EMTALA and the Ethical Delivery of Hospital Emergency Services

Emergency Medicine Clinics of North America

Volumn 24, Issue 3, 2006, Pages 557-577

  Bitterman, Robert A ^a,b  

^a Bitterman Health Law and Consulting Group Inc   (United States)

^b Bitterman Health Law and Consulting Group Inc   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

COMMUNITY; COURAGE; EMERGENCY CARE; EMERGENCY HEALTH SERVICE; EMERGENCY PHYSICIAN; EMERGENCY WARD; FUNDING; GOVERNMENT; HEALTH CARE; HEALTH CARE ACCESS; HEALTH CARE DELIVERY; HEALTH CARE POLICY; HEALTH INSURANCE; HUMAN; HUMAN RIGHTS; INFORMED CONSENT; LEADERSHIP; MEDICAL ETHICS; MEDICAL LIABILITY; NEEDS ASSESSMENT; PATIENT CARE; PATIENT SAFETY; PATIENT SATISFACTION; PATIENT TRANSPORT; PHYSICIAN ATTITUDE; POLITICS; PRIORITY JOURNAL; PROFESSIONAL DEVELOPMENT; REVIEW; SCREENING; SOCIETY; TREATMENT REFUSAL; UNITED STATES;

EID: 33746303535     PISSN: 07338627     EISSN: 07338627     Source Type: Journal    
DOI: 10.1016/j.emc.2006.05.003     Document Type: Review

References (61)

1. Crawshaw R., Rogers D.E., Pellegrino E.D., et al. Patient-physician covenant. JAMA 273 (1995) 1553
2. 42 USC §1395dd.
3. Himmelstein D.U., Woolhandler S., Harnley M., et al. Patient transfers: medical practice as social triage. Am J Public Health 74 (1984) 494-497
4. Schiff R.L., Ansell D.A., Schlosser J.E., et al. Transfers to a public hospital: a prospective study of 467 patients. N Engl J Med 314 (1986) 552-557
5. See generally Rothenberg KH: Who cares? The evolution of a legal duty to provide emergency care. Houston Law Review 1989;26:21.
6. Bitterman RA. Providing emergency care under federal law: EMTALA. American College of Emergency Physicians; Dallas, TX: 2001. A supplement addressing the impact of the new 2003 EMTALA regulations was published in May 2004.
7. Derlet R.W., and Hamilton B. The impact of HMO care authorization policy on an emergency department before California's new managed care law. Acad Emerg Med 3 (1996) 338-344
8. Wood J.P. Emergency physicians' obligations to managed care patients under COBRA. Acad Emerg Med 3 (1996) 794
9. New Jersey Medical Society. Instruments of Association of the New Jersey Medical Society (1766), New Jersey Medical Society, New Brunswick (NJ)
10. American Medical Association Code of Ethics [emphasis added]. In: Baker R, editor. The codification of medical morality: historical and philosophical studies of the formalization of medical morality in the eighteenth and nineteenth centuries. Dordrecht (the Netherlands): Kluwer Academic Publishers; 1995:75, 86.
11. American College of Emergency Medicine (ACEP). Code of ethics for emergency physicians. Ann Emerg Med 30 (1997) 365-372
12. Bitterman R.A. A critical analysis of the federal COBRA hospital "antidumping law": ramifications for hospitals, physicians, and effects on access to healthcare. University of Detroit Mercy Law Review 70 (1992) 125-190
13. Hyman D.A. Patient dumping and EMTALA: past imperfect/future shock. Health Matrix J Law-Medicine 8 (1998) 29-56
14. Council on Ethical and Judicial Affairs, American Medical Association. Ethical issues in managed care. JAMA 273 (1995) 330-335 The council maintained that physicians, no matter what their payment (or managed care) structure, must remain primarily dedicated to the care of individual patients
15. 131 Congressional Record 13903 (October 23, 1985) (statement of Rep. Pete Stark).
16. McCaig LF, Burt CW. National Hospital Ambulatory Medical Care Survey: 2003 Emergency Department Summary. Centers for Disease Control, Division of Health Care Statistics, 2005. Available at: www.cdc.gov/nchs. Accessed May 28, 2005.
17. Hudson T. New patient transfer amendments pose problems for hospitals. Hospitals 3 (1990) 46-49
18. Sade R.M. Medical care as a right: a refutation. N Engl J Med 285 (1971) 1281
19. Elias P.H. Physicians who limit their office practice to insured and paying patients. N Engl J Med 314 (1986) 391
20. Baker R.B. American independence and the right to emergency care. JAMA 281 (1999) 859-860
21. Scheck A. No emergency? Go elsewhere. Emergency Medicine News 28 (2005) 1, 20, 21
22. th Cir 1997).
23. 42 CFR 489.24;42 CFR 489.20 (EMTALA regulations) Emphasis added. See 68 Fed Reg 2003;68:53,221-64. The new regulations were effective November 10, 2003.
24. Pellegrino E.D. Character, virtue, and self interest in the ethics of the professions. J Contemp Health Law Policy 5 (1989) 53-73
25. Osler W. Equanimities with other addresses. 3rd edition (1932), Blakeston Company, Philadelphia
26. Black's Law Dictionary. 8th edition. Eagan, MN: West-Thompson; 2004.
27. Bailey J.E. Asklepios: ancient hero of medical caring. Ann Intern Med 124 (1996) 257-263
28. Ring J.J. Past President, American Medical Association. Letters to the editor. JAMA 274 (1995) 1265
29. Statement of Sen. Durenberger. 131 Congressional Record 13903 (October 23, 1985).
30. 42 USC §1395dd(d).
31. Without the voluntary participation by hospitals, EMTALA would be a violation of the 13th Amendment, the prohibition against slavery or indentured servitude, and the "taking without just compensation" clause of the 5th Amendment.
32. McCaig L.F., and Nghi L. National Hospital Ambulatory Medical Care Survey: 2000 emergency department summary (2002), US Department of Health and Human Services, National Center for Health Statistics, Hyattsville (MD) 326:1-32
33. Bureau of the Census. Health insurance coverage, 1997 (1998), Government Printing Office, Washington (DC) 60-202
34. In: Fields W. (Ed). Defending America's Safety Net (1999), American College of Emergency Physicians, Dallas (TX)
35. Lambe S., Washington D.L., Fink A., et al. Trends in the use and capacity of California's emergency departments, 1990-1999. Ann Emerg Med 39 (2002) 389-396
36. Derlet R.W. Overcrowding in emergency departments: increased demand and decreased capacity. Ann Emerg Med 39 (2002) 430-432
37. See generally Kuttner A. The American health care system: health insurance coverage. N Engl J Med 1999;340:163-8.
38. Balanced Budget Act of 1997 (Public Law 105-33).
39. Medicare Prescription Drug Improvement and Modernization Act. (Public Law 108-173, December 8, 2003).
40. Burt C.W., and Arispe I.E. Characteristics of emergency departments serving high volumes of safety-net patients: United States, 2000. National Center for Health Statistics. Vital Health Stat 13 (2004) 155
41. Weissman J.S. The trouble with uncompensated hospital care. N Engl J Med 352 (2005) 12
42. Kane CK. Impact of EMTALA on physician practices. AMA Center for Health Policy Research; Washington, D.C.: 2004.
43. Connolly C. Some finding no room at the ER: screening out non-urgent cases stirs controversy. Washington Post, April 26, 2004, p. A01.
44. Rapaport L. MedCenter to steer patients away. The Sacromento Bee, February 4, 2005.
45. American College of Emergency Physicians. Code of ethics for emergency physicians. Ann Emerg Med 30 (1997) 365-372
46. ED screening changes put pressure on competitors. ED Management, April 2005, p. 40-2.
47. Truhe J.V. Uncompensated care for nonresidents-an emerging fiscal and policy minefield. In-House Counselor (American Health Lawyers Association) 6 (2000) 6
48. Marx J.A. The rightness of emergency medicine. J Emerg Med 27 (2004) 307-312
49. Pellegrino E.D. Character, virtue, and self interest in the ethics of the professions. J Contemp Health Law Policy 5 (1989) 53-73
50. General Accounting Office. Impact of EMTALA on hospital emergency departments, the delivery of emergency care, and CMS/OIG enforcement. GAO-01-747 (June 22, 2001)
51. Wanerman R. The EMTALA paradox. Ann Emerg Medicine 40 (2002) 464-469
52. Bitterman R.A. Explaining the EMTALA Paradox. [editorial]. Ann Emerg Med 40 (2002) 470-475
53. General Accounting Office. Medical malpractice: implications of rising premiums on access to health care. GAO-03-0836 (August 2003)
54. Iglehart J.K. The uncertain future of specialty hospitals. N Engl J Med 352 (2005) 1405-1407
55. Iglehart J.K. The emergent: a physician-owned specialty hospital. N Engl J Med 352 (2005) 78-84
56. Robert Wood Johnson/ACEP Survey of ED Directors: On-call specialist coverage of US emergency departments. September 2004. The RWJ/ACEP Survey confirms empiric evidence that CMS's recent on-call regulations only accelerated physician and hospital abandonment of on-call services, increased the risk of harm to patients needing specialty care, caused more delay in patient access to specialty care, and increased the number of patient transfers.
57. 42 USC 1395cc (a) (1) (I) (iii).
58. American Medical Association. Code of ethics. In: Baker R. (Ed). The codification of medical morality: historical and philosophical studies of the formalization of medical morality in the eighteenth and nineteenth centuries (1995), Kluwer Academic Publishers, Dordrecht (the Netherlands) p. 75, 86
59. Reinhardt W.E. For-profit enterprise in healthcare. Institute of Medicine 210 (1986) 213
60. Kassier J.P. Our endangered integrity-it can only get worse. N Engl J Med 337 (1997) 1666-1667
61. Kassier J.P. Managing care-should we adopt a new ethic?. [editorial]. N Engl J Med 339 (1998) 397-398