Johns Hopkins Howard County Medical Center in 2021. (Howard County Government photo)

Healthcare industry officials and politicians have been working together to propose solutions since a recent report from a Florida-based personal injury attorney group publicized that Maryland has the highest emergency room wait times of any state. In Howard County, where there is only one hospital, the lengthy wait time for service in the emergency department of the Johns Hopkins Howard County Medical Center concerns many. I recently was in the JHHCMC emergency department for 9 hours, and witnessed examples of experiences recently expressed in the community, including patients in serious pain, one having chest pain and even someone transferred from urgent care via ambulance, all having to wait in the crowded lobby for several hours.

Recently, Howard County Executive Calvin Ball announced a 24-bed behavioral health facility expansion at JHHC that will provide some relief to the ED. Ball provided a list of area urgent care facilities with a plea for their use for non-emergency care. JHHCMC, like other hospitals, must provide care for all. Those without insurance or ability to afford care elsewhere often seek multi-service care in the ED. Triage helps to minimize waits for those with serious conditions, but staffing and bed shortages are harder to fix.

You may wonder why the hospital cannot just expand their supply of beds. It’s a complex process. Maryland has a Certificate of Need program for health care facilities. Those facilities must apply for approval of expansion projects from the Maryland Healthcare Commission. Goals of the CON program include cost reduction, and creating equitable geographic access by ensuring new services are only provided as needed in Maryland. Defining capacity “need” and the procedures for approval of expansion are lengthy and time-consuming. Given Maryland’s high wait times, it might be prudent for our legislators to look into making it easier to expand hospital capacity.

In the 2023 legislative session, Bills were introduced, but not passed, that would have created a task force to investigate ED wait times. Instead, the Maryland Hospital Association was requested to form work groups on the topic and report back in early 2024.

Meghan McClelland, MHA Chief Operating Officer said by email that hospitals are working to decrease ED wait times, and shared issues that are outside their control. 

“Addressing hospital throughput is a complex and multifaceted challenge that requires a comprehensive, system-wide approach due to several factors … The Maryland Hospital Association has partnered with the Maryland General Assembly state agencies, elected officials, acute care and specialty hospitals, provider groups, behavioral health, and consumers to collaborate and develop innovative solutions.”

McClelland noted, among other problems, historic hospital workforce shortages, limited access to primary care, and lack of behavioral health resources. 

This past July, the Prince George’s County Council requested input from experts in the healthcare field on the topic of ED wait time. Several facilities made presentations and stated similar reasons to McClelland’s for long waits. There is widespread agreement on sources of the problem. Solutions will take time to implement and fund.

It is great news that Howard County will see an expansion of behavioral health services. It will take time, but will provide some patient number relief to the JHHCMC emergency department. The overloaded ED and lack of desired healthcare staffing in Howard County is not unique to the state nor the county, but recently passed county development growth goals seek to bring in tens of thousands of new county residents in the next decade. Finding the right solutions is more important now than ever.

Civic advocacy groups, like The Howard County Citizens Association and The People’s Voice, have called on County administration to hold a town hall to discuss the current medical service crisis and planned solutions. It will take a combination of civic advocacy for more capacity, and comprehensive programs to make significant improvement, not to mention accommodating so many new residents.