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Emergency Medical Treatment and Active Labor Act

Should the hospital treat you or wait until they know if you can pay

  • Total voters
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sangha

sangha

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You decide you need a little fresh air, so you go outside for a little stroll. Because you don't expect to be out long, or do anything of note, you leave without your wallet or purse and have no identification on you.

While you're walking, a car goes out of control, jumps the curb and mows you down. You're knocked unconscious and you have several life-threatening injuries. An ambulance quickly arrives, scoops you up and brings you to the hospital where they have no idea who you are or if you are able to pay for the care you need.

Should the hospital treat you or should they wait until they can make certain you can your bill for the care they're going to give you?

Just a refresher for some of the more important points:

1) You're at the hospital
2) You're unconscious
3) The hospital has no idea who you are of it you can pay
4) You're dying
 
Life threatening injuries? Absolutely they should be treated.

No ifs, buts or maybes.
 
The story only starts with the treatment. After the treatment and the patient is out of a life threatening situation, the question of payment needs to be addressed.

We have but two options once the care givers (including the ambulance service) ask the patient for payment 1) they get paid (that may include a payment plan over time) 2) they do not get paid. In the event of option #2, or missing a payment on option #1's plan, the patient has committed theft so they should be arrested just as one that removes an item from a store without paying for it would be. The idea that "society" must simply eat the cost of care by paying ridiculous prices when they can pay for care, to cover the losses incurred for those that will not pay, is insane.

There is a third option, that some seem to prefer, which is UHC. As I understand it that means that the (federal?) gov't will pay the care provider. But that option is tricky; because who gets to set the billing amount? This is the biggest issue that I have with UHC, besides how much taxation is required to pay for this UHC "right".
 
Last edited:
I havn't bothered to check but believe hosp. are required by law to treat.

Dear doctor, dear doctor, I need to be fixed
the ER is open, I'm between and betwixt
A hard spot and a rock while
the clock keeps going tick tock .
Is this my final day ?
Will you work without pay ?
Me thinks, only you can say.
Tick tock tick tock
Tick tock

Apologies to all poets

Thom Paine
 
ttwtt78640 said:
The story only starts with the treatment. After the treatment and the patient is out of a life threatening situation, the question of payment needs to be addressed.
Click to expand...

true, but my poll doesn't address that. Only the emergency treatment

We have but two options once the care givers (including the ambulance service) asks the patient for payment 1) they get paid (that may include a payment plan over time) 2) they do not get paid. In the event of option #2, or missing a payment on option #1's plan, the patient has committed theft so they should be arrested just as one that removes an item from a store without paying for it would be.
Click to expand...

an unconscious person committed theft?

Are you sure you're conscious? :lol:
 
The problem with the EMTALA is that the definition of a "Emergency Medical Condition" is incredibly broad. For example, a fever is considered to be an EMC. (Here)

In the scenario in the OP the hospital would probably get reimbursed through the drivers insurance but the real problem comes up when the treatment is for chronic drug addiction or mental health conditions of the homeless. Since we no longer have state run mental health hospitals these people all end up in the ER and, under the EMTALA, can't be discharged until they are "fixed".
 
sangha said:
true, but my poll doesn't address that. Only the emergency treatment



an unconscious person committed theft?

Are you sure you're conscious? :lol:
Click to expand...


I am quite sure that I am conscious and that I stated only after the patient has recovered from emergency treatment is the issue of payment addressed. Are you implying that since the treatment was "mandatory" that no bill is due for it?
 
ttwtt78640 said:
The story only starts with the treatment. After the treatment and the patient is out of a life threatening situation, the question of payment needs to be addressed.

We have but two options once the care givers (including the ambulance service) ask the patient for payment 1) they get paid (that may include a payment plan over time) 2) they do not get paid. In the event of option #2, or missing a payment on option #1's plan, the patient has committed theft so they should be arrested just as one that removes an item from a store without paying for it would be. The idea that "society" must simply eat the cost of care by paying ridiculous prices when they can pay for care, to cover the losses incurred for those that will not pay, is insane.

There is a third option, that some seem to prefer, which is UHC. As I understand it that means that the (federal?) gov't will pay the care provider. But that option is tricky; because who gets to set the billing amount? This is the biggest issue that I have with UHC, besides how much taxation is required to pay for this UHC "right".
Click to expand...

So you went for a jog and brought no ID with you. You have a stroke or got hit by a car or both. A citizen calls 911 a ambulance shows up takes you to the nearest ER, you cannot tell them anything because you are unconscious. And you have no ID on you at all no one knows you. Unfortunately your injuries were severe and you were in a coma for months, and no one was able to contact anyone that knows you. You wake up and cant remember your name or anything important. No money cant pay the huge bills that you owe for months of care and that ride to the hospital.

At least you wont have a clue how screwed it is to be in jail now.
 
Lutherf said:
The problem with the EMTALA is that the definition of a "Emergency Medical Condition" is incredibly broad. For example, a fever is considered to be an EMC. (Here)

In the scenario in the OP the hospital would probably get reimbursed through the drivers insurance but the real problem comes up when the treatment is for chronic drug addiction or mental health conditions of the homeless. Since we no longer have state run mental health hospitals these people all end up in the ER and, under the EMTALA, can't be discharged until they are "fixed".
Click to expand...

1) This thread isn't about every condition covered by EMTALA

2) You are misrepresenting what EMTALA requires of ER's when it comes to drug addiction and mental health.
 
ttwtt78640 said:
I am quite sure that I am conscious and that I stated only after the patient has recovered from emergency treatment is the issue of payment addressed. Are you implying that since the treatment was "mandatory" that no bill is due for it?
Click to expand...

No, I merely asked if you think the hospital should treat the person without first ascertaining if they can pay for the care.
 
ttwtt78640 said:
I am quite sure that I am conscious and that I stated only after the patient has recovered from emergency treatment is the issue of payment addressed. Are you implying that since the treatment was "mandatory" that no bill is due for it?
Click to expand...

I dont agree with treating it like theft. I believe the person should be treated. Then their ability to pay is determined. If they have the ability to pay, this also includes whatever insurace can and will pay, then a payment plan is set up. If the person misses a payment then it should be treated like any other bill or credit card payment that a person misses.
 
FreedomFromAll said:
So you went for a jog and brought no ID with you. You have a stroke or got hit by a car or both. A citizen calls 911 a ambulance shows up takes you to the nearest ER, you cannot tell them anything because you are unconscious. And you have no ID on you at all no one knows you. Unfortunately your injuries were severe and you were in a coma for months, and no one was able to contact anyone that knows you. You wake up and cant remember your name or anything important. No money cant pay the huge bills that you owe for months of care and that ride to the hospital.

At least you wont have a clue how screwed it is to be in jail now.
Click to expand...

Oh my, the lengths that one goes through to invent a trickier than usual case. I guess that is easier than dealing with the issue of payment for 99.9% of the typical cases. ;)
 
sangha said:
You decide you need a little fresh air, so you go outside for a little stroll. Because you don't expect to be out long, or do anything of note, you leave without your wallet or purse and have no identification on you.

While you're walking, a car goes out of control, jumps the curb and mows you down. You're knocked unconscious and you have several life-threatening injuries. An ambulance quickly arrives, scoops you up and brings you to the hospital where they have no idea who you are or if you are able to pay for the care you need.

Should the hospital treat you or should they wait until they can make certain you can your bill for the care they're going to give you?

Just a refresher for some of the more important points:

1) You're at the hospital
2) You're unconscious
3) The hospital has no idea who you are of it you can pay
4) You're dying
Click to expand...

In short, yes.

Law aside, there is a long standing tradition in this country and in the medical practice that you treat critical care needs without asking for payment up front. Save the life. Deal with the bill after they're stable and recovering.

Now that said, it's still the responsibility of the person responsible for the injury to pay; insurance of the car that hit the guy, or the guy himself if it was a stroke or heart attack, etc.
 
sangha said:
No, I merely asked if you think the hospital should treat the person without first ascertaining if they can pay for the care.
Click to expand...

I answered that clearly and then made further comments.
 
Amandi said:
I dont agree with treating it like theft. I believe the person should be treated. Then their ability to pay is determined. If they have the ability to pay, this also includes whatever insurace can and will pay, then a payment plan is set up. If the person misses a payment then it should be treated like any other bill or credit card payment that a person misses.
Click to expand...

Just who determines if they have the ability to pay? I would treat it at least as seriously as an unpaid traffic fine or missed child support payment.
 
AFAIK even today, and for years preceeding, the hospital will always take a patient under these circumstances.

We had a scandal about 20 years ago. A guy came in with a knife stuck in him and they hustled him off to the county hospital without treating him beyond some tape to hold the kknife in place. This caused a huge stir and now all hospitals provide emergency care but the cops will take you to county. County collects very little of their bills.
 
ttwtt78640 said:
Just who determines if they have the ability to pay? I would treat it at least as seriously as an unpaid traffic fine or missed child support payment.
Click to expand...

I guess that would have to be some sort of formula decided when the laws are enacted. I can handle it being treated like a missed child support payment.
 
sangha said:
You decide you need a little fresh air, so you go outside for a little stroll. Because you don't expect to be out long, or do anything of note, you leave without your wallet or purse and have no identification on you.

While you're walking, a car goes out of control, jumps the curb and mows you down. You're knocked unconscious and you have several life-threatening injuries. An ambulance quickly arrives, scoops you up and brings you to the hospital where they have no idea who you are or if you are able to pay for the care you need.

Should the hospital treat you or should they wait until they can make certain you can your bill for the care they're going to give you?

Just a refresher for some of the more important points:

1) You're at the hospital
2) You're unconscious
3) The hospital has no idea who you are of it you can pay
4) You're dying
Click to expand...

Stabilizing truly critical injuries is fine, and for the record it is a very small percentage of our overall health care costs. In fact, emergency care in general is in the single digits, maybe as low as 2-3%, of overall health care costs.

So the idea that we need universal health care by pointing to critical injuries involving unconsciousness and emergency room treatment is a red herring.

What ERs should never treat are mild complaints. No more "I came here because I have a headache" leading to CT scans of the head leading to the patient asking for more Vicodin or whatever. Or "I came here because I was feeling suicidal, can I be admitted to the psych unit again?" That is called Malingering.
 
Neomalthusian said:
Stabilizing truly critical injuries is fine, and for the record it is a very small percentage of our overall health care costs. In fact, emergency care in general is in the single digits, maybe as low as 2-3%, of overall health care costs.

So the idea that we need universal health care by pointing to critical injuries involving unconsciousness and emergency room treatment is a red herring.

What ERs should never treat are mild complaints. No more "I came here because I have a headache" leading to CT scans of the head leading to the patient asking for more Vicodin or whatever. Or "I came here because I was feeling suicidal, can I be admitted to the psych unit again?" That is called Malingering.
Click to expand...

So, how do they determin if the person is "faking" if they arent treated?
 
Amandi said:
So, how do they determin if the person is "faking" if they arent treated?
Click to expand...

You don't need to put "faking" in quotations when I'm referring specifically to the patients who literally do fake it.

There are several ways to determine that people do not need emergency medical treatment. The first is triaging. They already triage, but they over admit, presumably because the law requires it. Emergency physicians shouldn't have to rule out serious issues with expensive diagnostic tests when there are subjective mild complaints and no real evidence of any medical emergency. They should just point to the exit. Emergency rooms should be for objective, observable emergencies. This thread asks about people unconscious from their injuries/illness, which is objective and observable.

Another thing they shouldn't do is admit so many people who have drugs or alcohol on board who are presenting with probable effects of intoxication.

Police departments also shouldn't be required to medically clear inebriates through the ER before taking them to the drunk tank. I'm assuming someone was sued because some people died in the drunk tank. Who cares? That is no reason to legally require police to put all drunks through the ER before dealing with them. Deal with them cheaply. Abuse drugs and alcohol at your own risk.
 
Neomalthusian said:
You don't need to put "faking" in quotations when I'm referring specifically to the patients who literally do fake it.

There are several ways to determine that people do not need emergency medical treatment. The first is triaging. They already triage, but they over admit, presumably because the law requires it. Emergency physicians shouldn't have to rule out serious issues with expensive diagnostic tests when there are subjective mild complaints and no real evidence of any medical emergency. They should just point to the exit. Emergency rooms should be for objective, observable emergencies. This thread asks about people unconscious from their injuries/illness, which is objective and observable.

Another thing they shouldn't do is admit so many people who have drugs or alcohol on board who are presenting with probable effects of intoxication.

Police departments also shouldn't be required to medically clear inebriates through the ER before taking them to the drunk tank. I'm assuming someone was sued because some people died in the drunk tank. Who cares? That is no reason to legally require police to put all drunks through the ER before dealing with them. Deal with them cheaply. Abuse drugs and alcohol at your own risk.
Click to expand...

I used the quotes because there is no definitive way of knowing. I work at a hospital and spend a lot of time in the ER. There has been numerous times that a person came in with a headache to find out that they are about to stroke out or have a tumor. As far as the drunk, that is just a difference of opinion between the two of us. I think we should treat people who need to be treated even if the problem is caused by their stupidity.
 
sangha said:
You decide you need a little fresh air, so you go outside for a little stroll. Because you don't expect to be out long, or do anything of note, you leave without your wallet or purse and have no identification on you.

While you're walking, a car goes out of control, jumps the curb and mows you down. You're knocked unconscious and you have several life-threatening injuries. An ambulance quickly arrives, scoops you up and brings you to the hospital where they have no idea who you are or if you are able to pay for the care you need.

Should the hospital treat you or should they wait until they can make certain you can your bill for the care they're going to give you?

Just a refresher for some of the more important points:

1) You're at the hospital
2) You're unconscious
3) The hospital has no idea who you are of it you can pay
4) You're dying
Click to expand...

For the situation you describe it seems painfully obvious what the hospital should do. Of course they should treat first in that situation and figure out insurance and payment later. I would imagine in most cases like that, the person has insurance anyway and the hospital gets paid in the end. I know if that happened to me my insurance would pay and I would be happy to pay the deductible and co-pays to the hospital for saving my life. And the person driving the car would be paying up too. If the hospital does treat someone that doesn't have insurance and/or the means to pay, it is roughly analogous to a retail store having to deal with theft. It happens and they have to raise their prices to cover it.
 
Amandi said:
I used the quotes because there is no definitive way of knowing. I work at a hospital and spend a lot of time in the ER. There has been numerous times that a person came in with a headache to find out that they are about to stroke out or have a tumor. As far as the drunk, that is just a difference of opinion between the two of us. I think we should treat people who need to be treated even if the problem is caused by their stupidity.
Click to expand...

A drunk doesn't need emergency treatment for having the mental status of an intoxicated person. It's not a medical emergency and there is no real medically necessary treatment for it. Furthermore, emergency room social workers can't get a reliable read on a person's mental status or psychiatric conditions when those presentations are likely influenced or caused by the direct physiological effects of a substance. It's a pitiful waste of time and resources.

If we lay our emergency medical treatment out there like a doormat, it will be treated like one.

But again, in the grand scheme of things, I acknowledge that this opinion is somewhat nitpicky and specific to ERs, given that the percentage of overall health care expenditures being incurred by emergency departments is actually quite small.
 
Neomalthusian said:
A drunk doesn't need emergency treatment for having the mental status of an intoxicated person. It's not a medical emergency and there is no real medically necessary treatment for it. Furthermore, emergency room social workers can't get a reliable read on a person's mental status or psychiatric conditions when those presentations are likely influenced or caused by the direct physiological effects of a substance. It's a pitiful waste of time and resources.

If we lay our emergency medical treatment out there like a doormat, it will be treated like one.

But again, in the grand scheme of things, I acknowledge that this opinion is somewhat nitpicky and specific to ERs, given that the percentage of overall health care expenditures being incurred by emergency departments is actually quite small.
Click to expand...

Actually, the checking of a drunk person just because they are drunk, I could agree to not allowing in ER's. I think any medic could do that. Have a trained person watch the "drunk tank" and make sure no one is having an adverse reaction. IF they do and it needs an ER then an ambulance can be called. If something happens on the way, then I agree with you to the extent of saying their choice caused their problem and not the police.
 
Neomalthusian said:
A drunk doesn't need emergency treatment for having the mental status of an intoxicated person. It's not a medical emergency and there is no real medically necessary treatment for it. Furthermore, emergency room social workers can't get a reliable read on a person's mental status or psychiatric conditions when those presentations are likely influenced or caused by the direct physiological effects of a substance. It's a pitiful waste of time and resources.

If we lay our emergency medical treatment out there like a doormat, it will be treated like one.

But again, in the grand scheme of things, I acknowledge that this opinion is somewhat nitpicky and specific to ERs, given that the percentage of overall health care expenditures being incurred by emergency departments is actually quite small.
Click to expand...

I've never heard of any police dept having a policy of taking all drunk and intoxicated people to an ER before locking them up. Also, of the many cases I know of where the police locked up an intoxicated person, the # of people who were first brought to an ER was zero
 
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