It’s no secret that the health care industry has been facing enormous challenges. Health care workers are burning out while tens of millions of Americans are burdened by medical debt.

Meanwhile, Maryland has the longest emergency room wait times in the nation: 228 minutes, or three hours and 48 minutes. What does that mean for residents? We asked Marylanders to share their ER horror stories — and we heard a lot.

Here are some glimpses into what long ER wait times look and feel like to patients and their families.

‘Soaked in blood’ and unattended

Jennifer Hathaway, a Harford County resident, waited four hours in an emergency room while having a miscarriage in 2018.

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Hathaway was about seven to eight weeks pregnant when she started bleeding at home. She “immediately” called her obstetrician, who told her to get to the University of Maryland Upper Chesapeake Medical Center ER, where he would be prepared to help. Hathaway’s doctor told her to inform emergency room staff that he was on standby and expecting her.

Unfortunately, Hathaway says, her doctor’s orders didn’t help. Instead of whisking her away for treatment from her obstetrician, Hathaway claims staff ignored her for hours while she bled profusely, unattended.

“My clothes are soaked in blood, and it’s leaking on the floor,” Hathaway recalled. She recalls passing clots the size of a lemon, and said ER staff did “nothing” to help her.

Hathaway said that after four hours of waiting, she was finally wheeled into a medical room — and her doctor was “livid.” Hathaway said her obstetrician told her she had lost so much blood on the floor of the waiting room that her blood pressure was low.

“I never expected to have to sit there and kind of ride out a whole miscarriage in a waiting room in front of, you know, 30 other people,” Hathaway said. She said she spent more time in the waiting room than surgery, recovery and discharge combined.

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Hathaway and her husband now have three healthy children, who were delivered in the same hospital. “Our experience in labor and delivery was fantastic. It was just our experience there at the ER that — I shut it out of my mind.” She did not file a complaint and does not blame the staff for her experience. “I get how much work goes on behind the scenes and instances of being short staffed, not enough physicians, etc.,” she said in an email.

Her treatment in the ER that day cost over $3,300 and was largely covered by insurance, according to a medical document Hathaway shared with The Baltimore Banner.

Michael Schwartzberg, senior director of media relations for the University of Maryland Medical System, declined to comment on Hathaway’s experience, citing HIPAA and privacy regulations.

Fermin Barrueto, chief medical officer and chief clinical officer for University of Maryland Upper Chesapeake Health, said that industry-wide stressors affect hospital wait times. The emergency department is “a limited resource, it’s an expensive resource and it’s a 24/7 resource. So it is very convenient. But as with anything, when over-utilized you decrease its effectiveness and efficiency.“ COVID-19 cases and the recent spike in flu and RSV have stretched hospital resources even thinner in recent months, he said.

Across county lines

Michele Gregory, a Salisbury City Council member, says her son suffers from Lennox-Gastaut syndrome, a severe form of epilepsy. Seizures can flood his lungs with stomach fluid, causing aspiration pneumonia, a condition that requires immediate medical attention.

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“We are no strangers to hospitalizations,” Gregory said.

When her son experienced aspiration pneumonia in June 2022, she called an ambulance and headed to TidalHealth Peninsula Regional Hospital. When they arrived, “there was already five ambulances waiting in line just to get into the ER,” Gregory said. They waited in the hallway outside of an occupied room for around an hour, she said, until they finally saw staff bring the other patient out of the room and clean it so Gregory’s son could be brought in.

Her son received antibiotics and and a high-flow oxygen mask in the ER and then waited 23 hours to be brought to a progressive care unit for more advanced monitoring, she said.

“It wasn’t easy sitting there waiting, knowing the treatment was just in one of those rooms, but we couldn’t access it ,” Gregory said. The visit came with a $32,000 price tag, which Medicaid covered, according to a medical document Gregory shared with The Baltimore Banner.

Gregory hasn’t filed a complaint because “it’s no fault of theirs that they are backlogged or understaffed,” she said, referring to the health care workers who helped her. “I mean, I don’t want this to come down and cost someone their job or their livelihood.”

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Roger Follebout, director for strategic communications at TidalHealth Peninsula Regional, told The Baltimore Banner that he could not speak to Gregory’s experience at the hospital but stressed that the facility is the only trauma center on Maryland’s Eastern Shore.

“We typically treat between 210-225 people each day, every day,” Follebout wrote in an email. “What patients in the waiting room don’t see are those traumas coming in through a dedicated entrance and out of their view.” Summer tourism also puts seasonal strains on the emergency department, he said.

Along with sharing their experiences in emergency rooms, readers also had a lot of questions about ERs in Maryland. Here are answers to some of the most common questions we received.

1. Why do Marylanders experience the longest average wait times in the nation?

This is a complicated answer that intersects with many national issues, but there’s one local legal quirk that contributes to Maryland’s slow ER service: State law requires that hospitals obtain a “certificate of need” from the state before launching or expanding services to inpatient beds, a lengthy regulatory process that can contribute to backups in emergency departments. A handful of other states, such as Delaware, Massachusetts and Rhode Island, have similar laws and also top the list for longest national wait times for a hospital room. You can read more about it here.

Emergency departments are also being stretched thin by the failings of other medical institutions. For example, children with behavioral needs are being crowded into Maryland ERs, sometimes for months on end, because the state lacks adequate mental health care facilities for them. That leaves even fewer ER resources for other patients.

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“In 2022, there were 1.15 million emergency department visits in our state,” Bob Atlas, former president and CEO of the Maryland Hospital Association, said in an email. “At the same time, staffing shortages across the entire spectrum of health care can lead to backups. If a patient can’t get in to see a behavioral health specialist, then their medical concerns become more acute,” he said, which might lead them to the emergency department. Sometimes hospitals are also unable to quickly discharge patients, he said, which leaves fewer beds for incoming patients.

Earlier this year, many Maryland hospitals were over 90% full due to the surge in COVID-19, RSV and flu cases, according to the Maryland Hospital Association.

2. Did the pandemic cause this?

The head of the advocacy group Marylanders for Patient Rights said that the issue with Maryland’s ER wait times goes back many years. While COVID-19 certainly exacerbates the issue, Maryland’s wait time issues predate it.

3. When should you go to the ER?

Experts stress that the ER is for life-threatening medical emergencies.

If you have a sprain, mild allergic reaction, cold or flu, headache, insect bite, constipation or diarrhea, then you should seek urgent care, telehealth or a visit with your primary care physician, according to the Maryland Hospital Association. This chart from the University of Maryland Medical System explains when to go to urgent care or the emergency room.

ERs do not function on a first-come, first-served basis. They prioritize patients with the most serious medical conditions. Those with conditions deemed less severe can expect to wait longer.

4. Is it expensive to go to the ER?

Most insurance plans, including Medicaid, will cover part or most of ER costs. But check your insurance policy to be sure. If you do not have insurance, you can check if you are eligible for Medicaid here.

Low-income patients may also be eligible for charity care at nonprofit hospitals.

krishna.sharma@thebaltimorebanner.com

Krishna Sharma is an audience engagement editor for the Baltimore Banner. You can find him on the Banner's TikTok and Instagram. He has a background in environmental journalism and ecology. Do you have any tips or feedback? DM or email me!

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