The Bush administration plans to alter a 1986 law requiring hospitals to examine and treat people in need of emergency care regardless of their ability to pay, making it more difficult for some low-income people to access emergency services, including those suffering from AIDS-related complications, The New York Times reports. The 1986 Emergency Medical Treatment and Labor Act requires any hospital that participates in Medicare and offers emergency services to provide emergency care to anyone needing it. The rule states that anyone seeking emergency care on hospital property, even hospital departments not on the main hospital site, must be given an examination and provided with treatment to stabilize their condition regardless of whether the patient has health insurance or the ability to pay for the services. Hospitals that violate the law can be sued by patients, fined up to $50,000 per violation, and be prevented from participating in Medicare. Over the past four years the government has collected more than $4 million in fines from physicians and health centers that violated the law.
Hospitals have claimed that the old regulation is too costly and cumbersome for them to handle, and the Bush administration's changes to the law are designed to expand the situations in which hospitals and their departments are exempt from the regulations. The changes, which take effect on November 10 and will be formally announced in the September 9 edition of The Federal Register, limit the definition of hospital property to exempt sites off main hospital campuses that aren't specifically licensed as an emergency room; exempt doctor's offices, rural health clinics, nursing homes, and other "non-hospital entities" from the requirements; state that the law no longer applies to any person admitted to the hospital after receiving emergency care; allow hospitals to no longer have doctors on call 24 hours a day, seven days a week for emergency care; allow hospitals to exempt senior staff members from being on call to treat emergency room patients; and allow doctors placed on call to have simultaneous on-call duties at two or more hospitals or to schedule other procedures, including elective surgery, while on call.
Patients denied emergency care are still permitted to sue hospitals under the new rules, but the changes also give the hospitals stronger defenses against such lawsuits, the Times reports.
Federal health officials say the changes to the law will help reduce the costs for hospitals and doctors that must comply with the regulation without affecting the quality of or access to emergency care for low-income and uninsured patients. But not all doctors are pleased with the changes. Robert A. Bitterman, an emergency room doctor in Charlotte, N.C., told the Times that the new regulation could make it difficult for low-income patients to get timely access to specialists in emergency situations. "The new rule could aggravate an existing problem," Bitterman said. "Specialists are not accepting on-call duties as frequently as we would like. As a result, hospital emergency departments lack coverage for various specialties like neurosurgery, orthopedics, and ophthalmology."