The Sept. 16 editorial, Another Jackson ‘emergency,’ shows a troubling lack of understanding about the role of the Emergency Department at Jackson Memorial Hospital. Comparing the private management of food services to ER care is comparing apples to A-bombs. All of us who have worked at Jackson for years have done so for significantly less money because we are committed to the goal of providing excellent care to the neediest in our county.

We have established long-term relationships with the patients and our community and remember why we chose this career. The emergency department is also a teaching site for ER trainees and house staff in medical and surgery specialties. This is an area where the Jackson ER physicians have had a tremendous effect on both the quality of young physicians and the patients served. Many of the finest hospitals in the country maintain their own dedicated ER staff for just these reasons. The local community hospitals used for comparison in the editorial are not in this category.

This doesn’t mean we are oblivious to the cost of care, but we recognize that the emergency-room Band-Aids and discharges that other hospitals provide can only be done because JMH is around to pick up the care. (Even JMH North and South routinely apply a quick fix and refer patients to JMH Main.) Those ERs do not need to find follow-up care for the underfunded as long as Jackson is available.

The dedicated doctors and nurses have been depleted; some have left out of frustration while others finally left to pursue higher pay. Most have been sad to put monetary issues above ideals, but there has been a sense that they are not valued for their commitment.

While there are many aspects of Jackson’s finances, the role of managing patients and discharging in the emergency area is critical. Expanding access to primary-care and specialty clinics would allow the ER to discharge patients with a plan. This would allow more cost savings, as well. Return visits to the emergency room are frequent because they are provided no other options. This leads to costlier care, both in ERs and in house.

Thomas Harrington, MD, director, adult sickle cell, hemophilia programs and hematology clinic, Jackson Memorial Hospital/University of Miami, Miami