Tag Archives: EMTALA

Conflicting state and federal abortion laws put pregnant patients, physicians and hospitals at risk


Physicians treating pregnant women/people needing emergency medical care are wrestling with how to comply with what’s been called the bedrock law of emergency medicine when facing strict, new mandates on abortion.

“Confusion among emergency room doctors remains even after the Biden administration clarified this week that federal law allowing abortions in life-or-death situations supersedes any restrictions a state may have on the procedure,” Tony Pugh wrote for Bloomberg Law on Wednesday. His article explained how conflicting federal and state laws are complicating abortion care.

Early this week, Melanie Evans of The Wall Street Journal took a close look at how physicians and hospitals are addressing the mandates of the Emergency Medical Treatment and Active Labor Act (EMTALA) of 1986 in the wake of the overturning of Roe v. Wade. That decision in Dobbs v. Jackson Women’s Health Organization stripped away an almost 50-year-old right to an abortion.

Even before the SCOTUS decision on June 24, many states had enacted laws to either restrict or prohibit abortions or expand and protect access to abortion in anticipation of the ruling to overturn Roe v. Wade, as noted in the nonprofit Kaiser Family Foundation’s tracker of these measures.

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Dallas Ebola case raises questions about care for the uninsured

"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

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