Roy Exum: Erlanger's Growing Pains

  • Thursday, July 25, 2019
  • Roy Exum
Roy Exum
Roy Exum

When I learn two people have died not 20 feet away from Erlanger’s Emergency Room door while waiting to be seen, that it is now a common practice for some patients to wait up to two days in the ER before a room can be found, and that if a nurse calls in sick, they must give up a day of accrued off time plus make up the shift, I darn well know we can do better than that. I am not alone in my thinking: a couple of weeks ago the physician-led Executive Medical Committee delivered a “no confidence” letter regarding leadership to the hospital’s trustees.

So, for a good-sized chunk of my morning yesterday I was able to enjoy a closed-door meeting with hospital CEO Kevin Spiegel and his Chief of Staff Greg Gentry where the three of us dissected the mighty void between perception and reality. The two hospital leaders agreed with me – our Region’s Level 1 Trauma Center must be better than that. The reason for the pain is obvious: “We’ve gotten so big so fast “the growing pains” are part of it!”

As tough as growing pain is hard to master, nobody could have predicted six years ago, when Spiegel took over a sinking ship, that Erlanger would go from 4,000 employees to 8,000. Six years ago nobody would have dared dream our Emergency Room would treat a gunshot wound literally every day (400 a year), that because rural hospitals are failing across the country at such a dizzying rate Erlanger now has seven campuses in our region, or that when the state denied Erlanger an inpatient facility not long ago, it would drive over 20,00 citizens from Bradley and Polk County to the East Third Street campus a year.

The Cleveland mess becomes a case-in-point. The Bradley County Hospital is privately owned and refuses to offer indigent care. Erlanger, on the other hand, turns no one away. This year Erlanger -just as any Samaritan among us would do, bears the total cost of indigent care in our region and this year that will be $130 million. Again, no one is turned away. That is “bare bones” cost, too. In the six years Spiegel has led Erlanger, the indigent cost has risen over $45 million. (FYI: Hamilton County government gives Erlanger $1.5 million each year while the city of Chattanooga – ranked in the Top Ten of the Most Dangerous Cities in the United States – contributes nothing … every year.) 

The long waits? No emergency room is “first come, first served.” Instead it’s “worst is first.” (FYI: As we walked through the ER yesterday, there were patient beds open yet there was one patient on a gurney pressed up against the wall. “That is the safest place in the whole hospital. We have doctors who know that that patient is watched by our entire staff every second.”)

At a recent Board of Trustees meeting, this fact sheet was most interesting:

* -- According to the “Modern Healthcare” website, Erlanger is now the 10th largest public health system in the United States.

* -- Erlanger is the fastest growing healthcare system in Tennessee.

* -- Erlanger has the largest multi-specialty physician practice in the region.

* --  Erlanger’s “emergency department” is the 7th largest in the United States (with more construction just days from beginning.) According to Beckler’s, in the past 12 months Erlanger’s Emergency Department has treated 145,000 patients.

* -- In the last three months, Erlanger has opened three additional Express Care centers that will offer faster treatment and take non-critical pressure off the Main Emergency rooms.

* -- Erlanger has the 4th largest Interventional stroke program in the United States. This from MedPar data.

* -- Erlanger has six multi-state LifeForce air ambulances with one now stationed in Cleveland.

* -- Erlanger has the only Level 1 pediatric and Adult Trauma center in Southeast Tennessee.

* -- Erlanger has the only children’s hospital within a 100-mile radius. It is the only Comprehensive Pediatric Center with pediatric ER, pediatric ICU, and the only Level 4 Neonatal Intensive Care.

* -- Erlanger hires approximately 98 percent of all RN graduates in the Region.

* * *

Based on current-day statistics, Erlanger has made great strides in the betterment of Patient Access to Health care in the past 12 months:

* -- Outpatient visits are up 9.3 percent.

* -- Surgical inpatients are up 3.2 percent

* -- Orthopedic inpatient surgery is up 3.1 percent

* -- Bariatric procedures are up 18.6 percent

* -- System-wide ER visits are up 1.8 percent

* -- ER visits to Erlanger East (Gunbarrel road) are up 8.0 percent

* -- LifeForce transports to East Third Street ER are up 3.2 percent

* -- Erlanger East hospital admissions are up 21.3 percent.

* -- Out-patient surgery at Erlanger East is up 7.2 percent

* -- Cardiac Cath Lab procedures are up 2.1 percent

* -- Commercial pay utilization is up 7.2 percent.

* * *

Because you cannot borrow money for computer software, to install the new Epic system to all seven Erlanger campuses, Erlanger had to use “cash only” to purchase the super expensive program.

* * *

In a shocking announcement, Spiegel informed the board that one of the premier orthopedic surgeons in the world, Scott Steinmann of the Mayo Clinic, has submitted his resignation in Minnesota and will join Erlanger as the hospital’s Chief of Orthopedics in October. A comparison? Think of Dodgers pitcher Clayton Kershaw resigning in Los Angeles to pitch every fourth game for the Lookouts. It seems Scott’s wife is from Chattanooga and their dream has been to move to Chattanooga for some time. Now that a child will enroll at Bright’s next month and Steinmann’s vow is to never shovel snow again, the word in the halls of the hospital is the ‘coup’ is every bit as big as Tom Devlin in neurology or Melanie Blake in internal medicine.

royexum@aol.com

 

 

 

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