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EMTALA woes spark quest for national fix

Expansion of the "anti-dumping law" is driving Arizona physicians away from emergency care.

By Markian Hawryluk, amednews staff. Feb. 11, 2002.

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The unintended consequences of emergency department regulations designed to prevent inappropriate patient transfers have created an emerging crisis in Arizona and are spurring its elected officials to look for ways to fix the problem nationwide.

The Emergency Medical Treatment and Active Labor Act was passed by Congress in 1985 to ensure that patients in need of emergency care were not turned away for inability to pay. But the regulations now pull physicians away from their practices to provide uncompensated emergency care, physician groups say.

As a result, frustrated specialists are increasingly refusing to be on the on-call list for emergency cases. And hospital emergency departments are facing overcrowding, budget shortfalls, and in some cases, closures.

"We have a disaster in medicine today," said Michael Carius, MD, president of the American College of Emergency Physicians. "Emergency medicine, unfortunately, is at the forefront of that."

Regulatory reform bills in Congress would only begin to address EMTALA concerns. A bill passed by the House would create an EMTALA task force to review the regulations and suggest possible solutions. Meanwhile, the Senate is considering legislation that would require managed care plans to make emergency care coverage decisions based on presenting symptoms, not the final diagnosis.

Members of the Arizona delegation to Congress are working with officials from the Centers for Medicare & Medicaid Services to explore administrative solutions to the problems. Sen. Jon Kyl (R, Ariz.) has made EMTALA a legislative priority this year. [...]