St. Charles Medical Center’s emergency room has become so clogged that many patients have to wait one to two hours before seeing a doctor.

”People are so used to coming to St. Charles, and when you come to the ER you get right in,” said Marty Betsch, manager of the ER. ”That isn’t happening right now.”

A combination of population growth and an increasing number of uninsured patients without access to regular medical care has flooded the emergency room. Cuts in Oregon Health Plan benefits put further pressure on emergency rooms across the state in recent months. Effective Feb. 1, 110,000 Oregon Health Plan (OHP) members – including about 5,000 in Central Oregon – lost benefits.

Many patients show up at the emergency room with nonemergency conditions. They could be taken care of more cheaply at a medical clinic, such as an urgent care center or even at home with over-the-counter medication and self-care resources, Betsch said.

But because of a federal hospital ”anti-dumping” law passed in 1986 to ensure everyone has access to health care, emergency rooms have to screen and stabilize every patient that walks through the door.

As more physicians say they are forced to limit their practices because of declining Medicaid and Medicare reimbursements and increasing malpractice costs, some people have no choice but to go to the emergency room for care.

”It’s a huge community-wide problem,” said Dr. Randall Jacobs, director for Bend Memorial Clinic’s Urgent Care Center. ”More and more physicians are restricting their practices.”

Jacobs said the urgent care center, for instance, wants to do its part to continue to provide access to patients but doctors are challenged by reimbursement rates that don’t keep up with costs. Patients without coverage can pay a $50 down payment and make arrangements to pay their bills without interest in order to get urgent care, he said.

”The problem is, with the patients who don’t have resources to make down payments or have gotten into a problem in the past, there’s no options,” Jacobs said.

Hospitals across the state are experiencing the same problem as the recession has left more of the state’s residents without health insurance, said Ken Rutledge, president of the Oregon Association of Hospitals and Health Systems.

”If you’re uninsured, unless you go to a free clinic, you’re going to have a difficult time getting a physician to see you,” Rutledge said.

”Ultimately that means the person is going to end up accessing care through the ER.”

About 475,000 Oregonians, or 14 percent of the state’s population, does not have health insurance – up from 425,000 in 2001, according to the Office for Health Plan Policy and Research.

Emergency room visits at Oregon hospitals increased from about 914,000 in 1999 to about 1,077,000 in 2002, an increase of approximately 17 percent, according to a recent hospital association report. The number of emergency room visits at St. Charles was up about 31 percent in that same period, going from approximately 26,400 to 34,700.

Along with the increase in visits, Oregon hospitals have seen increases in the amount of money they spend on charity care and on bad debt because of the growing number of uninsured accessing care through the emergency room, Rutledge said.

The amount of free care provided by hospitals in Oregon was up 38 percent from 2001 to 2002 and the amount of hospital bills that went uncollected was up 17 percent, he said. That’s quite a step backward from the early 1990s when the number of emergency room visits and the amounts spent covering bad debt and charity care declined despite the state’s population growth.

And if more and more patients are coming to the emergency room – and if more of them can’t afford to pay for their care – that means patients who can pay will be paying more.

The increase in ER visits and charity care provided by hospitals drives up health care costs for everyone, Rutledge added. Costs will be spread to consumers through higher insurance premiums.

Aside from an economic turnaround, there does not appear to be relief in sight. State lawmakers are considering dropping 150,000 people from the state’s insurance plan for low-income residents in order to balance the state budget, Rutledge said. ”

”I think it’s going to get worse before it gets better,” he said. ”What we’ve seen today is going to pale by comparison if they basically drop 150,000 people from the Oregon Health Plan.”

In Central Oregon, doctors and hospital officials said they recognize the growing number of emergency room visits is a community problem.

A group of retired doctors is already working on a solution to help people without insurance access primary care.

The Volunteers in Medicine Clinic is expected to open later this year near St. Charles. An anonymous couple donated $1 million to build the facility. Doctors and nurses are already volunteering their time to see patients at the Deschutes County Health Department on Monday nights until the permanent clinic is built. Bend allergist Dr. David Coutin, a member of the board of trustees of the Oregon Medical Association, said local physicians want to help ease the pressure. They are looking for solutions to make sure the underserved have access to care while helping to free up the emergency room for emergencies.

Coutin said he has had preliminary discussions about doctors in the community volunteering to staff an urgent care at the hospital’s emergency room. Doctors could screen people who have less urgent conditions, freeing up the emergency room doctors for traumas. ”We physicians want to help,” he said.

In addition, doctors and hospital officials said they want to better educate patients on how best to use the emergency room to eliminate unnecessary visits.

”Colds and canker sores are not emergency conditions,” Coutin said.

Betsch, St. Charles’ ER manager, said people without life-threatening conditions need to consider whether they need immediate attention before heading to the emergency room, especially in the next 18 months when construction at the ER will add to the problems of a crowded emergency room.

”We’re not asking you not to come, ” she said. ”We’re asking you to think before you come.”

Self-care resources, such as CareWise online available at the hospital’s Web site, www.scmc.org, can help people assess the severity of their problem and possible self-care options. Those who do have an established primary care doctor should call for assistance if it’s not an obvious emergency.

Those without primary care doctors could access care at urgent or immediate care centers if they have the financial means.

Jacobs, the urgent care director, said the clinic can take care of most anything people can bring themselves in for – ranging from the flu to broken bones. Patients are charged the same as they would be billed for seeing a regular physician.

”In general, the cost is going to be less at an urgent care facility like ours,” Jacobs said.

Emergency room care costs more because of the staff and equipment required to respond to traumas ranging from car accidents to heart attacks. Nurses need a higher level of training and more certifications, which costs more, Betsch said. Plus, the emergency room needs to pay staff 24 hours a day, while urgent care centers or doctors’ offices are only open during the day.

The cost of a visit to the ER for an earache, for instance, is about $180, Betsch said.

At the urgent care clinic, Jacobs said the cost for treating an earache would be $111 for a patient who had never been to the clinic or $91 for an established patient. Still, with the growing problem of caring for the uninsured and for Medicaid patients, medical leaders recognize many people will have no choice but to go to the ER.

The hospital is doubling the size of the the emergency room so it can better accommodate more patients. But the hospital is going to need help from the community to serve the uninsured and keep non-urgent cases from crowding the emergency room.

”It will take a community plan,” Betsch said.

The hospital is committed to serving everyone who comes to the ER, she added. ”We’re trying to take care of these people. Even before the law, that’s always been the philosophy of St. Charles.”

Rebecca Merritt can be reached at 541-383-0348 or at rmerritt@bendbulletin.com.