Every law, like every drug, has its intended effects and its side effects. EMTALA is a law you perhaps couldn’t care less about, but one that’s kept many a hospital manager awake at night. I’m not a lawyer, politician or administrator and can’t claim expertise on EMTALA subtleties. But I thought I’d touch a couple ways it has shaped our medical lives.
The Emergency Medical Treatment and Active Labor Act of 1986 was meant to prevent “patient dumping.” Apparently, hospitals were telling poor and uninsured patients to get lost or go to other facilities in the darker days of emergency medicine. Stories of ambulances transporting women in labor getting hospital rejections added fuel to the fire. Sounds surprisingly mean. EMTALA mandates that every patient who shows up to the ER gets at least a medical screening exam, life threat stabilization and appropriate transfer if medically needed. Good idea, right?
EMTALA has had its intended effect and has done well for the life threats. As long as I’ve been in medicine, happily, I’ve never had to tell someone to go elsewhere for lack of insurance or ability to pay.
But how about the other end of the spectrum: the non-emergencies. If you appear in an ER waiting room asking this simple generic question: “I’m not sure if I need to be seen, but what do you think?” Beware! I will literally be spanked if I go to the waiting room to say: “I think you’re going to be fine. Wash it out and get a Band-Aid. Take an ibuprofen and get some rest. Try some Children’s Tylenol. Antifungal foot powder will probably do the trick. Maybe you shouldn’t use your roommate’s Adderall to study all night. Your PCP can probably solve your problem for at least a thousand dollars less.”
Not just spanked, but possibly fired and fined. In a hospital where I work, I’m told (semi-jokingly) the waiting room is a “doctor-free zone.”
In short, it’s hard to whittle with a wood chipper. As a patient, you can’t just tiptoe up to an ER with hopes for a band-aid. You’re all in, or you’re out. EMTALA has had its intended effect, but beware its side effects.
Sam Slishman is an emergency physician.
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