free_as_in_speech

Agreed. The sentence "hold the hospitals accountable" shows that OPs fundamentally misunderstand the root problem.

And ERs are not money makers for the hospital. If they were, then the ER docs would be running the place. Instead, the ERs are staffed by physician groups that can be replaced en masse ( as in all the docs suddenly lose their jobs) if another group underbids them.

My friend just won a night being a mermaid at the "Dive Bar"in Sacramento. Any advice for her?

I learned about the case of a critically ill baby who was turned away from a top children's hospital in Chicago 30 years ago and how the system in Illinois today is still failing to hold hospitals accountable.

This sentence makes it sound like hospitals just decide to turn patients away and need to be held accountable. I appreciate your added insight.

The problem has many layers and many moving parts.

An ED can go on diversion for lots of reasons but the basic idea is there are more patients in the ED and waiting room than the staff can treat.

There can be "too many patients" because people are using the ED for primary care, because there's a legitimate epidemic--like flu season or wild fire smoke, or just the random fluctuation of the daily census.

There can be "not enough staff" because people called in sick (because they are actually sick or their vacation wasn't approved or they are hungover), the staffing office couldn't find enough people to work the shift or because the patients are staying too long.

The patients can be "staying too long" because the floor nurse refuses to take report on the patient, the ED nurse is occupied with sicker patients and can't get to the discharge, the hospital won't pay for services to be available at off hours, the pharmacy is taking too long to approve and deliver meds because of helpful government oversight.

Laying the blame on "the hospital" is too reductive.

I didn't read these particular articles because I've read dozens of journal articles and listened to endless debates about the topic and lived it for the last 20 years. I apologize if I sold anyone short.

Thanks--I'm sure she'll enjoy it.

I'm an ER doc and I've worked in places with diversion problems just as bad. More than one night EVERY hospital was "on diversion" so EMS was just taking patients to random hospitals and camping in the hallway until they could unload.