The ever-expanding EMTALA

Fifteen years after the "anti-dumping" law passed, EDs are struggling to meet an unfunded mandate burgeoning with new regulations and lawsuits.

By Tanya Albert, AMNews staff. April 23/30, 2001.

Emergency physician Todd B. Taylor, MD, at age 43, is at the prime of his career and should be spending his time treating patients.

Instead, the Phoenix doctor spends hours of his days writing papers, talking to groups of physicians and meeting with politicians. The topic: How the Emergency Medical Treatment and Active Labor Act has become the "law of unintended consequences," harming emergency medicine.

"I'm semi-retired because it's a horrible place to work," said Dr. Taylor of emergency departments. He cut back to 20 hours a week in the EDs at Good Samaritan and Phoenix Children's hospitals last fall. "It's impossible to do a good job because you don't have the resources."

Congress passed the act in 1986 to stop hospitals from turning away patients who couldn't afford care. Over the years, Health Care Financing Administration regulations and court cases expanded it. Now some doctors say it's so burdensome that it's a large contributor to the crisis in America's EDs.

Patients know they can't be turned away from EDs, so they use them as primary care facilities. Emergency department waiting rooms sometimes get so crowded that patients wait for hours to see a doctor. Yet hospitals and physicians often don't get paid for their time or the supplies they need to treat patients. It's led some to call the law America's "national health care system."

And while the number of patients in emergency departments increases, the number of specialists willing to be on call in the ED declines. That leaves some departments without specialists to back up emergency physicians. [...]