Statements Regarding Emergency Room Reorganization
Statement from University of Chicago Medical Center Regarding Chicago Tribune Story and Emergency Room Care
February 13, 2009
The University of Chicago Medical Center is committed to the highest standards of care for all our patients.
In the case of Dontae Adams, who was the subject of a story in the February 13 Chicago Tribune, we are confident that we provided the proper standard of care.
We are pleased that Dontae has recovered from the wounds he suffered when he was attacked by a dog last summer. The care we provided was appropriate given his condition upon arrival, more than six hours after the attack. By that time, the doctors who treated him judged, based on the condition of the wound, that it would not be a good idea to close the wound or perform reconstructive surgery immediately.
Our emergency room doctors stabilized him, cleaned and dressed the wound, provided pain medication and a tetanus shot, and gave him a dose of IV antibiotics. They were concerned that immediate closure of the wound raised the risk of infection and could leave a permanent deformity.
Doctors exercise their best judgment in any situation, and medical opinions can differ, but in this case our doctors recommended that surgery be delayed. This case was carefully reviewed by our senior physicians, and we are confident that the right decision was made given the circumstances.
It is important to note that our emergency room is committed to treat all patients who need emergency care, regardless of their financial circumstances or their insurance status. We did so with Dontae Adams, and we would do so with any patient who came to us with an urgent condition requiring immediate treatment.
The Tribune attempted to link this case, from last August, to changes that we are making to our Emergency Department. These changes are designed to help connect patients who don't truly need emergency care to other, more appropriate health care settings such as neighborhood clinics. This effort to help patients establish medical homes applies to all patients, whether they have insurance or not. Routine care from a regular doctor is better for patients than episodic care in an ER.
It also allows our very busy emergency room to focus on treating emergencies. About 40 percent of the patients who visit our emergency room are better treated in a doctor's office or health clinic. The effort to find patients a long-term medical home has nothing to do with Dontae Adams, who did in fact receive the emergency care he needed at our ER.
The University of Chicago Medical Center provides more care to the poor and uninsured, in total, than any other private, not-for-profit hospital in Illinois. About 35 percent of our admissions are patients insured by Medicaid, a figure nearly three times greater than the average of other large hospitals in Chicago. Our percentage of what is labeled as "pure charity care" is misleading because we help those who lack insurance get Medicaid coverage, which provides them with the benefit of insurance going forward.
Statement from the University of Chicago Medical Center Regarding the American College of Emergency Physicians
February 19, 2009
The news release sent out today by the American College of Emergency Physicians was reckless and uninformed and based on hearsay. It was unprofessional to release such a statement without even attempting to verify the facts. We would have been happy to provide them with the information, had they simply asked.
American College of Emergency Physicians president Dr. Nick Jouriles, an Akron, OH, doctor, told The Associated Press "he did not try to verify the facts of the case with University of Chicago officials before issuing the statement. He also said he hadn't looked at the boy's medical records."
ACEP's understanding and description of the Medical Center's plans for the Emergency Department and inpatient services is incorrect. ACEP claims "there have been drastic reductions in inpatient beds for emergency patients." There have been none. Like nearly every hospital in the country, UCMC faces challenges relating to appropriate use of our limited Emergency Department resources and is seeking creative solutions. Any solution will honor our commitment to quality, patient safety and our community.
The following facts are critical to an understanding of the situation:
- The suggestion that there are no other providers on the South Side of Chicago is incorrect. In fact, UCMC provides less than 10 percent of the care for residents in its primary service area on the South Side of Chicago.
- Of the 10 largest non-public hospitals in Chicagoland, UCMC provides far and away the most care for patients covered by Medicaid (nearly three times the median of the other nine).
- The patient care goal of the Urban Health Initiative is to match patients to the appropriate level of care for a given condition. Finding medical homes for patients with non-emergency healthcare needs is core to that mission.
- Approximately one-third of patients presenting for treatment at UCMC ED are non-urgent. The resources devoted to these cases would be more appropriate for emergent patients.
ACEP's focus on the Dontae Adams case is unfortunate and unrelated to the core issues here. The criticism related to the case is unfounded. Physicians familiar with the case support the clinical decisions made at UCMC, which followed a widely accepted standard of care, supported by numerous textbook and journal article recommendations for the treatment of dog bites (including the guidelines on the ACEP Web site.) We regret ACEP's distortion of this case, and its mischaracterization of our efforts to responsibly address a nationwide crisis in healthcare.
For More Information
Read a statement from:
- Mark A. Grevious, MD, chief of plastic and reconstructive surgery at John H. Stroger Jr. Hospital of Cook County, who performed Dontae Adams' surgery.
- David H. Song, MD, chief of plastic and reconstructive surgery at the University of Chicago Medical Center, a member of the team that reviewed Dontae Adams' case.