Emergency rooms are not supposed to refuse service.....

[tyedyeto]

but they do.

Sorry mods as this is an extension of a locked post, but I have seen ER's who will send people elsewhere when they find you don't have insurance. Or send you miles away to somewhere who will, only to have your credit rating checked and then denied services.

Did you ever consider the OP may not be welcome at an ER?

The OP of the earlier thread was NOT seeking medical advice, just looking for discussion about the disparity of HEALTH CARE in the United States. If I had the same symptoms as the OP of that thread, I could not AFFORD to seek the medical care necessary even though I have insurance.

[napi21]

1. I don't know about where you are, but I can tell you about Ga. and Pa.

The only time anyone is ever turned away from and ER is if the ER has been inundated with emergencies from some tragedy and simply CAN'T handle anymore cases at that time. I used to live in Pa, and have a very close friend who is a manager with the largest HC system in Pgh. I talk to her all the time, and they NEVER turn anyone away, and certainly not because they can't pay!

[tyedyeto]

2. What kind of hospitals/ urgent care facilities are those?

Many facilities will not take anyone 'off the street'. You have to go to certain facilities if you have no health care insurance. Often patients will be in 'waiting rooms' for hours only to be told to go to a different facility.

Would you get discouraged?

[napi21]

5. I'm talking aobut the local hospitals in both States.

North Ga. Hospital System & UPMC in Pgh, Pa. That just doesn't happen in either.

[papau]

3. 1986's Emergency Medical Treatment and Active Labor Act says they can not refuse

The Federal Emergency Medical Treatment and Active Labor Act (42 U.S.C. § 1395dd, EMTALA) is a United States Act of Congress passed in 1986 as part of the Consolidated Omnibus Budget Reconciliation Act. It was designed to combat the practice of "patient dumping" - refusing to treat people because of inability to pay or insufficient insurance, or transferring or discharging emergency patients on the basis of high anticipated diagnosis and treatment costs. Hospitals that both accept Medicare and advertise emergency room services are statutorily required to provide appropriate screening examinations to determine whether emergency medical conditions exist, regardless of patients' ability to pay. Where emergency conditions are identified, EMTALA further requires the hospital to stabilize the patients.

Hospitals not accepting Medicare may still be required to accept non-paying patients if State Law says they must.

However they can tell ambulance that the ER is filled and direct it to go to some other hospital.

Also any patient that is in stable condition may have a right to a hospital, but the MD can refuse care to any such patient they do not feel like taking care of, unless state law says otherwise.

[papau]

6. That is also how I read the Federal law for Hospitals that accept Medicare dollars n/t

n/t

[Horse with no Name]

9. What they said.

I had the window open and didn't see your response. Spot on.

[Czolgosz]

42. As Secretary of H&HS, Tommy Thompson changed the internal rules so pregnant women in labor and their

newborns no longer have any real rights under EMTALA.

It used to be that anyone at the hospital in an emergency condition could not be dumped, now EMTALA only applies only if you come to the emergency room and aren't shifted to another hospital unit so once a laboring mom is shunted off to the labor and delivery unit instead of the ER, she can be left in the labor and delivery waiting room to deliver the baby herself. Also, EMTALA no longer applies if you call ahead and make an appointment - now you must just show up at the ER in an emergency medical condition. Finally, and most dangerously, EMTALA no longer applies once the hospital gets you "in process" by starting (but not necessarily completing) the paperwork so once you start to fill out the paperwork you can sit in the ER waiting room for a whole day while you bleed to death and, because the hospital got you "in process" by starting the paperwork, you have no rights under EMTALA.

Under Clinton and Shalala, EMTALA was a real health care safety net for acutely ill and mid-labor uninsured patients.

Under Bush and Thompson, EMTALA is just another batch of papers for the hospital to fill out.

[RB TexLa]

4. It's only life threating care they can not refuse

you can't go to an ER and demand treatment you can't afford for a condition that is not immediately life threatening. And once they have treated a life threatening issue they are going to have you transported to a public facility.

[Horse with no Name]

7. Let's be a little more forthcoming here

ANY ER that accepts federal funding (Medicare is FEDERAL, MEDICAID is FEDERAL) has an OBLIGATION to stabilize someone before sending them on to another facility.
Does this mean that for every snotty nose and stomach ache they are going to treat you? No.
But, by FEDERAL law you will be triaged and dealt with accordingly.
IF you are SICK such as that poster claimed to be, they WOULD be seen in ANY ER that accepted federal funding.

[uppityperson]

8. OP of other thread started by saying had serious illness.

Of course people will express sympathy and give advice. Welcome to the caring side of DU.
Edited to add that I won't bother repeating what the other posters have said here about ERs. Yes I will. It depends on if they get federal funding and who cares if you are "welcome" in an ER, ERs are meant to keep you from dying. You want to be "welcome", go visit friends.

[tyedyeto]

10. My bad for being logical when the Op said was NOT seeking med. advice

I tend to take that literally.

I have known people with non-life threatening illnesses who have been denied treatment at health care facilities... all based in their inability to pay. To me that is what the earlier discussion was all about.

[uppityperson]

12. my bad for expressing sympathy and concern.

Read other posts about ERs. I risked my baby's life because I couldn't afford to get child seen when a baby. I swore never again and work to get health care affordable and accessible.

[tyedyeto]

24. Where is one to go when they may not have 'life threatening' symptoms...

have no insurance and cannot afford to pay both the physician's fees and the prescriptions that could help their symptoms?

Personally, I am barely over the 'poverty' level, have insurance with a high deductible and could not afford to pay any of these fees, whether they are from an ER or a Doctor's office.


So, what does one do when they are left with so few options?

BTW, I've written my Senators but both neither McCain and Kyl of AZ seen to care about health care in this country since I've never received a response from either one about this issue.

[Horse with no Name]

27. THAT is where the real breakdown is

and there aren't any answers.
My best advice? Lie.
You got a headache? Walk in and tell them that it is the WORST headache you have ever had.
You got a fever? Walk in and tell them it has been 105.
You coughing? Congested? Walk in and tell them you are having trouble breathing.
I'm sorry...that is the best advice I can offer. The system is really broken and it is broken the worst right here.

[Roon]

33. I walked into a packed ER last week

complaining of fever, night sweats, body aches, cough, and I told them I had aids. They stuck me in an exam room almost immediately. I didn't lie of course, but it sure was nice to be able to lay down right away. I thought I was going to have to sit in a chair for two hours before I could be seen. UGH!!!

[Horse with no Name]

35. I hope you are feeling better

:hug:
There are keywords that put you at the front of the line.

[Roon]

39. Thanks horse

I guess I should also mention that they didn't know about my insurance status at that point. Although I do gave medicade/care.

[uppityperson]

50. 1 option I found out about is talking with billing people about sliding fee

most places have a thing where they will deduct 1/2 if you are low income enough. It still adds up and the whole thing is wrong. I had some labwork (blood) done recently and didn't know if my insurance would cover it. I talked with billing person and found out about the "we'd rather get some than none" plan. So I got the labwork done. They billed insurance for (random numbers for example) $500, ins paid $125, lab wrote off remainder. Now, if ins hadn't paid, I'd have been stuck with $250 (after filling out intrusive paperwork to prove my income).

This was not ER, but medical system and it is really maddening.

I am glad for my ins, did not have any for yrs and figured I'd have to declare bankruptcy or file for medicaid (right) or some such if something bad happened. Or just avoid needed care. Having no money, no income, no insurance, baby with croup, walking around in the cool night air watching to see if baby turned blue or could breath, really really really pissed me off. I called doctor the next day and they told me to never do that again but take baby to ER. I asked how the hell could I afford it, they said how the hell could I afford to have my baby die. Sometimes we don't want to think things are as bad as they are, avoid getting the help we need because we will have to deal with the bs.

I have been there and am still living close enough to the edge that I don't know if I can afford insurance when Jr gets out of college and we lose the dependent child status (sliding scale insurance based on family # and income, have to fill out papers at least every yr to stay on it, usually some stupid month like Nov. I wish they would wait until the end of the yr and when we did taxes).

[Horse with no Name]

15. The MORTALITY rate for pneumonia is 10-25%

It is the SIXTH leading cause of death in the United States.
It is THIRD most frequent reason for hospitalization.
>>>snip
For patients who require hospitalization for pneumonia, the mortality rate is between 10% and 25%. If pneumonia develops in patients already hospitalized for other conditions, the mortality rates are higher. They range from 50% to 70% and are greater in women than in men.
http://adam.about.com/reports/000064_3.htm

The DISCUSSION was about trying to get a critically ill person to take themselves to the hospital. Period.

[Richard Steele]

16. I saw that thread, and it seemed pretty clear to me...

...that the OP wasn't really looking for any actual DISCUSSION, either.

[EFerrari]

22. Maybe acknowledgment would have been welcome, though.

Poverty is a funny thing. It isolates you. You mostly seem to begin speaking a language other people can't hear or understand, even people who were fine with you yesterday. Sometimes an "I gotcha" means a lot.

[Richard Steele]

37. I know.

And that's all I have to say about that.

Please don't ever ask.

[EFerrari]

38. Okay.

:pals:

[Richard Steele]

43. Thanks. I really do appreciate it.

:pals:

[EFerrari]

14. I don't think that by "welcome" anyone means greeted with flowers.

I guess you have to be really poor and really sick and really alone when the system tries to shake you off because there is no oversight to really understand what being "unwelcome" is like.

It's a nice way of saying, "they didn't give a shit if I died in the parking lot because then I couldn't sue them."

:(

[uppityperson]

20. And sometimes people mistake the coldness of ERs as uncaring.

Yes, they can be unwelcome, can not care if you live or die.

I have heard from people that ERs are unwelcoming, but, working there, I am busy doing what needs to be done. I don't have time to be welcoming if dealing with life/death/triage stuff. On the other hand, I have tried to make people feel welcome because it is a cold and scary place during a time of high emotions.

A 21 yr old relative died because didn't go to ER, had diabetes complicated post flu pneumonia and didn't want to bother the doctor any more than necessary. So died instead. Felt had bothered them so much due to other diabetes things that wasn't welcome to pop in for treatment.

[EFerrari]

23. I totally agree that people who resort to the ER are not at their

most rational.

But ERs routinely turn people away no matter what the law says.

That's no reflection on the overloaded clinicians who do the actual health care. That's a business decision and pretty much, public policy that we just don't talk about.

[Horse with no Name]

26. The hospital that I worked for had a self-funded insurance plan

Which basically meant that anytime you used it, the funds came out of the hospital pocket.
I took my 18-month old to the ER one night with 106.1 temperature.
They gave her Tylenol and cool baths and then were going to send her home. The hospital wasn't going to pay for anymore than they had to.
I BEGGED the Doctor to run an RSV test because we were overrun with it in the unit I worked.
He refused, said she didn't have the symptoms of RSV.
I worked in Pediatrics so I went up to the floor after we left the ER. My Unit Manager was a Pediatric Nurse Practitioner. She looked at my baby and IMMEDIATELY called the Physician that was the Head of Pediatrics.
He sent us back down to the ER and told me to wait for him to get there. They were PISSED that we were back.
The Doctor found out that this particular physician was on his way to see my child so he came back to try to "run some more tests".
I told him No thank you.
Dr. Boren got there and IMMEDIATELY admitted her to the hospital under an oxygen tent and with Ribavirin (back in the dark ages when we still used that poison). Turns out she had a particularly bad strain of RSV Pneumonia. Was in the hospital for almost two weeks.
The system tries to shake you off no matter what. More so when you are uninsured--and Lordy I have been there.
I was so sick once when I was uninsured that I went to two different hospitals trying to get them to do something. Turns out I had pneumonia. I stayed sick for two months. I totally understand the plight. Sometimes though, you just have to work the system.
And it ain't easy because the sad truth is that very few that are in the position to help you are WILLING to help you. The second trip to the ER for my pneumonia I BEGGED the Doctor and the Nurse to do something. Neither of them did.
Sadder still, I work with those people but I have NEVER told them that I remember how shitty they treated my because I didn't have insurance.

[EFerrari]

28. The real catch is, when you need them the most, you tend to be

the least able to navigate.

:(

I sure don't mean to disparage health care workers. I don't know how you all manage.

But people like Bobbie and me and so many are on our own, lol, literally. I get up every morning hoping nothing goes wrong and you know how good that kind of insurance is.

[Horse with no Name]

30. I know.

I see it everyday.
People shouldn't have to live worrying about dying. :hug:

[EFerrari]

31. I'm sorry to be such a pain. So many fires, so little time.

:hug:

[Horse with no Name]

Not a pain

Love ya.:hug:

[Horse with no Name]

11. There are certain things that cannot be turned away

1. Chest pain
2. Difficulty breathing
3. Worst headache I have ever had in my life
4. Fainting
5. High fevers
6. Seizures

These are among the things that CANNOT be turned away.

[EFerrari]

13. They tried to turn me away with a head injury. I had to call a friend

to be a witness and then got grudging care only after she was there.

Well, I guess I was a grudging patient, too. I didn't want to be there.

This system is insane.

[Horse with no Name]

17. I totally agree it is insane

which is why I just gave a list of things to get your foot in the door.
Head injuries, for some reason, have a tendency to get overlooked, even though 24 hours later that person could be dead.:(

[EFerrari]

19. Bobbie is right. We have to work on this. n/t

[uppityperson]

21. The system is broken. copy/pasted from another topic

The healthcare system is broken. The medical system sucks. Providers are pushed to see more and more, actually do less and less and let more and more go by. Patients wait longer and longer, hard to find providers who will take your insurance or be anything affordable if no insurance. Insurance costs going up up up and ins companies dictating what care can be done. Big Pharm pushing drugs more and more and overworked providers falling back on basic bandaid treatments.

It is all bad.

[EFerrari]

25. The last time I went to an ER after my schizophrenic partner

had an episode and my body got in the way, I was triaged and bad as I was, there were 17 hours of worse off people ahead of me. :(

SF General has a fantastic ER staff, one of the best I'm sure, but the wait can kill you.

Thank you, BushCo!

/oops

[tavalon]

18. EMTALA laws forbid that

If the hospital gets caught, it is a $50,000 fine for each violation and the possibility of losing medicare/medicaid funding. JHACO doesn't look kindly on it either. I'm not saying it doesn't happen but it doesn't happen as much since this law came into effect.

[EFerrari]

29. We've seen no improvement here.

And people are not overtly turned away. It's a war of attrition. Make a really sick person uncomfortable enough, they will move on out of instinct.

Same with our community clinics. On paper, we have many in this city. In practice, you're looking at a very very very long wait.

[DU GrovelBot]

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[Luna_C_06]

34. How is bobbolink doing?

I'm worried about her.

[Richard Steele]

54. Unknown, but I feel I can safely say...

....not well.

By your standards, she's not doing very well at all.

[Luna_C_06]

57. Damn...

I wonder if there is some bug going around. For the past 2 days I've done nothing but throw-up (sorry to be so gross). And on top of that I'm a type 1 diabetic. Hello 300 plus blood sugars!

[boobooday]

36. Or they could just leave you in the waiting room until you die

I guess that isn't technically 'refusing' service . . .

http://www.latimes.com/news/local/la-me-king20may20,0,6057993.story?coll=la-home-center

[Cleita]

40. They admit you, but they don't do much until the insurance

person comes around to evaluate your financial health first.

[EFerrari]

41. And it can be very subtle. During my head injury fiasco

no one said, "Go away." They left me sitting in a room for hours. Then someone came in and told me they didn't treat those injuries and that I would have to go to a facility across town. My vision was blurring at the time. They asked me if I did drugs. And then, they went away.

They didn't help me figure out how to get to that facility across town. I was on my own. That's when I called a friend to come help me because obviously these people were not on my side in any way.

I kept the paper work. It's hilarious in a way.

My friend and I watched a back specialist help the attending doc read my scan. (I knew he was a back specialist because I worked for the company that leased him his clinic space.) The attending doc finally scribbled "Head injury" and recommended Tylenol on the form.

Whew! That was close!

[Cleita]

45. When my husband died,I had to call 9/11 while I was trying

to resuscitate him. We had ambulance, paramedics everything all the way to the emergency room, but while they were working on him, some lady came by with a clipboard and nicely started asking me for information. I was distraught and yelled that he was in the ET last week and that the information hadn't changed. She nicely backed off saying that this is what they needed to know.

:mad:

We need single payer universal health care now!

[EFerrari]

47. Yes, we do. I'm so sorry, hermanita.

:hug:

[Czolgosz]

44. Under Clinton appointee Shalala the poor had a right to treatment to stabilize the medical condition

Under Bush appointee and Republican also-ran Tommy Thompson, the poor now has a right to insist that the hospital start the process of filling out some paperwork.

[Horse with no Name]

46. I am not sure if it is just Texas

but several ER's have instituted triage teams consisting of an RN and a Physicians Assistant/Nurse Practitioner.
When they triage you and you don't have one of the things I mentioned above, they can do a couple of different things.
They can give you a prescription and send you on your way or they will give you a list of clinics--this applies to insured AND uninsured alike.
We have been debating this because some in our area are doing it. I think at this point that our hospital has concluded that just ONE lawsuit incurred from something being missed would make it cost prohibitive to do this.
I find that extremely scary because there is no doubt that there is a lot missed.

[Czolgosz]

48. That is exactly the sort of behavior that was an EMTALA violation under Shalala but was made legal

under Thompson.

In Texas, there is no real legal remedy for anything short of a deliberate act of abuse if it occurs in the ER. It used to be that the standard under EMTALA was whether the indigent person was given the same treatment as an insured person. Now, all the hospital has to do is either (1) screen the patient (and it doesn't matter if the screening process is done carelessly as long as it it isn't designed to deliberately harm the patient) or (2) start the paperwork for admission and the do nothing until the patient hives up and goes elsewhere.

[bobbolink]

55. Thank you so very much for taking the time and energy to followup with REAL information.

Sadly, not many want to hear what you are saying.

It's so much easier to blame victims.

Your posts have meant a lot to me.... at least knowing that ONE person hears!

:hug:

[EFerrari]

49. It doesn't work in cities. I'm really not exaggerating when I say

I sat there for 17 hours. And that's not to mention all the times I just didn't go in because I didn't have 17 hours. :(

And I'm sure that SF General has a great triage team.

There are just too many people with nowhere to go.

[Czolgosz]

51. But it DOES work in cities; it works exactly as Thompson intended it to work to benefit hospitals

[EFerrari]

52. You have a good point there.

[Czolgosz]

53. The big hospital corporations dictated Thompson's new EMTALA regulations just as Big Oil dictated

the Cheney administration's energy policy.

[bobbolink]

56. How 'bout some recommends for an important topic?!

There is important information here.... how bout rating this up?!