Emergency care in California: no emergency?

Glenn Melnick and colleagues' analysis of emergency department (ED) capacity and access in California is fatally flawed because the authors do not consider the operational constraints that severely compromise ED functioning. Simple counts of ED beds and distance to the closest hospital ED are virtually meaningless without considering, for example, the operational impact of loss of inpatient bed capacity, the nurse shortage, declining availability of on-call specialists, lack of access to primary care, and growing numbers of uninsured people. Other surveys indicate that ED overcrowding and ambulance diversion are serious and growing problems-not only in California, but nationwide.