem to be of like mind on this. Increasingly, both parties are shams.

C. Wright Mills was right.

Bottoms up, America. What's in YOUR wallet?

by architek 2009-03-19 04:59AM | 0 recs
Re: The Busiest Emergency Room in America

Another argument for why we need universal health coverage in this country NOW.

by LakersFan 2009-03-17 11:40PM | 0 recs
Re: The Busiest Emergency Room in America

I am negatively impressed with the implications of this ER experience. It says that for some people, once a year medical care is better than none.

Only in America, one of a few industrialized countries in the West that lacks a socialized medical care system. It is a Darwinist approach to medical care.

by MainStreet 2009-03-19 05:08AM | 0 recs
Re: Busiest Emergency Room in America

I am negatively impressed with the implications of this ER experience. It says that for some people, once a year medical care is better than none.

Only in America, one of a few industrialized countries in the West that lacks a socialized medical care system. It is a Darwinist approach to medical care.

by MainStreet 2009-03-19 05:08AM | 0 recs


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