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Hennepin Healthcare’s emergency department has a new chair, one of the first tribally enrolled people to lead an academic emergency department in the U.S. Dr. Thomas Wyatt (Shawnee/Quapaw) is believed to be the first Indigenous physician to chair an emergency department in Minnesota.

HCMC is the busiest and largest Level 1 trauma center in the state. It’s considered a safety-net hospital, providing care for low-income, uninsured and vulnerable populations. And like many similar hospitals, it struggles to find post-emergency care for patients, especially those with behavioral health and substance use disorders.

Dr. Wyatt spoke with MPR News senior health reporter Erica Zurek about serving a diverse population, overcrowding in emergency departments and investing in preventative care.

This conversation has been edited for length and clarity.

Tell us about Hennepin Healthcare’s patient population.

It comes as no surprise that Hennepin Healthcare serves a very diverse and unique patient population. It is not just people within the county, but people from all over the state and surrounding states. 

We have one of the largest urban American Indian populations in the whole country and certainly the largest in Minnesota. We have a large Somali and Hmong population, Latino patients, Black patients. 

Even though the majority of Hennepin County is white, the patients we serve are diverse

Some studies show that patients do better when they see providers that look like them and have the same lived experience. This is important because providing a cultural welcome to patients makes a difference in their care and not just how they are treated, but also their outcomes.

In the emergency department we have a diversity committee that has been in existence since 2017 and we try to focus on things like recruitment, education, and outreach to communities. That has been an important part of what Hennepin Healthcare is.

It sounds easy, like, hey, let’s just recruit a bunch of doctors, providers and nurses that look like the patients that we serve. We see a large number of American Indian patients in the emergency department, so let’s recruit a whole bunch of American Indian physicians. 

But it is not so easy because there are not very many of us physicians out there. So, it is getting people involved early, being deliberate and putting resources into identifying people — for all the different underrepresented minorities that I mentioned — that want to have a career in health care.

A recently released study by the Minnesota Department of Health and Wilder Research found that across the state 17 percent of behavioral health patients remained in emergency rooms and inpatient settings for days or weeks longer than necessary. The most common reason the study found was a lack of available beds in residential treatment facilities and inpatient psychiatric units for adults and youth to be transferred to. How does this relate to what you see in Hennepin Healthcare’s emergency room?

It is not just a Hennepin Healthcare problem. It is a whole health care system problem. And it is not just in our state, it’s nationwide. Over the last decade or so, or even longer, we are seeing more people that are suffering from things like mental illness and addiction.

We can handle emergency after emergency, and that includes emergencies of people that are having a mental health crisis or a crisis with addiction or overdose. But once we get past that acute care phase, I do not think that our health care system — I am talking about the whole country — has figured out a way to help with that.

The hospital and sometimes the emergency department becomes the kind of fail-safe part of the entire system. We see people boarding in our emergency departments or hospitals that would be better served if they were in some type of stable outpatient facility, such as a residential home or inpatient or outpatient treatment for addiction. But a lot of times people are kept in the hospital because those spaces are not available.

Some of it has to do with not being prepared. Some of it has to do with parity. And those services that are super important do not get reimbursed the same way as acute care does.

So, I think a lot of people, legislators in particular, the government and [federal] Centers for Medicare and Medicaid Services need to start paying attention to that. Otherwise, what will happen is people that have true acute emergencies are not going to have a way to get into the system because it is clogged up by those that are waiting to be placed in less acute facilities.

There’s not enough capacity. That is part of the problem. And does it have to do with the pandemic? Certainly possible. Does it have to do with the rise of mental illness, especially among adolescents? Is it social media? There are a whole lot of different theories about it, and I do not know the right answer, but clearly something has changed.

Mental illness and substance use disorder get the most attention, rightly so, but the emergency department also is a place where people come if they are hungry or if they have food insecurity. They come if they are unsheltered or homeless and they are looking for a place to stay.

There are not enough social services being offered or available in communities. And again, this is not just a Hennepin County or a Minnesota thing. It is across the country. People will come to the emergency department and of course we are going to feed them, and we are going to help try to find them a shelter bed or something.

Hennepin County used to be known for never saying no, never refusing a transfer from an outside hospital and we simply have to say no these days because we do not have the capacity to take everyone. But sometimes that’s part of the moral injury, that we can only do so much as an acute care facility, especially as an emergency department. That does not feel good.

As you mentioned, some people are dealing with on-going behavioral health or substance use disorders prior to arriving at the emergency room. Should there be a greater focus on preventative care?

We found that with the pandemic our public health infrastructure did not work. How do we improve upon this as a health care system, as a country and as individual states? This should be a focus, in my opinion, because if you look at other countries in Europe, for example, which do preventive medicine very well, they have better outcomes than we do in our country. It is because they invest in it and resource it properly.

This is the conversation that our legislators and the people in government that help set the reimbursement fees for health care need to really think about: How does preventive care and public health play into our health care system?

We know that it does not get reimbursed and that is not a financially viable way to run health care, at least in our country. But I think we really need to look at if we have the right model to deliver the best care to our patients in America.

Erica Zurek

Author

Dr. Thomas Wyatt says HCMC, like many hospitals in the U.S., has too few places for people to go for more treatment once they’ve had acute care in emergency rooms. 

Hennepin Healthcare’s new emergency chair says more diverse staff and public health approach helps patients

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