- The plan that was condemned by the ACEP and the American Academy of Emergency Medicine (AAEM) was announced in February 2009, a month after Michelle Obama's resignation, and after she had been on an extended leave for the presidential campaign.
- The plan announced in February 2009 was described by detractors as a drastic change from the hospital's previous policy. The policy change in 2009 involved attempts to move patients to alternative settings before treating them, and allegedly "without proper referral", while the previous policy was about informing patients about clinics for follow-up care after treating them.
- In March 2009, about a month after announcing their intent to introduce the changes that were condemned by the ACEP and AAEM, the University of Chicago Medical Center announced that it would halt that plan. They further followed up with additional changes to improve the service provided by its ER.
- Michelle Obama's efforts to educate patients about use of the ER during her time at the University of Chicago Medical Center (i.e. before 2008) were praised by some and criticized by others.
- The current policy of the AAEM supports redirection of patients with non-urgent conditions from emergency departments following "appropriate medical screening examination by a qualified provider" and ideally with a "referral to alternative low-cost hospital affiliated or community resources that are appropriate for the patient’s presenting complaints".
In February 2009, the University of Chicago Medical Center announced a change in the way it admits ER patients. As reported by the Chicago Tribune:
the hospital is changing the way it admits emergency room patients as part of its effort to deal with the worsening economy, a move underscored by Monday's announcement of 450 layoffs, or 5 percent of its workforce.
Specifically, the change was:
Under the escalated program, the emergency department will be reorganized to provide more evaluations from doctors and nurses before care is provided. In the past, the U. of C. treated the patients and then educated them about health clinics, setting appointments at doctor's offices and community centers for follow-up care.
The condemnation you have quoted in your question is a reference to this change. As reported by the Chicago Tribune shortly afterward, it was condemned by the American College of Emergency Physicians:
The group, which represents 26,000 doctors nationwide, also expressed "grave" concerns that U. of C.'s policy is "dangerously close to patient dumping," a practice made illegal by the Emergency Medical Treatment and Active Labor Act. The group also is concerned other medical centers across the country could adopt similar strategies to cope with long waits for emergency treatment and rising health costs amid the deepening recession, which is what U. of C. said were the primary drivers of its initiative.
It was also condemned by the American Academy of Emergency Medicine, whose president said that the hospital's policies had drastically changed in the new plan:
AAEM President Larry Weiss, MD, JD, told Medscape Emergency Medicine in an email that the academy received information from University of Chicago physicians that the hospital had "drastically changed" the manner in which nurses and physicians perform triage and screening examinations in their ED. The doctors told them, "A physician is now directed by policy to discharge a patient at the time the physician determines that the patient is stable, rather than completing a diagnostic evaluation and providing admission or appropriate outpatient treatment," wrote Dr. Weiss, professor of emergency medicine at the University of Maryland School of Medicine, Baltimore.
"AAEM has a policy stating that an emergency department may triage a patient to another facility for treatment and follow-up care," he added. "However, this must be done in a safe manner. Hospitals should not merely tell patients to go to another hospital without proper referral."
In March 2009, the University of Chicago Medical Center said it would halt the policy change:
The University of Chicago Medical Center has decided to halt plans to redirect patients deemed nonurgent from its ED to other facilities, the Chicago Tribune reported on Saturday. The move came after external and internal protests of the plans.
This announcement followed allegations from the Centers for Medicare and Medicaid Services that the hospital was in violation of the Emergency Medical Treatment and Active Labor Act. Specifically, per a survey by the Illinois Department of Health on February 18, 2009, it "failed to "maintain a central emergency services log" and "provide a medical screening exam." The hospital attributed this to staff members failing to follow the official protocol, and said that they were taking disciplinary actions. In response to these allegations, the hospital was required to submit a corrective action plan.
As part of their correction, per a November 2009 article:
the UCMC hired advocates to conduct the review. They consulted with released emergency room (ER) patients, created staff positions to transfer lower risk patients to other hospitals, and streamlined its admissions and ER waiting room policies.
Wait times have decreased 65 percent since the changes, according to UCMC officials.
Other changes included
changing the ER admissions policy to make it more efficient and creating a surge plan to deal with overcrowding in the ER.
Michelle Obama resigned from the University of Chicago Medical Center in January, one month before this change was announced. Before that, she had been on an extended leave for the presidential campaign. (She was part-time in 2007 and on a leave of absence in 2008, according the U of C.)
A 2008 Washington Post article suggests describes Michelle Obama's efforts to educate patients about the appropriate use of the ER during her time at the University of Chicago Medical Center:
One of Michelle Obama's signature efforts has been working to relieve crowding in the emergency room, the second-busiest in Chicago. It logs 80,000 visits a year.
Backed by a federal grant, Michelle Obama in 2005 launched the South Side Health Collaborative, under which counselors advise patients with noncritical needs that they can receive care elsewhere at a reduced cost. The medical center said in a report that some patients "make frequent visits to the ER because no one in the family has a personal doctor."
"Obama's goal is to connect people in the community with doctors at [community health] centers, to let them know that they can use those physicians on a regular basis instead of ignoring symptoms until they send them to the ER, where care can cost five times more."
The Washington Post said the program got favorable news coverage:
Obama's program has enjoyed favorable news media coverage in Chicago and was eventually expanded into a broader program, the Urban Health Initiative. Under the effort, the hospital has started providing selected clinics with part-time medical personnel and has given $350,000 to enable a nearby clinic to nearly double in size.
and some praise:
Howard Peters of the nonprofit Illinois Hospital Association praised the medical center's efforts, saying the ER is not the place to provide patients with primary medical care.
"Patients need a source of ongoing care, and this initiative is trying to make that care available in a more appropriate setting and in a more timely way," Peters said.
However, they also quote some critics:
Center executives said the initiative, on which they spent $2 million last year, could be a national model. Critics, however, describe the program as an attempt to ensure that the hospital retains only affluent patients with insurance.
"If you put enough money into it, you could save a whole bunch of community health centers," [local physician Questin] Young said. "But to date, they haven't."
Edward Novak, president of Chicago's Sacred Heart Hospital, declined to discuss the center's initiative in particular but dismissed as "bull" attempts to justify such programs as good for patients. "What they're really saying is, 'Don't use our emergency room because it will cost us money, and we don't want the public-aid population,' " Novak said.
In response to the Washington Post article in 2008, Scott Gottlieb, a former FDA official now affiliated with the conservative American Enterprise Institute, said in a Wall Street Journal editorial (also full text here):
When Michelle Obama was an executive at the University of Chicago Medical Center, she worked to expand a program that encouraged uninsured patients on Chicago's South Side to visit local health clinics in lieu of her hospital's emergency room. That "Urban Health Initiative" saved her hospital money, and it also surely improved the health of the people it served.
The success of these community health clinics is supported by plenty of clinical data proving that patients are helped by the continuity care that they offer. The fact is, many poor patients visit ERs simply because they don’t have a family doctor.
In response to the 2008 Washington Post article, Senator Chuck Grassley from Iowa asked the hospital for more information about how they were serving the community. The hospital responded.
The current position of the American Academy of Emergency Medicine supports efforts to redirect patients with non-urgent conditions away from the emergency room, and encourages referrals to alternative health care options:
Emergency departments and emergency physician’s primary directive is to care for ill and traumatized patients presenting in an unscheduled fashion. This is constructed without regard for ability to pay and with a high expectation for accurate and timely evaluation and management to exclude and treat emergent and urgent life and limb-threatening conditions. Increasingly limited resources coupled with increasing patient volumes in emergency departments across the country have further strained the expected duties of the acute care hospitals and providers. It is becoming more apparent that emergency department can no longer assume the long-standing role of being everything for everybody. Therefore, it is the position of the American Academy of Emergency Medicine that the redirection of patients who do not have medical emergencies or urgent conditions away from an emergency department is ethical and that a well-developed screening process that appropriately redirects patients is frequently in the patients best financial interest, especially if they have limited resources for payment. The exclusion of an urgent or emergent medical condition requires the performance of an appropriate medical screening examination by a qualified provider. It is the Academy’s position that this process is best performed by a skilled emergency physician. If a hospital enacts such a program, AAEM encourages the screening hospital to provide referral to alternative low-cost hospital affiliated or community resources that are appropriate for the patient’s presenting complaints.