02/22/2012
Kevin OuttersonYesterday, 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.
KO
by V on February 22nd, 2012 at 11:20
This post mixes up two separate issues:
1. Do illegal aliens deserve free care at the expense of the US taxpayer? (I agree I have indulged in negative framing but how most people think about it)
2. How effective is the health care safety net?
Most of the public would agree that #2 applies to US citizens and here you are being disingenuous as someone with cancer and without insurance would likely eventually get on Medicaid and receive their chemotherapy.
One can make several arguments that this is insufficient (i.e., the level of care in Medicaid is deficient, the time lag to get on the rolls or start treatment endangers the patient’s life, etc.) and these are reasonable. However, somehow tying a cancer patient to EMTALA when cancer is not commonly treated in ERs is ridiculous.
by Aaron Carroll on February 22nd, 2012 at 11:33
Unfortunately, you’re wrong about Medicaid as it currently stands. In most states, if you’re an adult without children under the age of 18, you cannot get on Medicaid no matter how poor you are. Period.
The ACA changes that. Even if the law holds, though, that provision has not yet gone into effect.
by Austin Frakt on February 22nd, 2012 at 11:37
More support for Aaron’s point: http://theincidentaleconomist.com/wordpress/health-reform-is-about/
by V on February 22nd, 2012 at 17:26
Fair enough, I am definitely wrong about Medicaid coverage after looking at these links. The ACA changing this facet of the safety net looks like a clear win for patient care.
However, I still find this post extremely lacking. Its chief example is that of an illegal alien which arguably is not a health care issue to most American (ie, they, rightly or wrongly, view the case as a side effect of a lack of border control). Why not just use the example Aaron gave? It would at least support the idea that we need a stronger safety net (assuming the ACA was repealed)…
Furthermore, this post doesn’t really discuss the full range of funding options
https://docs.google.com/viewer?a=v&q=cache:N_RXO36LMMMJ:www.cancer.org/acs/groups/cid/documents/webcontent/002562-pdf.pdf+&hl=en&gl=us&pid=bl&srcid=ADGEEShYYQeEbd36Lsg1D1iZu9vKFy6u5WHsgPxnnABKOXhVwDKYLf2S1pTnkShdmbknVzLKPj0JJdfNyouwpcgAeTQqt5rmW74MKKlPAyY6o7uNokyW9tp6BfuJwEQvvnT4KN5QTFcY&sig=AHIEtbTCDqhrPB8-nakeHRvfL5gXGNJAaw
Apologies for the long link but it is from the ACS’s site. See the section on the uninsured specifically and again, this excludes charitable care programs from the discussion.
Nor does the post take seriously the idea that cancer is not an appropriate condition for ER’s to be treating.
Again, the overall argument that we need a stronger safety net is defensible but a post like this is not exactly the strongest case for it.
by Aaron G on February 28th, 2012 at 01:52
I challenge the assumption of this post that it is either the gov’t or nothing
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