B O S T O N, Jan. 15 — Patients with a medical emergency now have one more thing to worry about — a health care system that might not be able to deliver.
 

In several cities across the country, hospital emergency rooms are closing for hours, forcing ambulances to divert from the closest one and find a hospital that can accept them. It means a patient in need will have to wait longer for treatment. 

The situation has already become a crisis in Boston, and it's a developing problem in the country. 
"In most of the major metro areas in this country there is no guarantee tonight that a patient can get promptly evaluated, quickly seen, and quickly admitted to a hospital," says Arthur Kellerman of the American College of Emergency Physicians. 

'The Ambulance Parked' 

Last week, Anne Marie Breuer accompanied her mother to the hospital, but the ambulance had nowhere to go, so it pulled over. 

"The ambulance parked," Breuer says. "And it took several minutes and several telephone conversations. They did not go to the designated hospital, and they informed me they would not take her there. That if they took her there it would be illegal." 

Emergency rooms are the choke point. Not too long ago, "filled" meant that every bed and examination room was occupied. Now, surging demand for care keeps hallways and waiting rooms packed with patients. 
"We're closed for some period of time every day now," says Ron Walls, chairman of the department of emergency medicine at Brigham and Women's Hospital in Boston. "Two years ago, [it was] maybe once or twice a week. It's frustrating. It's frustrating for the providers, it's frustrating for the patients. There's a lot of anger when people have to wait." 

Hospitals Losing Money 

The ambulance diversion problem can be attributed in part to financial troubles at hospitals in general. Nationwide, a third are losing money, so they cut the number of patient beds and staff, squeezing emergency rooms even more. 
This climate is driving many workers out of emergency care. Emergency room nurse Rita Evans sees fewer and fewer young nurses. 

"It's a very difficult thing to try to sell nursing the way the health care system is," Evans says.