Some things that "might" be going on.
If say, 50% of those ER visits could have been handled at the doctor's office or at an Urgent Care facility (non-critical care). The hospitals may consider just working to improve accuracy of their triage assessments (i.e., ensure so no one dies while waiting or is harmed). The ER generates a lot of business, and if a lot of the patients are "not critical care" they may not be motivated to increase capacity unless it absolutely cannot meet demand. It could be a (relative to other operations) low expense, high revenue (huge number of visits) profit center (cash cow). Think about it, they have every financial motivation in the world to maximize the profit of any operation. As long as it works and does not generate lawsuits or result in people being harmed. For example, if a company can run an operation at 150% and not spend more money, since some of the expenses are fixed expenses or Stepped Variable (Fixed expense till saturation) , they might reap more profit.
Consider how the ER visits cause tests to be administered, medical supplies and medicine dispensed (other aspects of the hospital the generate profit) at the hospital and its other facilities. They may use the ER profit center to drive business to other areas of the facility and offset some other activities in the hospital where they suffer losses. If one has staff and test equipment... run it full on 24x7... why have people standing around at night?
Another possible motivation to let it continue.
If that area has a large number of uninsured that visit the ER... there may be no reimbursement (write-offs). It could be a move to limit financial losses... Assuming thier triage works well, long lines could result in people without serious problems choosing to go home and schedule a doctors visit the next day.
Add to those, the the expense of increasing operational capacity. With the economy being the way it is today, how many businesses today are wanting to "spend more" on plant and equipment and hire additional permanent staff.
Plus, consider the complications of the impact of health care law and what it might mean to their operations. Will the ER experience decreased use since unisured may now go to a doctor... or will it increase after all? My guess is they will build out once they see actual numbers.
One thing is for sure, the Administrator and Management watches activity, loads, staffing, and the money. They know exactly what is going on and they know why they are doing certain things.
If you feel it is a real problem and it is just the ER, get the local goverment involved. Citizen action! Don't wait for someone else to do the work. You do have representatives don't you? Raise the issue at local government meetings. Don't shutup till it is fixed!
The community (government or CCDs) could work with the hospital to expand the physical facility, they might even float some of the bonds to pay for part of the infrastructure to be built or do some sort of cost sharing arrangement to help the hospital build a larger ER.
For the ER, due to the high demand, the hospital could probably justify hiring more nurses (RNs). Likewise, because of the ER demand, they could put another ER doc or two on staff.
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