Thursday, March 15, 2012

EMTALA, the Ebola of Modern Health Care

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Well, at least for the middle class it is the equivalent of the ebola virus.

This is the last post, completely rewritten

Locally on the Medicare and Health Plan front I learned something the other night after falling into an unmarked and uncovered culvert drainage basin, and slamming my right shoulder full force of my body weight in a drop of four feet, onto a solid rock face.. This was after the tow truck had carted my now destroyed vehicle up on to the platform, and I was asked to get into the passenger side of the truck. Rock falls happen, right before your very eyes and too late to stop. 2/10th of a mile up towrds NSJ from SYR Bridge. Only uncovered such basin, less than 4 feet from the fog line.
Suffice it to say, shoulder was damn good and sore, hardly movable, and so a trip to Sierra Nevada Hospital was in order. I checked with United Health Care, my primary provider, and ask specifically if the ER at SNMH was “in network.” They assured me it was.
I arrived and went through the intake process, with only one other mother daughter with a fever in the waiting room. I was initially identified via computer (I’d been there some years before) and pronounced fiscally fit. Even so I inquired to make doublke triple sure that I wanted this whole visit on my UHC account, with me paying a 15% co-pay. I was told they would only discuss it at the “end of the visit” I then went to a nurse who summarized my problems and called a doctor to see what should happen next.
Xrays, 1, 2, and 3. Off to the xray area, click click click, very modern digital xrays, fast results, cool. Nice technician as well. She now walks me quite a ways through the maze that’s under SNMH, to an area called: “area 2″ and marked Urgent Care. I spent quite a long time sitting there, I had arrived at 6:30. I may have even gone to sleep. The lady again has me sign some more papers, which I assume are the standard liability releases.
Then finally the doctor calls me in to the back area of area 2, and as I pass through the door I notice a sign stating that the physicians here are all independent contractors, and separate from the hospital, financially.
All the alarm bells go off in my head.
I ask point blank if this means that he is NOT part of the ER, even though he is the first doctor I get to see “in ER?”? And will I get a separate bill, ? Yes.
So we haggled. And I learned that the xrays were also “not part of ER.” As the doctor put it, the system is totally broken. I have to agree. I got out at 9:30, the waiting room was packed.
As for not stating the costs up front, there’s a crazy set of laws abbreviated as EMTALA. Buried in the middle of this is a prohibition about telling the patients anything about costs until the patient’s condition is “stabilized.” This is so they won’t go away untreated, supposedly. In my case I couldn’t be considered “stabilized” until after the xrays had been taken, and I too had been taken, but in this case by the hospital having to live up to the law. EMTALA was total news to me, to be discovered as outlined below, and I suspect total news to my daughter as well, a newly minted MD in a large university teaching hospital.
For further information on this ghastly addition to “kill the middle class” laws, check out:
from Wikipedia. see for a whole lot more information:

My recommendation is that SNMH post the fact that they are bound by the terms of EMTALA, in the ER waiting room.  That way those of us with electronic communicators could check it out and get a heads up.

Now for the entertainment, compliments of a crazed world.

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