Brian Kamoie

Finding a Way through the Hospital Door: The Role of EMTALA in Public Health Emergencies:

his article examines the Emergency Medical Treatment and Labor Act (EMTALA) in a public health T emergency context. Congress enacted EMTALA in 1986 to prohibit the practice of “patient clumping,” which involved hospitals’ refusal to undertake emergency screening and stabilization services for individual patients who sought emergency room care, typically because of insurance status, inability to pay, or other grounds unrelated to the patient’s need for the services or the hospital’s ability to provide them. But in fact EMTALA, whose conceptual roots can 1x found in the Hospital Survey and Construction Act of 1946 (Hill Burton) as well as an evolution in both the common law and state statutes related to hospital licensure,’ can Ix viewed 21s having a far broader purpose than protection of individuals, and indeed, one that is related to the protection of communities and the public health. it is this Iiroader purpose with which this article is concerned. EMTALA imposes on all Medicare-participating hospitlls a singular, legally enforceable duty of care, entitling all individuals who seek care at hospital emergency departments to an appropriate (i.e., non-discriminatory) examination and to either stabilizing treatment or a medically appropriate transfer if an emergency medical condition is identified.2 The duty to screen and treat is vimially absolute, although somewhat circumscribed in recent years through judicial and regulatory action.’ So definitive are the undertaking duties that fall within the ambit of EMTALA that courts have held hospitals and physicians to a duty of emergency intervention and rescue even in cases when treatment can he considered medically futile!

Managed Care and Public Health: Conflict and Collaboration

Achieving the basic public health goal of protecting the public against population health threats for which there are effective medical interventions depends upon a viable working relationship between public health and managed care. The central public policy question in the coming years is whether and under what circumstances the basic characteristics of the modern approach to American medical care delivery and financing will give way to certain basic imperatives in public health.