Regulatory reform panel targets EMTALA rules

Draft recommendations would limit the scope and modify definitions of the law prohibiting "patient dumping."

By Markian Hawryluk, AMNews staff. April 15, 2002.

Washington -- About 15 years ago, Gary Dennis, MD, installed a shunt for a newborn with hydrocephalus -- not an unusual procedure for a neurosurgeon. But when the Washington, D.C.-based physician recently received a telephone call about the patient, he was stunned.

The shunt had become obstructed and the girl, now a teenager, had lapsed into a coma. The hospital emergency department where she was being treated had no neurosurgeon on-call and wanted to transfer the patient to Dr. Dennis -- from West Virginia.

Despite his protestations that the girl could die, the hospital sent her on a four-and-a-half-hour journey to the nation's capital. Thirteen hospitals were passed along the way. Under federal regulations, Dr. Dennis could not refuse the patient.

Dr. Dennis is now a member of Health and Human Services Secretary Tommy Thompson's Advisory Committee on Regulatory Reform, charged with reducing the burdens of federal health care rules. One of the committee's first targets is the Emergency Medical Treatment and Active Labor Act -- the law that required Dr. Dennis to take that patient.

Passed in 1986, EMTALA was intended to ensure emergency departments did not turn away critical cases because of the patient's inability to pay. But it is now criticized by some as a morass of regulations and guidelines that has health care lawyers working overtime. The law has been blamed for overcrowded emergency departments and a shortage of specialists willing to serve on hospital on-call lists.

In March, the government reform panel released a set of draft recommendations aimed at reducing EMTALA's burden, and the group may vote to finalize them as early as May or June. The draft includes immediate fixes, such as simplifying the regulations and limiting their scope, and long-term solutions, such as creating a board of emergency physicians and other advisers that would guide future emergency department regulations and guidance. Once the panel makes its formal suggestions, it would then be up to HHS to accept or reject them. [...]