Emergency Medical Treatment & Labor Act (EMTALA)

In 1986, Congress enacted the Emergency Medical Treatment & Labor Act (EMTALA) to ensure public access to emergency services regardless of ability to pay. Section 1867 of the Social Security Act imposes specific obligations on Medicare-participating hospitals that offer emergency services to provide a medical screening examination (MSE) when a request is made for examination or treatment for an emergency medical condition (EMC), including active labor, regardless of an individual’s ability to pay. Hospitals are then required to provide stabilizing treatment for patients with EMCs. If a hospital is unable to stabilize a patient within its capability, or if the patient requests, an appropriate transfer should be implemented.

Kaiser Permanente endangered a former patient by dumping that patient on skid row in Los Angeles. Video captured by security cameras shows a 63-year-old patient from Kaiser Permanente’s Bellflower hospital, dressed in a hospital gown and slippers, exiting a taxicab on Skid Row. She is later seen shuffling toward the Union Rescue Mission, the city’s largest homeless shelter.

Skid Row has one of the nation’s largest concentrations of homeless people, and is known for the shelters and services for them that are concentrated in the area. Ten other L.A. hospitals are under investigation for allegedly discharging homeless patients onto the streets, instead of into the custody of a relative or shelter.

While this happened a few years ago, the practice still occurs.  EMTALA was passed because of situations like this, so that patients were not just dumped, because they couldn’t pay, but do they want to?

Going to the ER is a blast, you wait for hours to be seen by and overworked resident or attending doctor.  You are worked up with labs, test, etc. and then the best course is decided.  If you need to be admitted they call someone like me who swoops in and assesses, orders medications and admits you, yay (you hope). If not, you are sent home with a nice bill in the mail in a few days.  If you have insurance this is usually ok, if not…well you ain’t gonna like the costs. In other words, better sell an arm and a leg.

If its not serious, consider you PCP.  If you don’t have one, find one.  Don’t have insurance?  There are lots of clinics that do sliding scale and often they can help point you towards low cost insurance.  If you are primary care, I would hope you do payments and minimize procedures to save a patient money (it will keep them out of the ER).

Funny anticdote here.  A friend of mine is quite British.  He told me about an someone visiting that was having cold symptoms and went to the ER.  The person was sent home, sternly cautioned on wasting resources and set up with an appointment in Primary Care. He was told when his appointment was available and that was that.  Show up or don’t get treated.  Ok, seems a bit over the top for America, but hey, there is some efficiency there that would be helpful in our overcrowded ERs.  EMTALA helps, but a system like this would alleviate the crowding in the ER.

As a society we have used the ER as a solution for homelessness as well.  Believe me, everytime it gets cold or a storm brews, the homeless do a lot to get admitted. This is not a solution for our failure to effectively house people or to provide affordable housing.

Don’t just go to the ER.  Go to a “Doc in the box” a Now Care, etc.  They are straight forward with payment as well.

ER, should be a triage and if your condition is not serious, you should be sent to primary care or Urgent Care, etc.  It also costs less and believe me they will saddle you with the bill.

Ya know for all the screaming that one party and their drones did about the ACA it was a definite better situation.  If you were one of the screaming drones, maybe you need to look at how big you are getting screwed and not the party that does it?