It never ceases to amaze me what patients risk to get to County for health care because they’re uninsured and don’t want to incur thousands of dollars in medical bills. The emergency response system works this way: An ambulance by law must take a patient to the closest ER. No exceptions. But that doesn’t work for people who are uninsured and County isn’t the closest ER. So they argue with 911 operators and plead to be taken to County. When the ambulance arrives they beg the EMT’s to take them to County. They refuse to get in the ambulance if it won’t take them to County. An ambulance ride is safe and quick but to avoid medical bankruptcy some choose to drive or take public transportation which is dangerous because care is delayed.

My middle-aged, uninsured patient with diabetic retinopathy and peripheral neuropathies lived far away. He was legally blind. In an emergency he would never be brought to County but instead to the hospital a few short blocks from his home.  He started experiencing stroke symptoms and told his wife. They didn’t even bother to call an ambulance. They jumped on a bus that dropped them at the Blue Line train and came to County. That took almost 2 hours. The patient waited in the ER for 5 more hours until doctors diagnosed him. 

There is a golden window for stroke patients: 3 hours. If they get to the ER within that window and receive a powerful clot busting drug called T-PA (Activase), the chances are good they’ll survive with little to no deficits in brain function. Doctors can even insert the drug directly into the affected artery which is even more effective.

3 hours and the window closes. 7 hours, SOL, shit-outta-luck. The doctors told the patient he would probably suffer residual disabilities from the stroke. And he did. According to his wife his memory was now poor, he was often confused, and he had more falls. The man could never be left alone.     

Over 300 patients are seen every day in the County ER. That’s 10,000 patients a month.

There are over 1 million people uninsured in Cook County.

Add it up: Blue Line, stroke, uninsured, overcrowded ER, 7 hours.  

7 hours too late.