\n\tBrett Kelman and Samantha Liss<\/span><\/p>\n

In the small Appalachian city of Bristol, Virginia, City Council member Neal Osborne left a meeting on the morning of Jan. 3 and rushed himself to the hospital.<\/p>\n

Osborne, 36, has Type 1 diabetes. His insulin pump had malfunctioned, and without a steady supply of this essential hormone, Osborne\u2019s blood sugar skyrocketed and his body was shutting down.<\/p>\n

Osborne went to the nearest hospital, Bristol Regional Medical Center. He said he settled into a wheelchair in the emergency room waiting area, where over the next few hours he drifted in and out of consciousness and retched up vomit, then bile, then blood. After 12 hours in the waiting room, Osborne said, he was moved to an ER bed, where he stayed until he was sent to the intensive care unit the next day. In total, the council member was in the ER for about 30 hours, he said.<\/p>\n

Osborne said his ordeal echoes stories he\u2019s heard from constituents for years. In his next crisis, Osborne said, he plans to leave Bristol for an ER about two hours away.<\/p>\n

\u201cI want to go to Knoxville or I want to go to Roanoke, because I do not want to further risk my life and die at a Ballad hospital,\u201d he said. \u201cThe wait times just to get in and see a doctor in the ER have grown exponentially.\u201d<\/p>\n

Ballad Health, a 20-hospital system in the Tri-Cities region of Tennessee and Virginia, benefits from the largest state-sanctioned hospital monopoly<\/a> in the United States. In the six years since lawmakers in both states waived anti-monopoly laws and Ballad was formed, ER visits for patients sick enough to be hospitalized grew more than three times as long and now far exceed the criteria set by state officials, according to Ballad reports<\/a> released by the Tennessee Department of Health.<\/p>\n

Tennessee and Virginia have so far announced no steps to reduce time spent in Ballad ERs. The Tennessee health department, which has a more direct role in regulating Ballad, has each year issued a report saying the agreement that gave Ballad a monopoly \u201ccontinues to provide a Public Advantage.\u201d Department officials have twice declined to comment to KFF Health News on Ballad\u2019s performance.<\/p>\n

According to Ballad\u2019s latest annual report<\/a>, which was released this month and spans from July 2022 to June 2023, the median time that patients spend in Ballad ERs before being admitted to the hospital is nearly 11 hours. This statistic includes both time spent waiting and time being treated in the ER and excludes patients who weren\u2019t admitted or left the ER without receiving care.<\/p>\n

The federal government once tracked ER speed the same way. When compared against the latest corresponding federal data<\/a> from 2019, which includes more than 4,000 hospitals but predates the covid-19 pandemic, Ballad ranks among the 100 hospitals with the slowest ERs. More current federal data is not available because the Centers for Medicare & Medicaid Services retired this statistic in 2020 in favor of other measurements.<\/p>\n

Newer data tells a similar story. The Joint Commission, a nonprofit that accredits health care organizations, collected this same measurement for 2022 from about 250 hospitals that volunteered the data, finding a median ER speed of five hours and 41 minutes \u2014 or about five hours faster than Ballad\u2019s latest annual report.<\/p>\n

Ballad Health spokesperson Molly Luton said in an email statement that, by holding patients in the ER, where they are observed while waiting for a bed, Ballad avoids \u201coverwhelming\u201d its staff. Luton said ER delays are also caused by two nationwide crises: a nursing shortage and fewer admissions at nursing homes and similar facilities, which can create a backlog of patients awaiting discharge from the hospital.<\/p>\n

Luton added that Ballad\u2019s ER time for admitted patients has dropped to about 7\u00bd hours in the months since the company\u2019s latest annual report.<\/p>\n

\u201cOn those issues Ballad Health can directly control, our performance has rebounded from 2022, and is now among the best in the nation,\u201d Luton said.<\/p>\n

Luton also noted that Ballad performs better than or close to the national average on several other measurements of ER performance, including having fewer patients who leave without being treated. CMS data shows the national average is about 3%. Ballad reported 1.4% in its latest annual report.<\/p>\n

Osborne, the Bristol council member, attributed this statistic to Ballad\u2019s monopoly.<\/p>\n

\u201cJust because they aren\u2019t leaving the ER doesn\u2019t mean they are happy where they are,\u201d he said. \u201cIt just means they don\u2019t have anywhere else they could be.\u201d<\/p>\n

Ballad\u2019s Big Monopoly<\/strong><\/p>\n