EMTALA-rama
Let's imagine that, hypothetically, you were an individual of Hispanic descent who spoke not a word of English, and you suffered a horrible injury in Mexico which led to a stay of several weeks in a Mexican hospital. You would never walk nor recover the ability to care for yourself ever again. You would need to be fed, suctioned, and turned in your bed every 2 hours for the rest of your life. You would probably need several more expensive procedures over the next few weeks, but your current condition had been fairly well stabilized.
Fortunately for you, your family was able to scrape up the money for an aeromedical flight to the US, and somehow they were able to produce some sort of proof of citizenship that enabled your entry into this country. So they checked you out of the Mexican hospital and brought you to the airport, where your journey to the US and our bountiful (and free!) healthcare system could proceed.
Of course in our hypothetical scenario you are uninsured, and your local family spent all of their money on your treatment in Mexico, maybe a few bribes, and your medical flight here. But those are only minor inconveniences, really, thanks to EMTALA. You don't need no stinking MOT (transfer approval), you don't need to have an accepting physician, you don't even need to bring any paperwork or X-rays from the other hospital. And you certainly don't need insurance coverage. No copay? No problemo.
All you need to do is show up. Any ER will do, and we're open 24 hours a day even on weekends. Just pick the nicest hospital you know of that is most convenient for you. Don't bother going to those busy, dirty, impersonal county facilities. You deserve the best! It's your right.
You might get (relatively) lucky and happen to have an incidental emergency medical condition that requires hospital admission in order to stabilize you. Honestly, that would make both of us lucky, because it would be pretty hard for someone like me to discharge someone like you who can't care for yourself and whose family has made no other arrangements for your care. But it's also pretty hard to admit someone like you solely to arrange long-term nursing home care and rehabilitation, even if you might need more procedures in the upcoming weeks. No matter how sad and unfortunate your situation may be, "social" admits to the "no-doc" admitting staff are usually about as welcome as a fart in an elevator. Particularly when they are unfunded midnight weekend language-barrier system-abusing complicated social admits of questionable medical necessity.
When patients like you get admitted, you tend to be challenging for the hospitalists to discharge too, so you end up receiving much more medical care than the emergency stabilization which is mandated by EMTALA. And that is both the beauty and the curse of that legislation.
Fortunately for you, your family was able to scrape up the money for an aeromedical flight to the US, and somehow they were able to produce some sort of proof of citizenship that enabled your entry into this country. So they checked you out of the Mexican hospital and brought you to the airport, where your journey to the US and our bountiful (and free!) healthcare system could proceed.
Of course in our hypothetical scenario you are uninsured, and your local family spent all of their money on your treatment in Mexico, maybe a few bribes, and your medical flight here. But those are only minor inconveniences, really, thanks to EMTALA. You don't need no stinking MOT (transfer approval), you don't need to have an accepting physician, you don't even need to bring any paperwork or X-rays from the other hospital. And you certainly don't need insurance coverage. No copay? No problemo.
All you need to do is show up. Any ER will do, and we're open 24 hours a day even on weekends. Just pick the nicest hospital you know of that is most convenient for you. Don't bother going to those busy, dirty, impersonal county facilities. You deserve the best! It's your right.
You might get (relatively) lucky and happen to have an incidental emergency medical condition that requires hospital admission in order to stabilize you. Honestly, that would make both of us lucky, because it would be pretty hard for someone like me to discharge someone like you who can't care for yourself and whose family has made no other arrangements for your care. But it's also pretty hard to admit someone like you solely to arrange long-term nursing home care and rehabilitation, even if you might need more procedures in the upcoming weeks. No matter how sad and unfortunate your situation may be, "social" admits to the "no-doc" admitting staff are usually about as welcome as a fart in an elevator. Particularly when they are unfunded midnight weekend language-barrier system-abusing complicated social admits of questionable medical necessity.
When patients like you get admitted, you tend to be challenging for the hospitalists to discharge too, so you end up receiving much more medical care than the emergency stabilization which is mandated by EMTALA. And that is both the beauty and the curse of that legislation.
Labels: crossing the line, dodged bullet, ER, health care crisis, medical, patients
posted by scalpel at 9:03 AM
19 Comments:
Of course this is not hypothetical.
Or border is so porous that Mexicans with end stage cancer, liver disease, completed strokes, brain tumors, femur fractures somehow make it to my little community hospital 100 miles inland for their EMTALA entitlement.
Goddamn Mexicans. I just don't understand why those Mexicans make choices that tend to maximize their survival. It's not like they're rational human beings or anything. Nope. They're Mexicans.
Oh, wait a minute. The "hypothetical" medical flight crossed the border "legally" because the patient had "proof of citizenship." So the patient is -- let me get this straight -- American?
Well, that explains it all, I guess.
Please refrain from using the term Mexican as a pejorative. Thank you.
If I was never ever to be able to move again, or talk, or use my limbs, I would want to be put down, even if my brain is still in perfect working condition.
Free healthcare for certain people stink. Meanwhile the working people pay up to the wazoo in just health insurance, and then they gotta pay a co-pay too
Disgusting. Disheartening. Dismal. I don't care of people are from the far side of Venus. There is no free lunch, and there shouldn't be free health care - especially when that "free" comes out of my wallet.
I am so glad I don't work in Texas.
Well, as annoying as a case like this is (I had a guy illegally cross the border via the desert and the back of a semi truck - just to make it to my north east hospital where he presented for DIALYSIS - so of course he was admitted and it took them weeks to get him out and voluntarily return to Mexico), I can certainly understand why they do it. Most of the medical care in Mexico is absymal so people are desperate for the promised land. Of course EMTALA has major problems but could you imagine what hospital administrators (let alone subspecialists!) would do if there was no law forcing them to treat the indigent? I guess it might be like a Dickens novel. Romantic, but pretty damn harsh. Clearly no easy solution for this dilemma.
Erp,
As a subspecialist, I treated indigent people before there was a law requiring it. However, then I could choose, now I am a slave. And there is no funding for that mandated care. We can't collect extra from our paying patients, and all commercial carriers are getting ready to reduce reimbursements along with Medicare.
Should the government require grocers to give free food to the indigent, and hotels to give them a room? Food and lodging are also necessities.
As I said, Joints, there is no easy solution. You (and many other orthopods, plastic surgeons, and other subspecialists - plenty of them are my friends) may be willing to come in and see the displaced colle's fx in the indigent guy, but many other's would say - "splint it and have them get seen in clinic" - which would be fine except that it takes months to get registered and seen in subspeciality clinics (at least at my hospital) if you are a new patient.
I liken it to affirmitive action. In theory I am opposed to it because inherently it is wrong, but it is hard to count on the generosity (or lack of racism) of everyone.
And yes, I like to be paid for what I do as well. We all have to just eat it sometimes unless we want to be like Mr Potter in "A Wonderful Life".
I lived in El Paso. It was common to drive by the county hospital and see very pregnant women sitting calmly outside the hospital on concrete benches, in the shade, watching the traffic and waiting to go into labor. Now their child is American and is entitled to all things free.
God bless the freaking USA!!
f#@king imperialist racist scum.
Please elaborate, after you've sobered up of course.
We had an illegal pt several years ago at a hospital that I worked at. He had broken all of his limbs in a MVA. His stay ran up into the multi-million dollar area.
He had family come visit frequently,but no one was willing to take him home. He ended up staying months until all of his fractures healed and then the hospital bought him a ticket back to Mexico.
I really don't agree with this. And I certainaly think if an illegal has a child in the US then that child shouldn't be a citizen.
Just my two cents.
I certainly don't think noncitizens should come to our country illegally and expect to receive free medical care. That's just common sense. I don't care what their motivations are or how sad their story is....they are breaking the law and stealing from our taxpayers.
Indigent citizens with devastating injuries should be covered by Medicaid, but I don't think that they should necessarily have an unlimited choice of facilities.
OK Scalpel, I see your point. However, how bout this scenario. A foreigner presents to the ER with a devesting injury - lets say he was run over by a car and is potenitally unstable. He is brought to your hospital because it is closest (lets assume you are not a trauma centre). First, you have no idea (or the time to figure out) whether he is a legal tourist, student, or illegal alien. Of course, you treat him first and ask questions later (or at least someone has to ask the questions). Now, if he turns out to be a visitor with money or insurance, the hospital gets paid. If he is self pay and destitute (illegal foreigner or not) everyone eats it. Does our country hold him until he or his relatives back home can pay? I agree about a stable patient coming across for better free care - these people could be discharged immediately upon exam by the MD once found that they don't have an emergent condition. The bedridden guy in an ambulance with decubs all over would be a tough one. Theoretically you could discharge him but obviously it would have been better to have him stopped at the border in the first place. Once they make to the ER, they become a complicated problem.
Here's a thought: The government comes up with a program to transport sick illegals back to the country of origin and get them to the closest hospital there. It would be expensive but probably less so than what we are doing now.
It is just amazing that someone can break the law but still have legal protection! And if we screw something up they have the RIGHT to sue us for thousands of dollars. JACKPOT!!!
We have to have some humane way of dealing with these people. Like, say, border patrol agent and paramedic on a fixed-wing air ambulance direct to wherever south of the Rio Grande they came from.
BTW, those who are easily offended, we have the same problem here in Maine with Canadians who come over to get stuff done that they don't want to have to wait for their wonderful system to do.
http://docsontheweb.blogspot.com/2006/12/hello-taxpayers.html
i saw his brother not too long ago.
cheers, have some more of my money!
I find the US concernes with private vs public health strange as an Australian (we have a public health system with private care usually reserved for elective procedures). In your example the patient is an united States citizen - on this basis - in an Australian context - they are entitled to be fully treated for the their condition at public expense. Why do you care what language they speak? Isn't the United States (like Australia) founded on imigration?
Are they good enough to clean your house but not recieve your health care?? I find the general sentiment disturbingly racist for such a diverse country.
Do I demand that they clean my house for free?
Then why should they demand that I give them my services for free?
911, that case is amazingly similar.
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