• This is a political forum that is non-biased/non-partisan and treats every person's position on topics equally. This debate forum is not aligned to any political party. In today's politics, many ideas are split between and even within all the political parties. Often we find ourselves agreeing on one platform but some topics break our mold. We are here to discuss them in a civil political debate. If this is your first visit to our political forums, be sure to check out the RULES. Registering for debate politics is necessary before posting. Register today to participate - it's free!

Pawlenty: Let ER's turn away patients to cut costs

Goyboy said:
Wouldn't it be helpful to post the actual EMTALA laws for everyone to see?

Here are excerpts from EMTALA:

TITLE 42, CHAPTER 7, SUBCHAPTER XVIII, Part E, § 1395dd

(a) Medical screening requirement

In the case of a hospital that has a hospital emergency department, if any individual (whether or not eligible for benefits under this subchapter) comes to the emergency department and a request is made on the individual’s behalf for examination or treatment for a medical condition, the hospital must provide for an appropriate medical screening examination within the capability of the hospital’s emergency department, including ancillary services routinely available to the emergency department, to determine whether or not an emergency medical condition (within the meaning of subsection (e)(1) of this section) exists.

(b) Necessary stabilizing treatment for emergency medical conditions and labor

(1) In general
​
If any individual (whether or not eligible for benefits under this subchapter) comes to a hospital and the hospital determines that the individual has an emergency medical condition, the hospital must provide either—
​
(A) within the staff and facilities available at the hospital, for such further medical examination and such treatment as may be required to stabilize the medical condition, or
​
(B) for transfer of the individual to another medical facility in accordance with subsection (c) of this section.
​
[Sections c and d skipped for the sake of brevity.]


e) Definitions
In this section:
(1) The term “emergency medical condition” means—
​
(A) a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in—
​
(i) placing the health of the individual (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy,
​
(ii) serious impairment to bodily functions, or
​
(iii) serious dysfunction of any bodily organ or part; or
​
(B) with respect to a pregnant woman who is having contractions—
​

(i) that there is inadequate time to effect a safe transfer to another hospital before delivery, or
​
(ii) that transfer may pose a threat to the health or safety of the woman or the unborn child.
​
If I am not mistaken, nothing in EMTALA requires an emergency room staff to treat a patient for a non-emergency problem once the emergency room staff has determined that the patient has a non-emergency problem.

If I am correct, then Pawlenty is mistaken about EMTALA needing changed.
Click to expand...

Pawlenty needs to be removed from office.
 
The hospital where Michelle Obama was on the board set up a program to try to do exactly this - divert people who really didn't belong in the ER to regular doctors.

The right wingers screamed "patient dumping"!
 
misterman said:
The hospital where Michelle Obama was on the board set up a program to try to do exactly this - divert people who really didn't belong in the ER to regular doctors.

The right wingers screamed "patient dumping"!
Click to expand...
:shocked2: misterman, do you have a link to a story that confirms what you say about "right wingers"?
 
CrusaderRabbit08 said:
Is it really taking money without our consent? After all; if enacted into law, it was with our consent.

The cheaper option is to establish after-hours urgent care clinics .. a great idea! .
Click to expand...

Medical care is a service.
The hours of operation should be 24/7, so the clinics must be fairly large to economically have a full staff..
I'd like to see no insurance companys involved, but a government subsidized system, similar to the VA.
Every American citizen should have the same basic health care, there should not be such a huge gap between the "best" HC recieved (the President, Senators, Generals) and our American working man.
But the working man must know how to apply a bandage, the President or CEO can pay $100 for this service.
Another good idea is to have the idividual states handle the HC and keep the feds out of it....
Pawlently does not present his idea that well, then the media twists and spins things..but he is thinking....
 
Councilman said:
Having been to the emergency room at least 15 or 20 times in my life and 4 times last year I know a little bit about how they work.

The triage system evaluates treatment based most in need and likely hood of benefiting and recovering from immediate treatment.

This is the time people with a minor condition such as a splinter or other problem treatable at home should be given instructions on how to deal with the issue and sent on their merry way. Those people are the ones who find they get to wait hours and hours for a band aid.

If you show up with shortness of breath and chest pains your wait will be less than a few minutes guaranteed. I know this for a fact.

But you still have the issue of what happens when the person who decides who is really in need makes a mistake and sends the wrong person away. Many problems that appear to be minor on the surface can be complicated by problems that are not readily visible at a certain point in time.

In that case the cost to the hospital is going to be very high indeed.

Pawlenty has an idea I just don't see it as the cure to high costs, and the current plans under consideration as I have said over and over fail to address the real issues at all.
Click to expand...

I agree.

They should, then, expand the abilities (hire more people, train more efficiently, etc) and area for triage and have adequate, on staff care (like a walk-in clinic) for those who are not major - yet underlying condition might be found when they're actually examined by a doctor.

Redirecting to a neighboring area, rather than turning away completely, will reduce the number of patients that an ER must see and tend to.

More and more lately, though, it seems that they're demonizing doctors and patient care rather than holding it up as a revered practice. For someone to be so important it's surprising that there's so many dispassionate words being shared. (this is just a general statement based on attitudes towards doctors via media and politics - not in this thread).
 
Last edited:
Goyboy said:
Oh, OK. Thanks.
Click to expand...

I'll bet you'll even see some of the same people who whined about Michelle Obama endorsing Pawlenty's proposal!

Obama's was alot better - her hospital didn't just turn people away (it legally coudn't), it found doctors for the patients.
 
misterman said:
I'll bet you'll even see some of the same people who whined about Michelle Obama endorsing Pawlenty's proposal!

Obama's was alot better - her hospital didn't just turn people away (it legally couldn't), it found doctors for the patients.
Click to expand...
misterman, you are correct. I found examples of whining by people who don't know what EMTALA actually requires of hospital emergency rooms.

Nothing in EMTALA prevents an emergency room staff from sending established non-emergency cases to a health care provider outside of the emergency room.

Being that I don't suffer from Obama Derangement Syndrome, I can correctly understand what the Urban Health Initiative is all about. It's about reducing the number of non-emergency cases handled by emergency rooms so that those emergency rooms handle more cases that are actual emergencies.
 
Goyboy said:
misterman, you are correct. I found examples of whining by people who don't know what EMTALA actually requires of hospital emergency rooms.

Nothing in EMTALA prevents an emergency room staff from sending established non-emergency cases to a health care provider outside of the emergency room.

Being that I don't suffer from Obama Derangement Syndrome, I can correctly understand what the Urban Health Initiative is all about. It's about reducing the number of non-emergency cases handled by emergency rooms so that those emergency rooms handle more cases that are actual emergencies.
Click to expand...

Thanks for your comment.

If only you could reach all the screaming loons out there and tell them.
 
Tort reform is the key to this whole problem.
 
Goyboy said:
Although I am in favor of tort reform, it's a different subject that does not pertain to the subject of this thread.
Click to expand...

Believe me, it has everything to do with this thread.:cool:
 
nonpareil said:
So I'm curious how else capitalism can come in and fill the void?
Click to expand...

You should probably direct your question to the poster who made the statement.

nonpareil said:
But let's concentrate on the "cases that should be in the clinics". How do we classify them?
Click to expand...

There are plenty of public clinics to handle cases who cannot pay much. The problem (in many cases, based on experience working in public hospitals) is that these patients don't really want to fill out the paperwork and wait. In a public health system, people will pay with their time.
 
As a physician and being married to a physician, my wife and I can come up with myriad examples of patients that could have been turned away at the point of entry following immediate assessment. Common examples include patients that come to the ED for insulin or blood pressure Rx refills. A typical ED intake charge by the hospital is $1,100-1,500. Many of these patients arrive with no exacerbation of their primary ailment a several days remaining of their prescription, but claim they don't have to wait as long if they come to the ED (I find this hard to believe). Anyway, in most cases the local taxpayer ends up paying for the ED intake. We also see children being brought in for vaccinations. Again, a ED intake charge in addition to the vaccination (usually charged to the taxpayers) when the child can receive vaccinations at the county health department. My state (Oklahoma) has a program that provides these vaccinations to children free of charge as opposed to ~$1200 via the ED.
 
Shadowfax8 said:
As a physician and being married to a physician, my wife and I can come up with myriad examples of patients that could have been turned away at the point of entry following immediate assessment. Common examples include patients that come to the ED for insulin or blood pressure Rx refills. A typical ED intake charge by the hospital is $1,100-1,500. Many of these patients arrive with no exacerbation of their primary ailment a several days remaining of their prescription, but claim they don't have to wait as long if they come to the ED (I find this hard to believe). Anyway, in most cases the local taxpayer ends up paying for the ED intake. We also see children being brought in for vaccinations. Again, a ED intake charge in addition to the vaccination (usually charged to the taxpayers) when the child can receive vaccinations at the county health department. My state (Oklahoma) has a program that provides these vaccinations to children free of charge as opposed to ~$1200 via the ED.
Click to expand...

Medicaid and SCHIP both take care of those.

The hospital should be able to turn away people coming in for that.
 
Councilman said:
Having been to the emergency room at least 15 or 20 times in my life and 4 times last year I know a little bit about how they work.

The triage system evaluates treatment based most in need and likely hood of benefiting and recovering from immediate treatment.

This is the time people with a minor condition such as a splinter or other problem treatable at home should be given instructions on how to deal with the issue and sent on their merry way. Those people are the ones who find they get to wait hours and hours for a band aid.
Click to expand...
There's a way around that. Call an ambulance for the stubbed toe, splinter, etc. Then you get seen immediately. And cost the system even MORE.

ERs should just be allowed to turn non-emergencies away.
 
Goyboy said:
Although I am in favor of tort reform, it's a different subject that does not pertain to the subject of this thread.
Click to expand...

Tort reform is a nonsensical attempt to prevent unscrupulous big business scumbags from being held completely responsible for the damage their greed causes.

In three words: Mindless Republican Bull****!
 
Vader said:
Tort reform is a nonsensical attempt to prevent unscrupulous big business scumbags from being held completely responsible for the damage their greed causes.

In three words: Mindless Republican Bull****!
Click to expand...

Are you pooling physicians into the "big business scumbags" group? Because they're the primary defendant in frivolous lawsuits.
 
Catz Part Deux said:
If hospitals were allowed to turn away non-emergency cases, I can easily see capitalism stepping into the void and filling it.
Click to expand...

I can see it too. A form of capitalism that would have lawyers camped out in ER parking lots trying to stir up malpractice law suits. Until poor people stop using the ER as a clinic, turning folks away would be a lawsuit waiting to happen.

How do we get people to stop using the ER as a clinic?
The much less expensive practise of preventive medicine.
How do we do that?
Everyone has health insurance

Preventative medicine is the best way to keep health care costs down. Catch a problem before it turns into a costly emergency room visit. Until then, those with health insurance will continue to pay for those who don't. HMO's PPO's and every other kind of "O" don't want that though. Why?
Because the status quo is what earns them huge profits. ER visits are not bankrupting folks, organized insurance companies are.
 
lizzie said:
You should probably direct your question to the poster who made the statement.
Click to expand...

I did. And you chose to pick it up.


There are plenty of public clinics to handle cases who cannot pay much. The problem (in many cases, based on experience working in public hospitals) is that these patients don't really want to fill out the paperwork and wait. In a public health system, people will pay with their time.
Click to expand...

:confused: How does this answer the question of how to classify the cases into real emergency or non-emergency?
 
Shadowfax8 said:
Are you pooling physicians into the "big business scumbags" group? Because they're the primary defendant in frivolous lawsuits.
Click to expand...

Many doctors are very right wing and go out of their way to charge exessive fees. At one point and time there were to rates for medical services (a) Insurance rate; and (b) cash rate (which was usually less than the former).

Doctors did nothing when the insurance companies lobbied for laws that made this process illegal (because people were paying a cheaper cash price and they didn't like that.)

Some doctors charge $600.00 FOR A SINGLE OFFICE VISIT. This is bull****. It's excessive and it shows a lack of regard for the common working man. It makes care prohibitively expensive.

Doctors in this group deserve no mercy. Doctors in the other group do not usually find themselves on the receiving end of a lawsuit.
 
Goyboy said:
Wouldn't it be helpful to post the actual EMTALA laws for everyone to see?

Here are excerpts from EMTALA:

TITLE 42, CHAPTER 7, SUBCHAPTER XVIII, Part E, § 1395dd

(a) Medical screening requirement

In the case of a hospital that has a hospital emergency department, if any individual (whether or not eligible for benefits under this subchapter) comes to the emergency department and a request is made on the individual’s behalf for examination or treatment for a medical condition, the hospital must provide for an appropriate medical screening examination within the capability of the hospital’s emergency department, including ancillary services routinely available to the emergency department, to determine whether or not an emergency medical condition (within the meaning of subsection (e)(1) of this section) exists.

(b) Necessary stabilizing treatment for emergency medical conditions and labor

(1) In general​
If any individual (whether or not eligible for benefits under this subchapter) comes to a hospital and the hospital determines that the individual has an emergency medical condition, the hospital must provide either—​
(A) within the staff and facilities available at the hospital, for such further medical examination and such treatment as may be required to stabilize the medical condition, or​
(B) for transfer of the individual to another medical facility in accordance with subsection (c) of this section.​

[Sections c and d skipped for the sake of brevity.]


e) Definitions
In this section:
(1) The term “emergency medical condition” means—​
(A) a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in—​
(i) placing the health of the individual (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy,​
(ii) serious impairment to bodily functions, or​
(iii) serious dysfunction of any bodily organ or part; or​

(B) with respect to a pregnant woman who is having contractions—​
(i) that there is inadequate time to effect a safe transfer to another hospital before delivery, or​
(ii) that transfer may pose a threat to the health or safety of the woman or the unborn child.​


If I am not mistaken, nothing in EMTALA requires an emergency room staff to treat a patient for a non-emergency problem once the emergency room staff has determined that the patient has a non-emergency problem.

If I am correct, then Pawlenty is mistaken about EMTALA needing changed.
Click to expand...

You are correct.
 
You must log in or register to reply here.
Back
Top Bottom