Friday, March 17, 2006


So the government has written a law to prevent patient dumping. EMTALA, the Emergency Medical Treatment and Active Labor Act. This prohibits facilities from transferring patients with an emergency condition that could be cared for at the facility to which the patient presents. Of course it is not that simple. It is hugely complicated and well intentioned but as with most legislation the uninteded consequences are legion. The first is that it's an unfunded mandate. In other words we have to take care of all comers regardless of their ability to pay. Fair enough, we are in the business of Emergency Medicine and I personally don't care what someone's financial status is when they show up sick in my ED. But since this is a government mandate it seems only fair that the government would subidize this. No. We have just been ordered to lose large ammounts of money. How does this work? Cost shifting. Costs for everyone else go up and our paychecks go down. So sad you say... poor rich doctor doesn't get his money. Well, okay, but I'm damn good at what I do and I'm the one who might save your life. Is this skill deserving of high pay? I would say so, we are, I think, living in a free society where people chose careers based on reimbursement (and many other factors of course). I'm also the one that can go do just about anything else I want to do outside of medicine. You will eventually get what you pay for. Oh, just an afterthought, government facilities are exempt from EMTALA. Neat huh? Today we got a patient by ambulance sent 30 miles from an active military base. She crashed her car on the base and was a few hundred yards from their emergency department. She is not on active duty. They sent her here.

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