So Just Do It

From the mouth of the Panda:

"If we just got aggressive with triage..."

I've never quite understood why EMTALA, the legislation referred to as an "unfunded mandate" by all the ER docs who bitch and moan about having to see everyone who walks through the door whether or not they can pay, is such a big deal. Here's the text:

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 exists.

Here's how they define "Emergency medical condition," by the way:

(i) A medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain, psychiatric disturbances and/or symptoms of substance abuse) such that the absence of immediate medical attention could reasonably be expected to result in-

(A) 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;

(B) Serious impairment to bodily functions; or

(C) Serious dysfunction of any bodily organ or part.

I've gone on to read all the rest of the regulations and amendments and commentary and so on. At no point is there any mention of the obligation of a facility or provider to an individual WITHOUT AN EMERGENCY MEDICAL CONDITION. In fact, they say so over and over again in the 44 page document containing the 2003 EMTALA amendments:

The statute plainly states that the objective of the appropriate medical screening examination is to determine whether or not an emergency medical condition exists. Therefore, hospitals are not obligated to provide screening services beyond those needed to determine that there is no emergency medical condition.

There is no way a rash for three months constitutes an "emergency medical condition", yet somehow Scalpel still interprets EMTALA as a mandate to treat. What's to stop you from booting someone once you've ascertained that no "emergency medical condition" exists?

I know what you're going to say, all you ER folks: there's no way to be 100% certain that no emergency condition exists, so not going ahead and treating everyone would put you at unreasonable risk of liability. Yeah; right. In theory; perhaps. But still! Just reading your blogs, it sure seems like plenty of folks come around offering pretty clear histories in triage (stubbed toes, for crying out loud!) that they aren't dealing with an emergency. Grow some testicles and street them.

Oh, wait: do some of them have insurance? Might they be a source of easy revenue? Is it your hospital's policy to treat all comers (as opposed to the dreaded "EMTALA")? Then quitcherbellyachin'. Or, as Panda says: "If we just got aggressive with triage..."