April 5, 2011
It was called "dumping." Very simply, prior to the implementation of the Emergency Medical Treatment and Active Labor Act of 1986, a patient coming into a hospital emergency department often had no right to treatment or even evaluation, no matter how dire his or her condition. If patients could not prove that they had the resources to pay for care, they could be turned away or sent elsewhere—sometimes in a taxi, or on foot. They often suffered adverse health consequences and sometimes they died.
"Indefensible" is an appropriate term. Ron Anderson, M.D., CEO of Parkland Memorial Hospital in Dallas, was the director of the emergency department at Parkland in the 1980s, and he knew all about dumping. "I would see patients transferred with knives still in their backs, or women giving birth at the door of the hospital, simply because they were uninsured."
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Parkland recorded calls from transferring hospitals. In one, a physician said he wanted to transfer a woman with heart failure who was in the ICU. When the Parkland physician asked for more information, the other physician replied, "She does not have any insurance, the hospital does not want to take care of her, OK? This is a private, capitalistic, money-making hospital"
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EMTALA represented the first time that anyone other than prison inmates gained an affirmative right to treatment. "Before EMTALA, patients only had rights if they were already in care in hospitals. They had the right to refuse treatment, the right to change physicians, and the right to walk away, but they had no right to care in the first place. This was the first recognition of a patient's general legal right to receive health care,".
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Mariner concludes, "EMTALA changed the baseline. It changed the expectations of both patients and physicians, and the concept of what people are entitled to."
And from Anderson, who fought so hard and for so long to do something about the dumping: "I think getting EMTALA passed may be the most important thing we ever did. It was and is a moral imperative."