Emergency Room

Following an investigation that found serious and sometimes fatal problems in patient treatment, the state Health Department shut down nearly all of the Giuffre Medical Center in North Philadelphia yesterday. Beginning yesterday no new patients were admitted to the hospital - except to the drug and alcohol treatment unit - and, at about 6:30 p.m., the emergency room was closed. The state allows Giuffre to continue to operate only its primary care clinic, which includes family practice, pediatrics and other outpatient care, and drug and alcohol inpatient services.

After vigorously cutting the rug most of the evening at a wedding recently, my stepfather - "Pop" - woke up with an excruciating pain in his back. When the pain would not lessen, my mother called me and I raced to South Philly, where I found Pop ashen, sweaty, and looking perturbed that such a fuss was being made about him. He said that he wasn't in much pain - of course - but I knew that if he was allowing himself to be taken to a hospital, the pain must have been considerable. We went to a Center City emergency ward.

Three Philadelphia hospitals have filed for bankruptcy protection in the past year - University Medical Center (the former Broad Street Hospital), St. Mary in Fishtown, and earlier this month, St. Joseph's in North Philadelphia. Others are teetering on the brink. This isn't just a story for the business pages. Hospitals everywhere are tightening their belts because they are being paid less to take care of people who are poor or uninsured, and because of changes in the way Medicare and other insurers pay for medical care.

Seth Ruderman usually spends his drive to work thinking about the kinds of patients he and the rest of the emergency-room staff at Virtua-Memorial Hospital in Burlington County might see that day. With snow blanketing cars, driveways and backyards, and ice covering steps and pavement, it was not hard to predict the types of injuries that emergency staffs in the Philadelphia region would treat this week. "This is something we haven't seen in three years," said Ruderman, an emergency-room physician, about the volume of snow- and ice-related injuries at the hospital.

A stray bullet fired in a drive-by shooting killed a young boy who just hours earlier was sitting in an elementary classroom. Paul E. Gourley, an emergency-room physician, remembers the sounds of the boy's mother crying as he entered the waiting room to deliver the news. Experiences like that one, he said, persuaded him to become medical director of the Youth Violence Prevention Program for Albert Einstein Medical Center. "Until you've had a parent fall into your arms, collapse on the floor after you tell them their child was killed, you don't understand the impact of violence," Gourley said.

Within the next few weeks, the Crozer-Keystone Health System, already the largest health-care provider in Delaware County, plans to launch a three-year, $42 million expansion project that will add needed emergency-room space, hospital beds or parking spaces at three of its six facilities. In an interview this week, Gerald Miller, the health system's president and chief executive officer, and Joan K. Richards, its chief operating officer, said that a new emergency room to be built on a parking lot in front of the Crozer-Chester Medical Center in Upland will be triple the size of the current one. A five-story parking garage will be built a short distance away.

David Saninocencio's first visit to Fitzgerald Mercy Hospital yesterday morning was to get stitches in his forehead. His second visit was to be identified by a woman whom police say Saninocencio assaulted just minutes after he left the emergency room for the first time. According to a police affidavit, the woman was walking on Main Street from MacDade Boulevard toward 13th Street at 5:45 a.m. Saninocencio, who was walking in the opposite direction, approached the woman and punched her in the face, knocking her to the ground, police said.

Members of the medical staff at West Jersey Hospital-Voorhees are preparing for an emergency-room expansion that will help them better accommodate the needs of a growing community. By rearranging existing space and adding new space, officials plan to increase the emergency room's capacity from 15,000 visits per year to 33,000, hospital spokeswoman Pat Hennessy said. Last year, doctors at the hospital treated 28,000 patients, said Joseph Hummel, chairman of the Department of Emergency Medicine at West Jersey Health System, which operates the hospital.

The emergency rooms at South Jersey Hospital System's Bridgeton and Millville divisions were plagued by lapses in the physicians' on-call system, late administration of medication, and other errors involving 11 patients, including at least three who subsequently died, according to a state report released yesterday. The findings are part of a state investigation completed Dec. 10 that resulted in an unprecedented state action forcing the Cumberland County hospitals to close their emergency rooms for three days.

Bob Sing feels pressure every day as a physician and the director of the Springfield Hospital emergency room. He sees cardiac arrests, car accident injuries and stabbings. So when he's away from work, he likes to relax - by throwing the javelin. "Obviously, I don't have the time to throw as much as I'd like to," Sing said yesterday as he attended to his 14-month-old daughter, Adriana, before winning the 40-44 age-group javelin competition at the Keystone State Games with a throw of 215 feet, 7 inches.