Nobody should have to die because a hospital turns an ambulance away

In 1990, a 4-week-old baby in cardiac arrest was rushed from one South Side hospital, which could not provide the necessary specialty care, to a second South Side hospital.

The baby, Lenise Nelson, didn’t make it.

Lenise might be alive today had the paramedics taken her to a superb hospital, the University of Chicago’s Wyler Children’s Hospital, just five blocks from her home. But the hospital firmly told the paramedics on the phone that, no, its intensive care unit was too full. The hospital was turning ambulances away.

Why are we recalling this story now, some 30 years later?

As of result of Lenise’s death, which outraged the public, the Illinois Legislature in 1995 passed, and later revised, a law regulating when and how frequently hospitals can close their emergency rooms to ambulances.

But as revealed in a special report by the Milwaukee Journal Sentinel, published in the Sunday Sun-Times, the law has gone largely unenforced. Some of Chicago’s top hospitals continue to go on ambulance diversion or bypass, as the practice is called, for thousands of hours a year. And the state has been lax about oversight, issuing only sporadic and inconsistent warnings. No hospital has ever been fined.

We see two solutions to the problem.

Hospitals could do a better job of keeping bypass hours to a minimum, voluntarily, and the state could step up enforcement. This would include increasing the maximum fine, which is $10,000.

If, however, hospitals continue to routinely close their emergency rooms to ambulances — and if state regulators continue to fail to crack down — Illinois could ban the practice of bypass altogether.

The first solution — everybody simply doing a better job of following and enforcing the law — is clearly preferable. There may be legitimate reasons a hospital ER goes on ambulance bypass now and then, a fact noted by the Chicago Tribune in a separate, recent investigation of the practice.

Especially in the big city where Level 1 trauma centers can take on huge caseloads, an ER can become overwhelmed with patients. Hospitals are allowed, by law, to temporarily close emergency rooms to some or all ambulances, but they cannot turn away people who walk in off the street.

“When we go on bypass, we’re ensuring that those patients who are brought into our hospital are well cared for,” Michele Mazurek, Mount Sinai’s Hospital’s chief nursing officer, told the Tribune.

It would not be unprecedented, however, if Illinois were to ban ambulance bypass completely. Massachusetts has such a ban, and Milwaukee and Seattle no longer allow diversions except in severe cases.

Study after study, the Journal Sentinel reported, has found that ambulance bypass does not solve the problem of ER overcrowding — though it can jeopardize safety.

A 2017 study, most alarmingly, found African American patients had an increased chance of dying from heart attacks because hospitals in largely minority neighborhoods were going on bypass more often than others.

How poorly has the state monitored the issue?

State regulators now review hospitals’ ambulance bypass hours four times a year — after years of doing almost no reviews at all — and send out letters of warning here and there. But with no discernible logic.

The University of Chicago Medical Center, for example, was cited by the state in early 2018 for going on bypass 16% of the time. But the hospital had reached that level almost every month in the previous two years. Similar inconsistencies were found for Advocate Christ and Northwestern.

Nationwide in the years since little Lenise died, the Journal Sentinel found, at least 20 people have died after their ambulances were diverted from one hospital to another.

Nobody can know for sure whether Lenise or any of the other 20 people might have survived. But forcing an ambulance to run a patient across town during a medical crisis because a closer hospital is on ambulance bypass is hardly the best of care.

The state Legislature, or the governor’s office, should be able to straighten this one out.

Send letters to letters@suntimes.com.