Tag Archives: EMTALA

Dallas Ebola case raises questions about care for the uninsured

About Joseph Burns

Joseph Burns (@jburns18), a Massachusetts-based independent journalist, is AHCJ’s topic leader on health reform. He welcomes questions and suggestions and tip sheets at joseph@healthjournalism.org.

"Ebola virions" by See Source - Charting the Path of the Deadly Ebola Virus in Central Africa. PLoS Biol 3/11/2005: e403 doi:10.1371/journal.pbio.0030403. Licensed under CC BY 2.5 via Wikimedia Commons.

Ebola virions” from “Charting the Path of the Deadly Ebola Virus in Central Africa.” PLoS Biol 3/11/2005: e403 doi:10.1371/journal.pbio.0030403. Licensed under CC BY 2.5 via Wikimedia Commons.

When Thomas Eric Duncan died Wednesday of Ebola at Texas Health Presbyterian Hospital in Dallas, one of many questions that remained unanswered was why the hospital didn’t do more to diagnose and treat Duncan initially. On Sept. 25, Duncan walked into the hospital’s emergency room, was given antibiotics and sent home, according to coverage in the Los Angeles Times and elsewhere.

The question about what happened on Sept. 25 is important because Duncan could have infected many other individuals between when he was sent home on Sept. 25 and when he returned on Sept. 28 and was put into isolation. Writing in The New York Times, Manny Fernandez and Dave Philipps suggest that Duncan might still be alive if he had been admitted on Sept. 25.

After his death, Duncan’s fiancée, Louise Troh, and other African-Americans, questioned whether Duncan had received substandard care. Continue reading

Decisions on Medicaid expansion could affect demands for ER care

About Joanne Kenen

Contributing editor to Politico Magazine and former health care editor-at-large, Politico, Commonwealth Fund journalist in residence and assistant lecturer at Johns Hopkins Bloomberg School of Public Health.

Now that Medicaid expansion is uncertain in a number of states, it’s likely that some low-income people who might have been covered will not be – at least not in 2014.

You’re probably hearing, from some quarters at least, the mistaken argument that the uninsured working poor don’t need help – that they (and for that matter, undocumented immigrants) can get all the care they want, for health problems big or small, at no cost, at emergency rooms.

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That’s not what the law – the Emergency Medical Treatment and Active Labor Act (EMTALA) – says. It says people need to be stabilized, regardless of ability to pay. It doesn’t mean that the hospital can’t at least try to collect the fee later. And it doesn’t mean that the patient gets more than the emergency stabilization – not necessarily any follow up, management of a chronic condition, or ongoing treatment of a disease diagnosed in the ER.

But today we take this life-saving, stabilizing, no-turning-away patients practice for granted. It wasn’t always this way. Noam Levey of the Los Angeles Times recently took a look at how EMTALA came to be, and the abuses it corrected. (Levey wrote it before the Supreme Court ruling, when there was speculation that the whole health law could be overturned, meaning millions might continue to rely on the emergency room as a main source of care. But his story is just as interesting under the actual post-SCOTUS scenario.) Continue reading