2003-09-04 -- More on Eliminating Hospitals' Obligation to Provide Emergency Care


This change in Centers for Medicare & Medicaid Services (CMS) rules,
basically legalizes the lapses in emergency care that are becoming
more common for those unable to pay.  What is outrageous is now the
government is now saying the assurance of emergency care for all is
not even part of the standards.  "Sharing" of emergency facilities and
specialists is the market system's way of denying care by keeping sick
or injured patients chasing after care.  The real incentive to
limiting emergency care, of course, is to limit hospital admissions
for non-paying patients.

Emergency specialists were curtailed several years ago when Sutter
Healthcare took over Marin General Hospital, and a woman died
following an auto accident.  Health activists posted themselves at
freeway entrances with signs reading:
"DRIVE CAREFULLY, NO NEUROSURGEON ON DUTY!"

CMS's policy is a continuation of the government's ruling this January
that states can allow Medicaid HMOs to restrict their patients' use of
out-of-plan emergency rooms. Previous regulations had mandated that
Medicaid managed care organizations had to provide their patients
coverage in situations a "prudent layperson" would consider an
emergency. (NY Times, 1-17-03)
http://home.comcast.net/~mlyon01/articles/emer-care.htm



Los Angeles Times, September 4, 2003


THE NATION

U.S. Eases Rules on Requirements for Hospital Emergency Care

California's stricter law means the changes shouldn't affect patients
here, providers say.

By Vicki Kemper and Tracy Weber Times Staff Writers


WASHINGTON - The Bush administration has revised federal rules
requiring hospitals to provide emergency medical care, easing some
regulations about screening, providing specialists and transferring
patients.

In California, the changes are unlikely to affect how emergency-room
patients are treated, hospital officials said Wednesday, because the
state's stricter law remains in effect.

"We will continue to do what we've been doing all along - providing
complete screening and stabilization" of emergency-room patients, said
Jim Lott, spokesman for the Hospital Assn. of Southern California. "I
don't see anything happening that will endanger anyone in California."

But some emergency-room doctors at county-run hospitals in Los Angeles
said they feared the new regulations would eliminate any incentives
for private hospitals to provide specialists to care for the
uninsured.

The new regulations amend the 1986 Emergency Medical Treatment and
Labor Act, (EMTALA).

That law requires any hospital participating in the Medicare program
to provide appropriate medical screening for all patients seeking care
in an emergency room or department, regardless of their ability to
pay.

Hospital personnel must stabilize the condition of any patient
determined to have a medical emergency or transfer the patient to
another medical facility.

Hospitals can be suspended from Medicare and fined $50,000 each time
they violate the law, which also gives patients denied emergency care
the right to sue hospitals.

Other provisions require hospitals to make specialty physicians
available around the clock for emergency care and to ensure that all
hospital-owned treatment facilities, such as radiology clinics,
laboratories and specialty hospitals, are capable of providing
emergency care.

The administration's changes relax those requirements, letting
hospitals "share" on-call specialists and allowing specialty hospitals
and outpatient clinics to transfer emergency patients to emergency
departments, including those owned and operated by other hospitals.

Bush administration officials said Wednesday that their changes to the
law, which the hospital industry had sought for years, simply clarify
hospitals' legal responsibilities to emergency-room patients.

"This regulation is going to make it easier for people to get
emergency-room care," said Thomas R. Barker, special assistant to the
administrator of the Center for Medicare and Medicaid Services.

Hospital emergency departments have become the first place an
increasing number of uninsured and underinsured patients turn to for
medical care.

The American College of Emergency Physicians said the change allowing
hospitals to share on-call specialists could backfire, resulting in a
flood of emergency patients transferred to the declining number of
hospitals that will choose to offer specialty care.

"It's going to be unfortunate for most of the county hospitals and the
big academic institutions," which have to have such specialists on
call, said Dr. Edward Newton, interim chairman of the emergency
department at Los Angeles County-USC Medical Center.

Dr. Jack Lewin, chief executive of the California Medical Assn., said
the changes to the regulations were overdue and would not result in
worse care for the poor.

"We were in an either-or dilemma," he said. "Either we close the
emergency rooms in those hospitals or use better coordination."

The American Hospital Assn. welcomed the new rule.

"It recognizes that in emergency departments, hospitals are seeing
emergency patients and patients who do not have emergency needs," said
Washington counsel Maureen Mudron. But the California Nurses Assn.
"condemned" the new rules.

"This policy could sign a death warrant for an unknown number of
people, and aggravate pain and suffering for many others," said
association President Kay McVay.

"It may provide a boon for the funeral industry, but it will be a
disaster for everyone else."

*

 Kemper reported from Washington and Weber from Los Angeles.