Even Patches of the Holes in the Safety Net Have Holes

A thirty-year-old uninsured woman came to the emergency department of a nonprofit hospital in a north Denver suburb, complaining of difficulty swallowing and breathing because of throat swelling. A computed tomography scan was performed, and she was found to have an abscess at the base of her tongue that was encroaching on her airway. The ear, nose, and throat surgeon on call was contacted, but he reportedly refused to see the patient because she was uninsured.

Denver Health then accepted the patient as an EMTALA transfer. Throat surgery, followed by a four-day hospital stay, yielded total hospital charges of $15,815.

This is not supposed to happen under EMTALA (Emergency Medical Treatment and Active Labor Act). Whether you’re insured or not, you should receive condition-stabilizing treatment at the first hospital with resources to provide it. A surgeon cannot legally refuse because of lack of insurance. But one did.

Now, this is an anecdote. The new Health Affairs article by Sara Rosenbaum, Lara Cartwright-Smith, Joel Hirsh, and Philip Mehler, the source of the quote above, includes several more, as well as a thorough analysis of the limitations of EMTALA. It’s worth a read. It would be more rewarding to have something like a complete (or representative) data set on EMTALA violations. None exist, which itself is troubling. The authors explain why.

If you think that everyone in this country is protected from the medical and financial challenges of a major health problem, you’re wrong. The safety net has holes. Even where we’ve patched it (EMTALA), closer scrutiny reveals more. We can do better. We really should.*

* Opinion, obviously.

[Cross-posted at The Incidental Economist]

Austin Frakt

Austin Frakt is a health economist and an assistant professor at Boston University's School of Medicine and School of Public Health. He blogs at The Incidental Economist.