Saturday, December 4, 2021
Today I read an interesting Washington Post article about a judge in a northern New Mexico town who has been willing to rethink criminal justice for drug-related offenses. The approach this judge is taking goes beyond the "drug court model, once widely viewed as a progressive alternative to jail." As described in The Judge Who Keeps People Out of Jail, Judge Jason Lidyard meets directly with participants in his program, outside the court house, to discuss progress one-on-one:
He does not expect his clients to abstain from using -- in fact, he assumes the contrary. 'I don't care if you're high, so long as you show up here,' he tells one. And informed by childhood memories of his own father's addiction, he categorically refuses to use jail as a sanction. 'Only two things will get you kicked out,' he explains. If you don't show up, or if you commit new crimes.
My own work doesn't focus on criminal justice. But I am ever more intrigued by the willingness of some prosecutors, jurists and court systems to rethink solutions to different forms of problematic behaviors.
This article also intrigued me because I had recently spent an evening in an emergency room of a small town hospital. An older friend -- in her 90s -- had been waiting since early afternoon for diagnosis of symptoms of light-headedness, "waves" of confusion, and sudden inability to walk normally. Her symptoms were serious. After more than an hour at an urgent care facility, transfer by ambulance and 3 hours in the hospital's ER, some tests had been conducted. But when I arrived the results were not available and she had yet to see a doctor. Friends and then her daughter (driving several hours from her home in a large city) had been taking turns sitting with her and hoping to get some recommendation about how best to handle these worrisome symptoms.
Over the last few years, as I suspect is also true for many of our readers, I've done this same sort of "camping out" in ERs in multiple hospitals with aging friends and family members.
But that evening was startling in the intensity of what I was observing. Every chair in this relatively new hospital was taken, and even more patients were sitting in wheelchairs. There was only one person at the "intake desk" and it is an understatement to say that person was suffering from front-line burn out. Rather, she was in full flame.
At least a third of the patients I was seeing were "older." Some of them had no family members with them. One woman, with no family and clearly deeply affected by some form of dementia, was wrapped in a blanket, no shoes, and, I realized, no clothes on under the blanket. She was wandering, and moaning, very unstable on legs that appeared distorted by cellulitis. Another patient was holding one of his legs in the air with his own hands, as he was in such pain that he couldn't stand to have his foot touch anything -- and no wonder, as I could see a large, weeping hole in the center of the foot. I was moving in and out of that ER for about 4 hours. Many of the patients that were sitting with agonized expressions on their faces when I first arrived at 6 p.m. were still in the same location when I left for the final time just after 11 p.m. There were no hospital rooms available. Period.
My friend could not take the chance of going home to wait for the tests results, and it was clear that if she did so, no one would be available to talk with her by phone who could give an informed diagnosis and discuss options.
COVID-19 and certainly the recent variants, have exposed and intensified what has long been a problem for hospitals: the process of emergency admissions. My father, years ago, summarized the problem accurately even while he was in the early stages of dementia. "I would rather die on the steps than spend one more night in that place" -- referring to the ER.
But it isn't just emergency rooms at hospitals. I've had to abandon waiting rooms in doctors' office, dentist offices, even the pharmacy, because whomever I was bringing in for help was panicking when they felt trapped in chairs that they were afraid to even touch. Post-Covid-personnel shortages at all levels of care are clearly making the problem of access to health care very problematic. But I suspect the problem pre-existed the pandemic. (Inadequate, un-separated seating in airport lounges and transport buses? I'm thinking of you too!)
Solutions? I'm not sure. But certainly some creative minds could tackle this. I know some care-sites ask patients, if possible, to wait in their cars to be called in for the actual appointment. But that doesn't work for many older persons, especially in hot or cold weather, or where it is a very long walk to get to a bathroom.
I do know that one source of help I stumbled across in one state was using the non-emergency number for the 911 responders in the area. In that state, I discovered calling that number resulted in a "first available" non-emergency response by a team of trained professionals who could do high level assessments, and who could help prioritize any needed transport to the ER. But that doesn't' seem to be a uniformly available alternative in all states.
There is a saying, sometimes attributed to Winston Churchill (probably incorrectly) reminding us to "never let a good crisis go to waste." Let's use the current crisis to rethink ways to more effectively access health care assessments. Certainly that would be better for patients, but also for the front-line responders.