The Death of the Emergency Room

The Death of the Emergency Room

If your local Emergency Room at the local Hospital went broke and closed – would you worry? That is what has happened to 84 California Emergency & Trauma Centers in the last 12 years, and is likely to accelerate even more. Why? Our Emergency Rooms are being stalked by a deadly predator…the Un-funded Government Mandate. Our elected officials join hands and chant, then pass new laws without regard to who will pay for the conformity to their law. This is called an un-funded mandate.

While EMTALA is not exactly a household name, nor a slogan for t-shirts and coffee cups, it stands for the Emergency Medical Treatment and Active Labor Act of 1985. What this lovely little piece of Federal Legislation does is compel hospitals and especially emergency departments (EDs or ER’s to you and I) to treat anyone, with any “emergency” who shows up regardless of their ability to pay for the services. This is not only folks who have no health coverage but a huge number of illegal aliens too, who routinely use the ER’s as their free clinics. EMTALA is an unfunded federal mandate.

EMTALA requires every ER to treat anyone with an emergency cough, emergency headache, emergency heart attack, emergency drug addiction or alcohol binge, emergency auto wreck, emergency mental problem, ( the list is practically endless) whether the recipient is here legally, or has any ability to pay. The fact is that the definition of an “emergency” is mandated to be vague enough to include almost any condition. Any patient coming to a hospital requesting care must also be treated until ready for discharge, or stabilized sufficiently to be transported to another facility. The Government backs up its bark with a nasty bite, in the form of stiff fines and penalties on any physician or hospital refusing to treat any “emergency” patient, even if the hospital or physician has declared the patient’s illness or injury non-emergency. This is a huge Strike One for Hospitals.

Imagine you own a clothing store, and the feds declare clothing to be a “universal right” of every citizen. They then decide that anyone who shows up in ratty clothing is to be given new clothing, regardless of their ability to pay. You, as a private business owner, have to provide anyone who comes through your door, with a fresh set of clothing, that you had to pay cash for from your wholesale supplier, and the reality is you cannot charge every third customer anything at all. That is what EMTALA does to our local ER’s.

You have two choices; one is to raise the prices on the clothing you sell to the other two thirds of your customers, even when these customers keep asking why the cost of clothing has risen so dramatically, or when the customers cannot afford to buy from you any longer, you have to close your doors for good. That is precisely what happened to 84 big ER’s and trauma centers in our State in the last 12 years.

Add to that, two more unfunded state level mandates, the new nurse-to-patient ratio law, and a another law requiring the retrofitting of hospital buildings to meet seismic standards.

The nurse to patient ratio law states that hospitals have a minimum number of nurses to cover patients, differing by area in the hospital. In emergency and trauma departments, a 1:1 nurse to patient ratio is required, and in Critical Care and Intensive care as well as Labor and Delivery, a 1:2 ratio. It’s rumored that many areas were understaffed with Registered Nurses in the past which prompted this law. Problem is, there is a huge nursing shortage now, and this new law only exacerbates the problem. What do Hospitals do? Hire as many Registered Nurses as possible to comply and sub contract with even more expensive contract nurses for the rest. This of course adds a huge cost to the ER and Hospital, without any way for them to charge more for these additional staff. Strict interpretation of the law requires these ratios to be maintained “at all times” and makes this law almost impossible to obey. This is “strike two” for the ER’s.

Seismic retrofits are hugely expensive for Hospitals and represent another unfunded mandate that is essentially “strike three” for our Hospital Emergency rooms in many cases.

The answers are as complex as the problems, but if we can alter the uninsured problem even a little it may relieve the financial pressures on our local Hospitals enough to avoid closing. Beware the unfunded mandate from the Government, as it has radically disastrous consequences for all of us.