>> IF SOMETHING IS WRONG IN THE NEIGHBORHOOD, WHO ARE YOU GOING TO CALL?

OF COURSE GHOST BUSTERS.

WHAT IS SOMETHING IS WRONG WITH YOU AND YOU HAVE TO BE SEEN?

THEN WHAT DO YOU DO?

PLEASE STAY WITH US AS WE DISCUSS THE CHANGING DYNAMICS OF EMERGENCY MEDICINE CARE NEXT ON "KENTUCKY HEALTH."

THE EMERGENCY ROOM IS A PLACE OF EXCITEMENT, DRAMA AND TEEDIUM.

BUT WHAT WAS ONCE INITIALLY DESIGNED TO BE A SOURCE FOR, AS THE NAME IMPLIES, EMERGENCY CARE, HAS BECOME, AT BEST, AN URGENT CARE FACILITY AND AT WORST, A PLACE FOR SOME TO GO FOR PRIMARY CARE SERVICES.

THE CARE DELIVERED IN THE EMERGENCY DEPARTMENT IS COMPREHENSIVE AND GOOD.

UNFORTUNATELY, IT IS ALSO THE MOST EXPENSIVE.

IN FACT, SOME HEALTH INSURERS HAVE BECOME RELUCTANT TO COVER THE COST OF THE EMERGENCY ROOM VISIT AND HAVE BEEN PASSING THE COST ON TO THE PATIENT.

WITH THE CHANGING DYNAMICS AND MYRIAD OF CONDITIONS ALREADY FACING PROVIDERS IN OUR EMERGENCY DEPARTMENTS, WE NOW HAVE THE ADDED CONCERN OF BOTH PATIENTS AND PROVIDERS OF COVID-19.

TO DISCUSS WHAT OCCURS IN THE EMERGENCY DEPARTMENT, WE HAVE AS OUR GUEST TODAY, Dr. WILLIAM MOSS.

Dr. MOSS IS A GRADUATE OF THE LOUISVILLE SCHOOL OF MEDICINE AND DID RESIDENCY IN INTERNAL MEDICINE AT WAKE FOREST UNIVERSITY.

HE IS THE DIRECTOR OF THE EMERGENCY DEPARTMENT IN BOWLING GREEN.

THANK YOU FOR BEING WITH US.

>> THANK YOU, WAYNE.

APPRECIATE IT.

>> THE GORILLA IN THE ROOM IS COVID-19.

HOW HAS THAT IMPACTED WHAT IS GOING ON IN THE EMERGENCY ROOM NOW.

>> IT DEPENDS ON WHAT MONTH YOU ASK ME.

EARLY ON WHEN WE WERE SEEING A LOT OF CASES IN NEW YORK, WE WEREN'T SEEING VERY MANY CASES IN KENTUCKY.

BUT WE WERE TAKING THE SAME PRECAUTIONS AND WE KIND OF BECAME LOCKED DOWN AND DIDN'T HAVE VERY MANY CASES.

AS WE OPENED UP AND RESUMED, YOU KNOW, ELECTIVE SURGERIES AND THE HOSPITALS GOT MORE CROWDED, THEN OF COURSE THEN OUR SURGE CAME IN SEPTEMBER, OCTOBER OF LAST YEAR.

AND THEN SO IT DEPENDS ON WHAT MONTH WE ARE TALKING ABOUT.

IT HAS BEEN IMPACTFUL NONETHELESS AT ANY ONE POINT.

THE SITUATIONS WE HAVE TO DEAL WITH, THE FEARS, THE PPE.

I'VE ALWAYS SAID THAT, YOU KNOW, IN 2019, WE HAD A COMMON COLD.

WE TREATED YOU IN THE WAITING ROOM AND ACCEPTED YOU HOME WITH HARDLY ANY OTHER SITUATIONS.

NOW IT'S THREE HOURS AND $5,000 TO GO THROUGH A COMMON COLD.

IT BECOMES VERY LABORIOUS AND LENGTHY BECAUSE YOU CAN'T TAKE ANYTHING THAT IS COMMON FOR GRANTED ANYMORE.

>> ARE WE USING EMERGENCY ROOMS IN THE RIGHT WAY?

AGAIN, THE NAME SAYS EMERGENCY, SO ONE IMPLIES, I THINK BROKEN BONES OR BLEEDING.

IS THAT WHAT IS HAPPENING NOW?

>> WELL, YOU KNOW, ON ONE HAND, YOU KNOW, WEARIED INDICATED.

WE KNOW WHAT EMERGENCIES ARE BUT TO THE COMMON PERSON, HOW DO THEY KNOW?

THEIR BABY IS WHEEZING, THEY CAN'T BREATHE.

I DON'T BLAME PEOPLE FOR COMING IN.

SOMETIMES YOU JUST HAVE TO KNOW, YOU JUST DON'T KNOW UNTIL YOU GET THERE AND SOMETIMES PEOPLE ARE EMBARRASSED TO COME IN BUT I TRY TO ENSURE THEM, THAT TO YOU IT WAS AN EMERGENCY.

AND IN THE END, THE THING IS, WE TAKE CARE OF PATIENTS AND WE TAKE CARE OF THEM WELL AND, YOU KNOW, IF IT WAS AN EMERGENCY, THEN PRAISE GOD.

IF IT IS AN EMERGENCY, YOU ARE IN THE RIGHT PLACE.

I LOOK AT IT THAT WAY.

I DON'T TRY TO BE MEAN OR CONDESCENDING.

THAT'S NOT USEFUL.

AND THEM THE INSURERS, THEY HAVE TO DEAL WITH WHAT THEY DEAL WITH.

I DON'T WORK POLITICS OR INSURANCE COMPANIES.

I TAKE CARE OF PATIENTS.

THEY COME IN TO SEE ME, WE'LL SEE THEM.

>> THAT'S A GOOD POINT.

WHAT I CONSIDER AN EMERGENCY IS GOING TO BE DIFFERENT FROM SOMEBODY ELSE.

I'VE ALWAYS TOLD MY PATIENTS, A LITTLE BIT OF BLOOD, I'M INTERESTED IN BUT A LITTLE BIT OF BLOOD IN ME, STOP THE PRESSES, WE NEED TO ADDRESS THIS.

>> IT MAKES A DIFFERENCE.

SO I DON'T JUDGE.

IT'S NOT USEFUL.

>> WHAT HAVE YOU SEEN THROUGH TIME?

SINCE YOU FIRST STARTED PRACTICING IN THE EMERGENCY ROOM, WOULD YOU SAY ARE THE BIGGEST DIFFERENCES IN HOW YOU ARE PRACTICING?

>> WELL, A LOT OF THAT-- A LOT OF IT IS THE ATTITUDE OF THE PATIENTS.

YOU KNOW, I REMEMBER WHEN I WAS IN PRIMARY CARE, I WOULD SEE A PATIENT WITH NOMINAL PAIN AND WOULD I ORDER BLOOD TESTS THAT WOULD COME BACK THE NEXT AFTERNOON AND GIVE THEM A CALL OR GET AN ULTRASOUND THE NEXT DAY.

IF THAT WASN'T ANSWERED, A CAT SCAN ON THE THIRD DAY.

NEXT YOU HAVE A POLYP IN YOUR GALL BLADDER.

THE FIFTH DAY YOU GET A SURGICAL REFERRAL AND SOMEWHERE IN THE NEXT WEEK YOU GET SEEN BY THE SURGEON.

EVERYONE EXPECTS THAT TO HAPPEN IN ONE NIGHT NOW.

AND IF YOU DON'T DO IT IN ONE NIGHT OR ONE VISIT, THEN YOU ARE THOUGHT TO BE AT FAULT BECAUSE YOU KNOW, IT'S THE ATTITUDE THAT YOU SHOULD HAVE IT ALL DONE AT ONE TIME.

AND THAT'S WHY IT GETS EXPENSIVE BECAUSE THAT ATTITUDE, YOU HAVE TO WORK THROUGH THESE PROCESSES AND THEN SOMEBODY WILL BE THERE FOR FOUR OR FIVE HOURS AND I'M THINKING TO MYSELF, THIS WOULD HAVE BEEN A WEEK 10 YEARS AGO.

IF YOU HAVE BEEN HERE FIVE HOURS, I UNDERSTAND BUT YOU'VE GOT A LOT DONE.

AND SO THAT'S ONE THING.

AND AS I MENTIONED TO YOU BEFORE THE SHOW HERE, I HAVE SEEN AN UPTICK IN VIOLENT THINGS.

AND EVEN SMALL TOWNS, AND YOU KNOW, YOU DON'T HEAR ABOUT IT IN THE NEWS.

I REMEMBER BACK IN 1997, IF YOU HAD A GUN SHOOTING IN BOWLING GREEN, IT WOULD BE ON THE NEWS AND IT WOULD BE THE NEWS FOR THE DAY FOR THREE OR FOUR DAYS.

NOW THERE ARE SO MANY, YOU DON'T HEAR ABOUT IT ANYMORE BECAUSE WE HAVE SHOOTINGS ALL THE TIME AND STABBINGS AND THINGS OF THAT SORT.

JUST MORE VIOLENT STUFF COMING IN.

IT IS UNDER THE RADAR BECAUSE IT DOESN'T GET REPORTED ON BECAUSE IT'S SO COMMON NOW.

AND SOMETIMES, AS I MENTIONED TO YOU, WE SOMETIMES HAVE ISSUES OF VIOLENCE IN THE EMERGENCY ROOM.

>> IN THE ROOM ITSELF.

>> YES.

A LOT OF PATIENTS BECOME VERY, PARTICULARLY WITH DRUGS AND OVERDOSES, AND JUST, ISSUES IN GENERAL THAT BECOME VERY EMOTIONAL AND BECAUSE THE ANSWERS AREN'T RIGHT THERE, YOU KNOW, SOMETIMES IT'S VERY LEGITIMATE.

I'M ANXIOUS BECAUSE MY CHILD CAN'T BREATHE OR WHATEVER, WHY AREN'T YOU DOING THAT TYPE OF THING, BUT I'M TALKING ABOUT BEYOND THAT.

WE HAVE TO HAVE MORE SECURITY GUARDS NOW.

WE HAVE TO HAVE MORE PRODUCTION FOR OURSELVES.

WE HAVE POLICE IN THERE FREQUENTLY HAVING TO HELP US OUT WITH SOME PATIENTS THAT ARE BECOMING UNRULY AND SO FORTH.

AND SOMETIMES OUR STAFF HAVE HAD ISSUES.

WE ACTUALLY HAD A SHOOTING IN OUR E.R.

BACK IN MARCH, IRONICALLY, THE VERY FIRST NIGHT WE HAD OUR VERY FIRST COVID PATIENT WE HAD A SHOOTING IN OUR E.R.

WHERE A PATIENT OVERTOOK A SECURITY GUARD AND GOT HIS GUN AND SHOT TWO OF OUR STAFF MEMBERS.

AND THAT WAS HORRENDOUS TO HAVE YOUR OWN STAFF, I MEAN-- THE THOUGHTS, THIS MOMENT JUST THINKING ABOUT OUR STAFF NURSE YELLING SHOTS FIRED, SHOTS FIRED AND EVERYBODY IS TAKING COVER IN OUR E.R., WAS A MOMENT THAT YOU DON'T FORGET.

>> IT SOUNDS ALMOST, BECAUSE I WAS GOING TO ASK YOU ABOUT, WHAT IMPACT TELEVISION HAS HAD ON THE EXPECTATIONS OF CARE THAT A PERSON RECEIVED IN AN EMERGENCY ROOM BUT IT SOUNDS ALMOST LIKE YOU ARE DESCRIBING A DRAMA THAT WE CAN SEE ON A LOT OF THESE SHOWS.

>> THAT'S ONLY HAPPENED TO ME ONCE.

BUT THAT'S ONE TIME TOO MANY.

BUT SOMETIMES THESE THINGS HAPPEN MORE IN SMALL TOWNS AND I'M SURE IN LOUISVILLE.

I COULD GO ACROSS TO E.R.s ACROSS THE COUNTRY AND YOU ARE GOING TO FIND VIOLENCE MORE AGAINST NURSING STAFFS, NOT JUST E.R., UPSTAIRS AND EVERYWHERE.

BUT E.R.

IS A VERY VOLATILE AREA AND OUR HOSPITAL TAKE GREAT PAINS TO GET SECURITY GUARDS AND TRAINING AND SO FORTH.

AND JUST A WATCHFUL EYE ABOUT HOW WE CAN PREVENT THAT.

BUT YOU CAN'T PREVENT EVERYTHING.

>> NO.

ONE MORE THING ABOUT COVID SINCE YOU ARE TALKING ABOUT HAVING TO HAVE SECURITY GUARDS.

WHAT IS THE PROTOCOL NOW AT YOUR FACILITY AND PROBABLY SOME OTHERS, I IMAGINE ARE GOING TO BE SIMILAR, WHEN A PERSON COMES IN AND YOU DON'T KNOW COVID OR NOT COVID?

TAKE ME THROUGH THAT.

>> WELL, IT'S A LOT LIKE WE DID IN THE 80s WITH H.I.V.

AND IT'S WHY WE GOT UNIVERSAL PRECAUTIONS.

AND WE HAVE EXTENDED THAT INTO THIS ERA.

YOU KIND OF JUST HAVE TO THINK EVERYBODY PROBABLY HAS IT UNTIL YOU CAN REALLY MAKE SURE THEY DON'T.

SO WE TRY TO MASK-- NOT TRY TO.

EVERYBODY GETS MASKED.

EVERYONE GETS TEMPERATURE CHECKED.

EVERYONE GETS SCREENED AND WE HAVE THE QUESTIONS WE GO THROO, THROUGH BUT AS YOU KNOW, THE QUESTIONS ARE NOT GOING TO PICK UP EVERYBODY.

I CALL THEM WHOOPS CASES, CASES YOU ARE WORKING ON AND THEY'RE TOTALLY SOMETHING DIFFERENT AND COMING IN FOR, I DON'T KNOW, A KNEE FRACTURE OR WHATEVER AND THEY'RE GOING TO THE O.R.

AND HAVE YOU TO GET A SCREEN BEFORE AND THEY COME UP POSITIVE AND YOU THINK, OH MY GOSH, THEY HAVE BEEN IN A ROOM, MASKED.

WE HAVE DONE ALL THE RIGHT THINGS.

THERE WAS A TIME WHEN THAT WOULDN'T HAVE HAPPENED, BUT WE TAKE THE UNIVERSAL PRECAUTIONS LIKE WE DO WITH H.I.V.

BACK IN THE 80s, GLOVES, HAND WASHING, ALL THAT KIND OF STUFF.

YOU HAVE TO REALIZE THAT IT'S GOING TO BE THERE AND THANK GOODNESS WE ARE ALL GETTING VACCINATED AND PROTECTING OURSELVES NOW.

AND WE ARE GETTING THROUGH IT.

THERE HAVE BEEN SOME STUMBLES, BUT WE HAVE PICKED OURSELVES UP AND KEPT ON GOING.

>> IS THE ASSUMPTION THAT SOMEONE IS COVID POSITIVE OR THE ASSUMPTION THAT THEY'RE NOT?

>> WELL, YOU KNOW, SOMETIMES YOU HAVE TO-- SOMEBODY COMES IN GUNSHOT WOUND, YOU DON'T HAVE TIME TO STOP.

YOU GOT TO GET OR A STABBING OR STROKE CASES, YOU HAVE TO PUT THAT ON THE BACK BURNER.

HAVE YOU TO TAKE CARE OF THE IMMEDIATE PROBLEM FIRST.

AND THEN WE DO, WITH ALL DUE CARE, MASK AND SO FORTH.

BUT SOMETIMES, IF YOU HAVE A PATIENT WITH A GUNSHOT WOUND OR TRAUMA, YOU HAVE TO INTUBATE THEM AND GET RIGHT IN THEIR FACE, SO YOU KNOW, WE TRY TO DO ALL THE VIDEO SCOPES AND WAYS TO KEEP AWAY FROM THAT.

WE HAVE EVOLVED MEDICINE A GREAT DEAL TO HELP WITH THAT AND I THINK THAT WILL STICK AROUND FOREVER, THANK GOODNESS, SOME OF THE THINGS WE ARE DOING NOW.

THE PROTOCOLS HAVE BEEN SET FORTH AND WE HAVE FOUND OUR WAY INTO IT AND MOST OF US HAVE BEEN PROTECTED.

SOMETIMES IT DIDN'T HAPPEN.

MOST TIMES WE DID OKAY.

>> HOW DOES A PERSON GET TO AN EMERGENCY ROOM?

TYPICALLY SOMEONE DRIVES THEMSELVES THERE OR IS IT FROM THE AMBULANCE AND/OR DOES IT MAKE A DIFFERENCE?

>> WELL, YOU KNOW, SOME PEOPLE THINK IF THEY COME BY AMBULANCE, THEY COME TO THE FRONT OF THE LINE.

BUT WE HAVE TAKEN PEOPLE FROM AMBULANCE BAY TO TRIAGE BUT THEY'RE SCREENED.

WE DON'T DO THAT CAVALIERLY AT ALL.

BUT MAJORITY ARRIVE BY CAR.

NOW WE DO WANT SOME PEOPLE TO ARRIVE BY AMBULANCE.

IF YOU ARE HAVING A HEART ATTACK OR A STROKE, THERE ARE THINGS THEY CAN DO FOR YOU ON THE WAY HERE THAT YOU WOULDN'T DO AND THOSE MINUTES MATTER SO IF YOU ARE HAVING A STROKE OR HEART ATTACK OR HEM RAGING HEMORRHAGING.

DON'T DRIVE YOURSELF OR HAVE A WRECK, BUT CALL EMS.

THAT'S WHAT IT'S FOR.

BECAUSE THEY CAN INTERVENE AND DO A LOT OF THINGS BEFORE YOU GET TO THE HOSPITAL.

VERY SKILLFULLY DONE AND TREATMENTS CAN INITIATE AND START.

WE ARE AHEAD OF THE GAME BY 15-20 MINUTES WHEN YOU ARRIVE.

>> IS THERE SOME COMMUNICATION THAT GOES ON BETWEEN THE EMERGENCY ROOM AND THE EMS WHEN THEY'RE IN TRANSIT?

>> YES.

VERY INTEGRATED INTO OUR E.R.

WE CALL AND TALK ABOUT THINGS ON THE WAY IN AND THEN WE HAVE ONE OF MY PARTNERS, Dr. WATSON IS THE MEDICAL DIRECTOR OF THE EMS.

SO HE IS EMERGENCY ROOM DOCTOR AND ALL OF OUR PROTOCOLS, THEY KNOW, AND THEY REFINE THOSE EVERY MONTH.

AND LONG RANGE PARAMEDICS SERVICES IS ONE OF THE HIGHEST RANKED IN THE NATION BECAUSE THEY HAVE A PHENOMENAL EMS SYSTEM IN BOWLING GREEN.

THEY HAVE-- THEY DO A GREAT DEAL OF WORK.

THEY'LL COME IN WITH, I WON'T GO OVER ALL THE MEDICAL STUFF THEY DO, BUT THEY DO THINGS THAT ARE NECESSARY THAT, YOU KNOW, THEY'RE NOT JUST AMBULANCE DRIVERS.

THEY ARE PARAMEDICS AND THEY'RE VERY SKILLED AND THEY KNOW THEIR STUFF.

>> SO IT'S AN EXTENSION OF WHAT IS GOING ON IN THE EMERGENCY ROOM.

>> PROTOCOLS FOR STROKE AND HEART ATTACKS, PROTOCOLS OR HEMORRHAGING, SEPSIS AND SHOCK.

THOSE PROTOCOLS ARE INITIATED BY PARAMEDICS VERY FREQUENTLY.

SO WHEN THE SEPSIS PROTOCOL, THRUDZ AND BLOOD PRESSURE AND TEMPERATURE AND PULSE, THEY GET THE STUFF DONE.

THEY GET I.V.s GOING AND GET THINGS GOING.

>> TYPICAL TOP FIVE PATIENTS THAT YOU MIGHT SEE IN THE EMERGENCY ROOM?

>> I WORKED AT TRAUMA SIDE SO I DON'T WORK-- WE HAVE A LESSER SEVERE AREA.

I DON'T WORK THAT TOO OFTEN.

IF YOU EXCLUDED THAT AND WHAT I SEE, TOP FIVE THINGS I THINK THAT ARE-- I SAY NUMBER ONE IS PROBABLY MEDICAL-RELATED ELDERLY PNEUMONIA, SEPSIS, JUST THINGS THAT HAPPEN WHEN YOU GET OLDER.

YOU THINK THEY'RE MORE COMMON.

SO WE SEE A LOT OF OLDER PATIENTS FROM NURSING HOMES OR REHAB CENTERS OR FROM HOME WHO HAVE DEVELOPED A FEVER AND VOMITING OR PNEUMONIA.

THAT TYPE OF THING.

WE SEE A LOT OF HEART ATTACKS.

SO WE HAVE-- MOST HOSPITALS HAVE THE SAME.

BUT WE TRY TO GET PATIENTS TO THE CATH LAB AS SOON AS POSSIBLE, WITHIN 60 MINUTES IF POSSIBLE, TO GET THE REVASCULARIZATION, THE PARAMEDICS WILL TRANSMIT TO US THE EKG.

BY THE TIME THEY'RE THERE, I HAVE THE CARD CARDIOLOGIST AND STAFF READY, THEY GO FROM THE AMBULANCE BAY TO THE CATH LAB.

THAT'S WHEN IT WORKS GREAT.

THAT'S REALLY REALLY GREAT OUTCOMES.

BEFORE, YOU KNOW, MANY YEARS AGO, YOU WOULD SIT IN THE E.R.

AND CARDIOLOGIST WOULD GET THERE FINALLY, AND NOW THE PROTOCOLS ARE JUST LIKE WE WORK THROUGH THE PROTOCOLS VERY CAUTIOUSLY.

SO THAT'S NUMBER 2.

STROKES, A GREAT DEAL.

AND TRAUMA OBVIOUSLY.

AND THEN I GUESS BEYOND THAT, A LOT OF KIDS, KID ILLNESSES, THAT KIND OF THING.

COUGH, FEVER, WHEEZING, ASTHMA.

THE THING ABOUT THE E.R., YOU HAVE TO BE A JACK OF ALL TRADES.

I HAVE TO KNOW HOW TO SPLINT A TOE AND DELIVER A BABY 10 MINUTES APART.

>> AND YOU MAY HAVE ONE IN ONE ROOM AND THE OTHER ONE IN THE OTHER.

>> RIGHT.

>> I GUESS YOU ALL ARE THE NEW ROCKSTARS OFFED IN SINCE MORE TV SHOWS ARE ABOUT EMERGENCY ROOM FOLKS.

I DON'T RECALL ANY TV SHOWS ABOUT COLORECTAL SURGEONS.

WE HAVE TO CATCH UP.

>> THAT WOULD BE A TOUGH SHOW TO PRODUCE, I IMAGINE.

>> PROBABLY A LOT OF SPONSORS AND TOILET PAPER.

THERE ARE DIFFERENT LEVELS OF CARE IN HOSPITALS.

WHERE ARE YOU DOWN IN BOWLING GREEN?

WHAT ARE SOME OF THE DIFFERENT LEVELS OF TRAUMA CARE BECAUSE YOU MENTIONED YOU DO A LOT OF TRAUMA.

WHAT DOES THAT MEAN REALLY?

>> WELL, THE TRAUMA CERTIFICATIONS ARE VERY IMPORTANT AND SOMETIMES WE ARE DOING A LEVEL OF CARE BUT WE HAVEN'T GONE THROUGH THE PROCESS OF GETTING THE CERTIFICATIONS.

A LOT OF THE HOSPITALS AREN'T.

I KNOW VERY FEW LEVEL 1 TRAUMA CENTERS.

U OF L AND U.K. A LOT OF LEVEL 2.

WE ARE LEVEL THE.

WE WERE LEAPS, STEPS AND BOUNDS GETTING LEVEL THE STARTED AND THEN COVID HIT SO WE HAD TO PUT THAT ON THE BACK BURNER.

BUT OUR GOAL IS TO BE A LEVEL TWO TRAUMA CENTER.

THAT IS ATTAINABLE IN THE NEXT FEW YEARS.

WE HAVE A LOT OF RESIDENCIES, WE HAVE SURGICAL RESIDENCY.

WE HAVE PULMONARY RESIDENCY, A LOT OF DIFFERENT FELLOWSHIPS IN OUR HOSPITAL THAT ALLOW A LOT MORE TEACHING AND STAFFING.

SO WE ARE HEADING THAT WAY.

I THINK WE WILL GET THERE SOON.

OTHER THAN THAT, YOU KNOW, AND BOWLING GREEN, IN LOUISVILLE, MANY HOSPITALS IN BIG POPULATION, IN OUR AREA OF THE STATE, WE HAVE US AND A COUPLE OTHER SMALLER HOSPITALS, BUT THERE ARE ABOUT 10 COUNTIES.

AND YOU PUT THE 10 COUNTIES, YOU HAVE THE SAME VOLUME WOULD YOU HAVE SO THEY ALL MIGRATE TO THE CITIES THAT HAVE THE SPERKTS SPECIALTIES.

WE DON'T DO PEDIATRIC TRAUMA BUT EVERYTHING ELSE.

>> WHEN YOU MENTION A PERSON CAN COME IN AND BE TAKEN TO A CATH LAB OR SOMETHING LIKE THAT RIGHT AWAY, SO I GUESS HAVE YOU TO HAVE SERVICES AVAILABLE 24 HOURS A DAY.

>> SURE.

YEAH.

>> THERE ARE NO DAYS OFF.

IF YOU NEED AN MRI AT 3:00 A.M., WE GET AN MRI AT 3:00 A.M.

IF YOU NEED-- I'M NOT SAYING, WE DON'T ADVERTISE THAT YOU SHOULD COME GET AN MRI AT 3:00 IN THE MORNING BUT IF YOU NEED AN MRI, IF THERE IS A MEDICAL NEED FOR THOSE THINGS.

IF YOU NEED TO HAVE AN OB SURGEON, WHATEVER.

AND EVEN IF YOU ARE A SMALLER E.R., MOST HOSPITALS HAVE AN AGREEMENT WITH, YOU KNOW, LIKE T.J. SAMPSON AND GLASS COMPANY HAVE AN AGREEMENT WITH U OF L OR THE PLACES THAT WILL TAKE THEIR PATIENTS AND SO FORTH AND SEE THEM QUICKLY.

SO THERE ARE SYSTEMS THAT ARE WORKED OUT, EVEN THE SMALLER HOSPITALS, THAT WILL GET PATIENTS SEEN QUICKLY.

YOU DON'T HAVE TO LANGUISH IN A SMALL E.R.

GO THERE AND GET STABILIZED.

AND IF YOU NEED SPECIALTY CARE, YOU KNOW, THE LAWS AND THE RULES, AND JUST COMMON MORAL ETHICAL MEDICAL PRACTICES.

IF YOU ARE THE CLOSEST APPROPRIATE FACILITY, THEN YOU SHOULD TAKE THAT PATIENT AND WE DO AND WE WORK THROUGH THAT AND IT'S A PROCESS OF GETTING PEOPLE TRANSFERRED SAFELY.

THERE ARE LAWS THAT DICTATE AND RELATE ALL THAT.

BUT EATS ALMOST COMMON SENSE NOW.

YOU JUST DO THE RIGHT THING.

>> THERE WAS A GREAT DEAL OF CONTROVERSY A COUPLE YEARS BACK, I THINK SOME VIDEO SHOWING SOME HOSPITALS TAKING PATIENTS OUT OF THEIR EMERGENCY ROOMS AND ALMOST DEPOSITING THEM BACK ON STREETS.

A ROT OF THIS WAS GOING ON IN CALIFORNIA, PARTICULARLY IN LOS ANGELES.

YOU MENTIONED THE MORAL AND ETHICAL THINGS AS WE THINK OF AS PHYSICIANS BUT THAT IS ILLEGAL, ISN'T IT?

IF THAT PERSON IS IN THE EMERGENCY ROOM, YOU ARE OBLIGATED TO TAKE CARE OF THEM.

>> THAT'S WHY I GOT OUT OF PRIMARY CARE AND WENT TO THE EMERGENCY ROOM BECAUSE I LOVE THE FACT THAT THERE IS NO WAY THAT I'M GOING TO TREAT A HOMELESS PERSON DIFFERENT THAN A SENATOR, YOU KNOW.

IN MY E.R., IN MY CARE, I'M NOT SAYING THAT TO EVERYBODY.

YOU GET THE SAME TREATMENT, THE SAME CARE.

AND IF YOU NEED TO BE IN A HOSPITAL, YOU ARE PUT IN A HOSPITAL AND YOU ARE NOT, THERE IS NOT AN EXCEPTION TO THAT.

LEGALLY AND MORALLY SO NOW THERE ARE SITUATIONS WHERE SOMEBODY IS BEING DISCHARGED AND THEY'RE STABLE, THAT WE TRY TO FIND A PLACE FOR THEM TO GO.

>> SURE.

>> AND HONESTLY, WE-- THIS IS SOMETHING MY ADMINISTRATOR WON'T WANT ME TO SAY, BUT MANY TIMES I'LL LET PEOPLE STAY IN THERE I ROOM UNTIL THE NEXT MORNING UNTIL THE SHELTERS OPEN UP BECAUSE SOMETIMES THE SHELTERS CLOSE, THEY CAN'T GET OVER THERE, OR THE CHURCH THAT ARE GOING TO CARE FOR THEM, THERE NO WAY WITH COVID, I HAD UBER THAT I SENT A PATIENT TO WITH MY UBER APP BEFORE TO GET THEM SAFELY SOMEWHERE.

WHEN THE CABS WEREN'T RUNNING.

YOU DO YOUR BEST AND EACH CASE IS DIFFERENT.

I'M NOT GOING TO TELL YOU IT'S ONE BAND-AID FITS ALL SCENARIO BUT EVERY DAY IS DIFFERENT.

YOU TAKE IT DAY BY DAY AND MAKE SURE HARM IS NOT DONE BY ANYBODY.

AND IF THERE ARE HOMELESS, WE TRY TO FIND SOCIAL SERVICES TO HELP THEM WITH OUTREACH WHERE THEY CAN BE KEPT OR TAKEN CARE OF.

I DON'T WANT TO ADVERTISE THIS A GREAT DEAL BUT WE HAVE A COMPASSIONATE RELEASE PROGRAM FOR MEDICATIONS THAT OUR HOSPITAL PROVIDES A FUND THAT IF SOMEBODY CAN'T GET THEIR MEDICINES, THAT WE WILL GET THEIR SUPPLY FOR TWO WEEKS.

WE DON'T DO NARCOTICS, BUT ANYTHING ELSE OTHER THAN THAT OR SCHEDULED DRUGS.

WE'LL GET THEM THEIR MEDICINE.

2:00 IN THE MORNING, WE'LL GET THEM FROM THE PHARMACY AND GIVE THEM TO THEM AND GET THEM HOME.

IT'S JUST COMPASSIONATE.

WE DO THE PRESCRIPTION AND RELEASE AND GET THE FORMS.

WE HAVE PROGRAMS FOR THAT, TOO.

BUT AGAIN, IT'S A DAY BY DAY BASIS.

>> YOU KIND OF TOUCH UPON THIS, BUT SOMETIMES YOUR EMERGENCY ROOM IS GOING TO BE FILLED AND THERE IS NO ROOM TO TAKE SOMEBODY ELSE IN.

SO ARE THERE ARRANGEMENTS WITHIN THE LOCAL E.R.s, HEY, WE CAN'T DO THIS, BUT SO I GUESS A DIVERSION, WE ARE GOING TO SEND THEM OFF OR... LIKE YOU MENTIONED ABOUT THE T.J. SAMPSON SENDING PATIENTS TO U OF L. >> DAYS OF COVID, WE'VE HAD ISSUES.

WE'VE HAD A LOT OF ISSUES WITH BEING PACKED AND OVERCROWDED.

AND WE HAVE WORKED OUT A SYSTEM WITH OTHER SISTER HOSPITALS.

IT'S SORT OF LIKE A PROCESS, YOU KNOW, THE SICK ONES, SMALLER HOSPITALS, SEND THEM TO OUR E.R.

AND WE START THE PROCESSES.

WE GET THEM STABILIZED, ADMITTED.

AS THEY GET BETTER AND THEY'RE GETTING BETTER BUT NOT READY TO GO HOME, THEY GO FROM THERE BACK TO THE HOSPITALS.

AND WE KIND OF, LIKE A CIRCULAR THING.

BUT WE ARE ABLE TO MAINTAIN A FLOW OF THAT.

NOW CASE BY CASE BASIS.

THERE MAY NOT BE A FAMILY THAT WANTS THEIR LOVED ONE IN FRANKLIN.

THEY MAY NOT WANT TO DO THAT.

AND IT'S A WHOLE SENSE OF THINGS.

I'VE ADMITTED PATIENTS FROM OUR E.R.

TO OTHER HOSPITALS.

NOT TO THE E.R.

TO E.R.

BUT E.R.

TO AN ATTENDING AT THAT HOSPITAL AND THE ATTENDING ACCEPTS THE PATIENT FROM OUR HOSPITAL TO THEIR HOSPITAL.

IT'S NOT NECESSARY TO HAVE THE HIGH LEVEL OF CARE AT OUR HOSPITAL.

THEY NEED TO BE ADMITTED AND WE TAKE CARE OF THEM BUT THERE HAVE BEEN CASES WHERE WE ARE SO FULL, EITHER THEY WILL BE HELD IN OUR E.R.

FOR A DAY OR TWO OR GO TO A ROOM WITH, YOU KNOW, WHERE THEY CAN BE TREATED AND SO FORTH.

>> WITH THE COVID AND DURING NON-COVID TIMES, DID YOU EVER HAVE DIFFICULTY GETTING A PATIENT ADMITTED INTO YOUR OWN FACILITY BECAUSE THE BEDS WEREN'T AVAILABLE?

AND WHAT HAPPENS THEN?

>> THEY BECOME A HOLD IN THE E.R.

THE PROCESS DOESN'T STOP.

I DON'T-- WE DON'T HAVE THE MIND SET THAT HIVE WE ADMIT YOU AND THEN WE FIND THERE MIGHT BE A HOLD AND THERE MIGHT BE THE NEXT DAY AND COME BACK ON THE NEXT SHIFT AND THEY'RE STILL IN THE E.R.

THAT HAPPENS ACROSS THE NATION QUITE FREQUENTLY.

>> ARE EMERGENCY ROOMS LIKE YOURS, ARE THEY SEPARATE ENTITIES FROM THE HOSPITAL SYSTEM OR PART OF?

>> VERY MUCH A PART OF.

WE ALL WORK TOGETHER.

IT'S A FLOW PROCESS.

AND WE TRY TO GET-- FOR INSTANCE, WE WERE VERY BUSY YESTERDAY AND I CALLED IN EXTRA HELP TO COME AND HELP.

THEY CALL IN EXTRA STAFF AND I HAD ADMINISTRATORS YESTERDAY IN OUR E.R.

WORKING BECAUSE THEY WERE SO BUSY.

SO THEY FIND A WAY TO HELP OUT.

ATHAN THEN WE TRY TO GET MORE DOCTORS IN AND SO FORTH DAY BY DAY.

>> AS YOU LOOK BACK ON YOUR CAREER, WHAT IS THE ONE BIGGEST THING THAT YOU HAVE SEEN CHANGE IN THE EMERGENCY ROOM FROM WHEN YOU STARTED?

>> I GUESS THE BIGGEST THING I MENTIONED EARLIER, MORE VIOLENCE TYPE OF THINGS WE ARE SEEING.

>> IT'S REALLY THAT SIGNIFICANT A CHANGE?

THAT'S THE BIGGEST THING?

>> MORE DRUG ISSUES?

>> IS THAT GENRE FLEX OF SOCIAL ATTITUDES.

>> I THINK IT'S A LOT OF IT IS DRUGS.

AND THINGS THAT HAPPEN WITH DRUGS AND VIOLENCE.

I SEE A LOT MORE KIDS INTOXICATED THESE DAYS.

A KID TO ME IS ANYBODY YOUNGER THAN 30 A LOT OF COLLEGE STUDENTS COME IN INTOXICATED.

AND ANOTHER THING WITH ARRESTS.

ANYBODY WHO IS ARRESTED THAT HAS ANY MEDICAL INCLINATION AT ALL, THEY HAVE TO BE MEDICALLY CLEARED BEFORE THEY CAN GO TO JAIL WHEREAS BEFORE THEY WOULD HAVE JUST GONE TO JAIL.

WE HAVE POLICE IN OUR E.R.

ALL THE TIME WITH A PRISONER OR SOMEONE WHO IS UNDER ARREST WHO NEEDS TO BE MEDICALLY TREATED FOR VARIOUS REASONS.

CHEST PAINS, INTOXICATED, ON DRUGS.

WE HAVE TO MAKE SURE THEY'RE OKAY AND STABLE TO GO.

WE DO A LOT OF THAT NOW AS WELL.

AND THOSE ARE, BELIEVE IT OR NOT, LESS VIOLENT MOMENTS AND THEN THERE ARE DRUG ISSUE, MEDS AMPHETAMINE IN PARTICULAR BECAUSE THE NATURE OF THE DRUG MAKES PEOPLE HAVE AWFUL HALLUCINATIONS AND THEY GET VERY VIOLENT.

>> LET ME ASK YOU WITH 30 SECONDS TO GO HERE.

>> SURE.

>> KIDS WATCHING, LIKE WHAT YOU SAY WANTS TO GET INTO EMERGENCY MEDICINE.

HOW DO THEY GET INTO THAT?

>> MAKE GOOD GRADES.

PURSUE PREMED AND YOUR COLLEGE CAREER, SCIENCE, MATH, THOSE TYPES OF THINGS.

AGAIN, MAKE GOOD GRADES.

AND APPLY AND THERE ARE OPPORTUNITIES IF YOU TRY.

I CAME FROM A FAMILY OF SEVEN AND MY DAD WAS JUST A FARMER.

WE DIDN'T HAVE MUCH.

BUT I DECIDED I WAS GOING TO DO IT, YOU KNOW.

I DID MY BEST.

MADE GOOD GRADES AND FOUND MY WAY, PAID MY LOANS OFF EVENTUALLY.

I MEAN THERE IS ALWAYS A WAY.

>> AND I BELIEVE YOUR SON IS FOLLOWING IN YOUR FOOTSTEPS.

>> E.R.

DOCTOR HERE IN LOUISVILLE.

>> SMARTER THAN YOU, TOO, ISN'T HE?

>> MUCH SMARTER.

>> I WANT TO THANK YOU VERY MUCH FOR COMING UP HERE AND TALKING WITH US TODAY.

AND I WANT TO THANK YOU FOR BEING WITH US TODAY, ALSO.

I HOPE YOU HAVE A BETTER UNDERSTANDING WHEN TO GO TO THE EMERGENCY ROOM AND WHAT TO EXPECT SHOULD YOU HAPPEN TO HAVE AN EMERGENCY THAT REQUIRES TREATMENT THERE.

IF YOU WISH TO WATCH THIS SHOW AGAIN OR WATCH AN ARCHIVED VERSION OF PAST SHOWS, PLEASE GO TO ket.org/HEALTH.

IF YOU HAVE A QUESTION OR COMMENT ABOUT THIS OR OTHER SHOWS, WE CAN BE REACHED AT KYHEALTH@ket.org.

PLEASE BE SAFE AND CONSIDERATE OF OUR NEIGHBORS.

I LOOK FORWARD TO SEEING YOU AGAIN ON THE NEXT KENTUCKY