5 Years Later, St. Louis ERs Still Diverting

Dispatchers reporting patients with chest pain, seizures, stroke, gastrointestinal bleeding, pregnancy problems, abdominal pain and injuries from motor vehicle accidents were told to find another emergency room.

During those three hours in February, nine hospitals on the Missouri side of the river were accepting ambulances. None of them was in North County; in St. Charles County, there was just one, an emergency room in a psychiatric facility in Wentzville.

Five years after Missouri hospital officials vowed to get a handle on the problem, many emergency departments in the St. Louis area still regularly turn away ambulances. Half of the time in the first seven months of this year, at least one hospital was diverting ambulances, according to a Post-Dispatch analysis.

The Post-Dispatch first reported on ambulance diversions in a series of articles more than five years ago. At the time, ambulances were circling the streets, and in some cases, pulling over to the side of the road, as paramedics scrambled to find an emergency room that would accept a patient.

Hospital administrators said they were working to fix the problem. Some hospitals have made progress. Barnes-Jewish Hospital, St. Alexius Hospital, Christian Hospital, St. Louis University Hospital and Northwest HealthCare all cut their diversion hours by more than 50 percent from 2001 to last year. But in St. Charles County and parts of St. Louis County, diversions have been rising, in one case by 785 percent.

"It started out as a minor nuisance, but it's gotten to the point where it happens daily at some hospitals," said Bob Stewart, a paramedic for 30 years who works in the St. Charles County Ambulance District.

In 2004, 31 percent of the time at least one hospital in the region was on diversion. Last year, it was 39 percent. And in the first seven months of this year, at least one hospital was on diversion 48 percent of the time, according to the analysis.

National experts say hospitals should not divert ambulances at all.

Diversions can be disastrous, said Dr. Robert R. Bass, an emergency room physician and president of the National Association of State EMS officials.

"It means ambulances have to travel farther, and that can delay care to the patient," Bass said. "It also delays the amount of time that an ambulance is out of service, and that means it is not available to other people in the community who might need it."

A recent Institute of Medicine report says there are only two reasons a hospital should divert an ambulance: a crisis within the hospital, such as a fire or power outage; or a mass casualty incident, such as a plane crash.

Patients who are conscious -- or family members, if they are not -- are supposed to have some say in deciding which hospital to go to, even in an emergency. But when an ambulance is diverted, patients can land in a hospital that doesn't have their medical records or grant their personal physicians privileges, or where the patients have limited insurance coverage.

When patients ask to go to a specific hospital and hear it's on diversion, "you get that blank stare, like: 'What do you mean? It's an emergency room. It's open 24 hours a day, seven days a week,'" said Brad Hatfield, a paramedic-firefighter with the Pattonville Fire Protection District in north St. Louis County.

Data from the Missouri Hospital Association show that after a dip earlier in the decade, the number of diversions regionwide has climbed.

Fifteen hospitals hit record highs in diversion hours last year or this year. There were no ambulance diversions in the same time period in the Metro East area. Regulations are stricter in Illinois, where no more than three hospitals in a defined area can go on diversion at the same time and ambulance transport time cannot exceed 15 minutes.

The Missouri Hospital Association says it does not analyze the data it collects, but believes the situation has improved.