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OPINION: Freestanding emergency rooms: advice from a former asthma patient

January 21, 2014 By Raanan Geberer Brooklyn Daily Eagle
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Recently, the Brooklyn Daily Eagle reported on two proposals for the troubled Long Island College Hospital: The Fortis-NYU-Lutheran plan and the Brooklyn Hospital Center plan. Among other things, both of them feature what could be described as “freestanding emergency rooms.”

Could freestanding emergency rooms (also known as freestanding emergency departments) work? It’s a matter of controversy. According to Healthcare Design magazine, there were 241 such facilities in 2009. They now exist in 16 states, according to the magazine. There’s even a firm, First Choice Emergency Room, which provides these resources throughout the western states.

Some critics say that a freestanding ER would have a hard time getting approved by the state Department of Health. I can’t offer a definite opinion, since I’m not an expert. But I can talk about my lengthy experience as an emergency room patient.

Between roughly 1985, when I had my first serious asthma attack, and 1995, when I had my last one, I must have been in the emergency room at least one a month. Because I moved around during that time, I became familiar with ERs in the Bronx (Jacobi), Brooklyn (New York Community, Beth Israel Kings Highway, Long Island College Hospital, Coney Island Hospital) and Manhattan (St. Vincent’s, St. Clare’s).

About 90 percent of the time, I was made to breathe in oxygen and medications through a mask and was as given fluids through an IV. I stayed there for a few hours until my lungs cleared up, and then was sent home with a prescription and instructions to call my own doctor. But about six or seven times, it was different. On those occasions, after my condition didn’t improve enough after the aforementioned treatment, the doctors ordained that I had to be admitted.

I remember that once I was taken to the intensive care unit. Another time, I was actually kept overnight in a hallway while hooked up to an IV until a space for me could be found the next morning (that was at Coney Island Hospital). The other times, I was put into a regular hospital room. The most I ever stayed was four days, and that was during my last, and worst, attack.

I wonder what would happen if I had been taken to a freestanding emergency room? Most of the time, there would have been no problem, since I was sent home within an hour or two. But what about the other times?

With today’s medical technology, if I were hooked up to the breathing mist and IV fluids while being transported from the freestanding emergency room to a “real” hospital, I believe I would have survived. But it wouldn’t have been pleasant, and it wouldn’t have helped my condition. In fact, the stress might have prolonged my recovery time.

As I’ve mentioned, I can’t give any expert opinion about whether a freestanding emergency room would be viable. For those people who go to the emergency room only for temporary conditions and are then sent home after a few hours, it would be all for the good. But for those conditions that require more serious care, I’m not so sure.

Freestanding emergency rooms are often established in sparsely populated areas where the nearest hospital is 10 or 20 miles away. In Brooklyn, it seems to me, we can do better.


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