Ambulance plight: Emergency rooms turn patients away

Lack of doctors, beds poses worse problem than usual in Anchorage

Posted: Tuesday, September 14, 2004

ANCHORAGE - A shortage of some medical professionals and a lack of bed space often forces Anchorage ambulances to go to more than one hospital before patients can receive emergency treatment.

Ambulance diversion is a national problem. In Anchorage, it was worse than usual this summer.

"It's a higher rate than we've been at for a long time, maybe ever," said Vince Huntington, Providence Alaska Medical Center's chief operating officer. "It's been alarming for us."

In July, Providence sent patients to other hospitals about half the time. Alaska Regional Hospital diverted patients about half the time in June, according to data from the Anchorage Fire Department.

Some of the reasons have existed for years, such as not enough beds or nurses in hospital critical-care units. But locally, there's another problem: a need for more neurosurgeons to treat people with serious head injuries.

"When these patients need a neurosurgeon, they usually need one badly," said Kurt Sorensen, a paramedic battalion chief with the Anchorage Fire Department.

Anchorage has four neurosurgeons with privileges to work at the hospitals here, said Dr. Richard Brodsky, medical director for Alaska Native Medical Center's emergency department. The Native hospital has one neurosurgeon on staff. Three others are in private practice and are on call for Providence and Alaska Regional.

Three is not enough, said Roy Davis, chief medical officer with Providence. Anchorage needs about five neurosurgeons, he said.

Dr. Erik Kohler, Alaska Native Medical Center's neurosurgeon, agreed that two or three additional neurosurgeons would help.

"Their resources are stretched, so at times we have no availability," Davis said. "Either they're tied up in a case in another hospital or there's no one on call because they've been tied up so long that it's inappropriate for them to cover."

Hospitals sometimes can find doctors to fill in when they're short neurosurgeons.

Alaska Regional has lacked a neurosurgeon about one week a month, leading the hospital to send patients with head injuries elsewhere, said Dr. Michael Levy, an emergency room doctor at Alaska Regional and the medical director for Emergency Medical Services for the Anchorage Fire Department.

Sometimes those patients are sent to Alaska Native Medical Center, but its primary mission is to care for Alaska Natives. Sending non-Native patients there occupies hospital staffers and beds needed for Native patients, Brodsky said.

If no neurosurgeon is available at the private hospitals, Kohler has to be on call 24 hours a day for all of Anchorage, with no one to relieve him, Brodsky said.

"If I try to go on vacation, we could be in trouble," Kohler said.

Kohler said he treats patients with head or spine injuries.

If a doctor is not available locally to treat head or spine injuries, the patient might be flown to Seattle, which delays treatment by several hours or more.

Doctors and paramedics say they aren't aware of any diversions here that have harmed patients, but diversion can cause problems when patients are taken to an unfamiliar hospital or when family members rush to one hospital only to find out the patient is at another.

Local hospitals are working on some of the causes of diversion. Alaska Native Medical Center didn't have enough nurses to staff beds last year but has since filled all those positions, Brodsky said. Huntington said Providence has dealt with its critical-care bed shortage by adding new beds within the past year. But the hospital still lacks staffing to care for patients using the new beds.

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