EMTALA and cancer

Yesterday, Aaron blogged about the limits of EMTALA, which doesn’t promise free care, only screening and stabilization of emergency medical conditions.

What if you crawl into an ER dying of cancer? EMTALA would require a screening and stabilization, which might include chemotherapy. But once the cancer was knocked back a bit, the hospital could discharge you without any commitment to further care, even if they knew the cancer would come back unless treatment continued.

You read that right – no EMTALA obligation until the cancer was almost killing you again.

Before you accuse me of making things up, read the case:  Diaz v. North Carolina, 628 S.E.2d 1 (2006).

In October of 2000, Diaz began experiencing sore throat, nausea, vomiting, bleeding gums, and increasing lethargy, which were later diagnosed as symptoms of acute lymphocytic leukemia (ALL). Doctors at Moses Cone Memorial Hospital in Greensboro, North Carolina treated petitioner beginning on or about 21 October 2000. Chemotherapy treatments commenced shortly thereafter and continued intermittently until July of 2002.

Diaz was an undocumented alien and therefore didn’t qualify for North Carolina Medicaid. The hospital refused to continue chemo without payment, despite EMTALA. The legal argument? The cancer was no longer an “emergency:”

At the time of his initial treatment in the emergency room, there is no dispute petitioner presented with an emergency medical condition. However, soon after his admission to the facility, petitioner’s condition dramatically improved. During petitioner’s chemotherapy treatments, his condition was stable and, therefore, he was no longer entitled to Medicaid coverage.

Even though the testimony agreed that without this chemo, Diaz “would have eventually regressed into a state of an emergency medical condition.” The court sent him away without treatment, but said that once he was nearly dead again, he could get emergency care under EMTALA.

EMTALA is a poor excuse for a safety net.


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