The Face of the ED Boarding Crisis Is a Child’s

June 23rd, 2023

By Gary Evans, Medical Writer

He was nine-years-old, wearing make-shift OR garb that included cut-off paper scrubs. His parents did not want him. The Department of Social Services said there was nowhere to place him. His last four "homes” had been emergency departments, including one that kept him for months.

“His parents flat out refused to get him,” said an emergency physician, commenting anonymously on website created by the American College of Emergency Physicians (ACEP). “They want to give him up for permanent placement, they feel they cannot handle him, and that he is so disruptive to their family that they fear for the safety of their other young children. Usually, they didn’t even answer the phone. They never visited him in the ED.”

To bolster its case for action on the boarding issue, ACEP created the website with some 140 first-hand accounts from emergency department physicians.

"In the emergency department, we are used to dealing with issues in the setting of minutes and hours,” the physician said. “We emergency folks become uncomfortable when dealing with boarding patients for 12, 24 hours — much less days.

But days, weeks, and months transpired, and the boy remained in the emergency room.

“He lived with us in our community ED behavioral holding area for the entire summer,” the ACEP physician said. “Our emergency department staff — doctors, nurses, techs, security guards — were all placed in this frustrating situation where we were told we had to parent this little boy with no end in sight.”

The boy could not control his anger when disappointed, and given the situation, he was disappointed a lot.

“The people who were supposed to be helping this little boy, child protective services, failed wholly and utterly,” the physician said.

People and even staff looked at the situation in horror, saying why is this little boy still here? “This is inhumane!” the doctor recalled, adding “It was quite a frustrating and angering position for us to be in, as if we were being blamed for his continued presence."

Given such tragic incidents, ACEP and the Emergency Nurses Association (ENA) are aggressively lobbying Congress to address the situation. They most recently gathered on the Hill on June 22, 2023, to underscore the crisis and push for passage of the “Improving Mental Health Access from the Emergency Department Act” (S.1346).

For more on this story, see the next issue of Hospital Employee Health.

Gary Evans, BA, MA, has written hundreds articles on infectious disease threats to both patients and healthcare workers for more than three decades. These include stories on multidrug resistant healthcare associated infections caused by bacteria and fungi, and emerging pandemic viruses like SARS-1, 2009 H1N1 flu, SARS-CoV-2, and Avian influenza. He has been honored for excellence in analytical reporting five times by the National Press Club in Washington, DC.