Opinion: How Unhealthy Is Healthcare?
photo credit: otisarchives3
Hospitals use a lot of energy, and not surprisingly the healthcare sector ranks second in energy intensity. Hospitals use 836 trillion BTUs of energy annually (over 2.5 times the energy intensity and CO2 emissions of commercial office buildings), produce 28.575 million tons of CO2 and over 30 lbs of CO2 emissions per square foot on an annual basis. It would logically follow that Hospitals have at their disposal myriad resources to make a change toward sustainability. Regrettably, this is not the case.
While my approach in trying to make a difference and improve our environment has been deliberately non-partisan, at some point it is necessary to take a definitive stand on something, even if that “something” is mired in controversy. Working in hospital administration these past six years, I fear that the healthcare system in California today is so dysfunctional that it borders on the edge of cataclysmic failure. Surprisingly, this systemic problem has not received the necessary attention a crisis of such magnitude should mandate.
How is it possible that healthcare’s impending breakdown remains below the radar as it continues to consume such enormous quantities of energy? My only explanation is the unfortunate reality that in our society — and for purposes of this discussion “our society” is more or less Los Angeles County – fewer people respond to the senseless deaths of individuals in a lower income bracket. Said a little differently, society as a whole appears less concerned when poor minorities die. In contrast, when tragedy strikes the middle class (and in particular attractive, affluent and sometimes famous individuals), there is an international demand for justice.
Most will agree that the facts behind some of the more notable “public” tragedies are horrific and devastating. Irrespective of Scott Peterson’s adamant denial of any involvement in his wife’s death, the ultimate fates of Laci Peterson and her unborn child were heinous. Likewise, whether or not Joran van der Sloot had any involvement in the disappearance and presumed death of Natalie Holloway probably pales in comparison to the inability of Natalie’s parents to unravel the mystery behind her disappearance.
Both examples brought a world together as the media reserved practically all headlines for months and months for these two, isolated, tragic stories. As these plots unfolded, and unfolded, and unfolded, few took notice of another tragedy down the street as the healthcare system in California, and Los Angeles County in particular, started to collapse.
When the King-Drew Medical Center in Los Angeles County faced closure, opponents argued in Court the desperate need for immediate judicial intervention so that members of the community would not be deprived of emergency medical services. (Los Angeles Times, December 3, 2004.) Even the California Medical Association stated in an October 2, 2006 press release that a “shut down of [King-Drew] would be detrimental because innocent patients would lose access to vital emergency healthcare. The county hospitals are already overcrowded [and] nearby local hospitals are not sufficiently equipped to absorb the patient load.”
Both statements were accurate, yet the impact the Hospital’s closure had, and continues to have, remains out of the public spotlight. Overcrowding in hospital emergency departments has reached epic proportions. In response, a recent study scheduled for presentation next week at an American College of Emergency Physicians meeting suggests that hospitals “should consider shifting patients in emergency departments who already have received care to hallways as a way to reduce ED overcrowding.”
This comes in the very same month that the Federal Government’s Medicare program implemented its plan to control the estimated 88,000 deaths which occur each year as a result of hospital-acquired infections. Known as MS-DRG’s (medical severity – diagnosis related group) in the healthcare industry, the government’s response is designed to hold hospitals accountable and make them financially liable for any medical condition acquired after admission and during that patient’s hospital stay.
To complete the trifecta, the Federal Government also started this month a program to identify and correct improper payments. Medicare Recovery Audit Contractor groups (known as “RACs” not only are charged with the authority to identify an inappropriate payment, but they also get to keep a percentage of the recovery. As described in an October 28, 2008 article at www.hospitalimpact.org: “[T]he most complex, onerous, burdensome, tedious, time consuming billing system in the world is created by the government, then the government finds an even more complicated way to come back and evaluate [Hospitals'] ability to maneuver appropriately through the white water part that they themselves are completely responsible for creating.”
So while hospitals continue to consume enormous amounts of energy, the number of places where a person can go for medical treatment is on the decline. The industry fears that an ever-changing regulatory environment may save energy, but only by putting hospitals out of business. Then what? Will what has already happened in communities similar to the ones surrounding King-Drew — the refusal by many to get medical care until it is too late — expand throughout the County and State?
A recent survey released by the Kaiser Family Fundation estimated that 36% of United States residents have delayed medical care in the past year because of cost. (See October 24, 2008 article in Medical News Today.) If an economic downturn results in a decision to skip and/or delay medical care, the immediate economic concerns will only increase this disturbing pattern. Eventually, this trend will move beyond lower income communities and into the ones that make headlines?
It would be nice to see the healthcare sector as a whole adopt positive changes in the way it consumes energy. If forced into a crisis mode, many fear that the political response may be ineffective and misguided. Personally, I am hopeful that hospitals will break this pattern, not because of politics or trends or celebrity endorsements, but because global sustainability is the right thing to do. But in order to focus on our environment, the healthcare system first needs to get healthy.
Can the healthcare system be saved by the time it reaches the middle- and upper-middle-class communities? Both directly and indirectly, King-Drew’s closing has had a devastating impact on its surrounding area and nearby hospitals. The system that communities rely upon for organic sustainability appears unable to sustain itself. Although the immediate victims of this problem apparently are not newsworthy, if this trend continues, it will draw media attention. The focus, however, will probably not be about the reduction of energy usage.
Identifying the problem is relatively straightforward: Hospitals use too much energy, yet the entire industry is forced to direct its efforts toward individual survival rather than global sustainability. There is no magical solution on the horizon, and unnecessary political obstacles should not keep people away from seeking necessary medical care. The decision to take a stand (on this and any other issue) should depend on whether or not the political arguments are “within reason”, and if both sides are worthy of consideration. When the issue is individual and global survival, however, it is very difficult to remain neutral. So I guess it’s time to take a stand.
