Monday, August 04, 2008

Should EMTALA be reserved for Legal US residents and visitors only ?

As I've mentioned, all US hospitals with an ER, both for- and non-profit, are required to provide emergency services to all patients regardless of insurance status. In an article riddled with mischaracterizations and quasi-facts, Robert F Protectionist asks if US hospitals should be allowed to refuse care to undocumented immigrants.

EMTALA. The Emergency Medical Treatment & Active Labor Act is the law requiring US hospital emergency rooms to treat ALL those arriving with an emergency. Currently, ALL includes illegal aliens.

It's widely assumed that US hospitals are reimbursed for costs associated with , EMTALA but are they getting enough reimbursement ? According to medical lawyer Madeline Pelner Cosman, "By spring 2005, 84 California hospitals had either declared bankruptcy, or were closing, because they were losing too much money due to indigent illegal migrant care. (1)

Having something to do with that, perhaps is the abuse of the law by "illegal aliens who specifically come to the United States to obtain health care. In fact, Mexican government documents provide details about this law and describe it as a benefit available to its citizens who travel illegally to the United States" writes Colorado Congressman Tom Tancredo (2). Dr. Cosman also writes "Illegal alien women come to the hospital in labor and drop their little anchors, each of whom pulls its illegal alien mother, father and siblings into permanent residency simply by being born within our borders." (3) (4) Also interesting to note, "Under EMTALA, any doctor or hospital that refuses to treat an 'emergency' case is subject to a $50,000 fine. (5)

The ramifications of EMTALA are serious. Our already troubled healthcare system is being traumatized by the additional cost of millions of illegal aliens having access to it, and without paying anything into it. American citizens are harmed by higher medical costs, higher insurance rates, less hospital beds available (I experienced that personally twice in the last 3 years), and lost services, whereby those reimbursement dollars could have been spent elsewhere (anti-terrorism, education, environment, highways, etc.) In addition, the health of Americans can be harmed by the overload on hospital care reducing the quantity and quality of care for each patient.

A lesser known, lesser mentioned problem also is the effect on the poor in Mexico. Whereas Mexicans who travel to the US and get these services are better off, their poor brethren, in Mexico, are made worse. The more help that's given to illegal aliens here, the less help is bestowed in Mexico, while Mexico's greedy rich, paying a miserly 10% annual income tax use this as a safety valve to perpetuate their national neglect. Are we aiding and abetting neglect there by providing care here ?

Is this issue really only as simple as "let's help everyone who needs it" ? Any suggestions about what could be done about EMTALA ? Perhaps providing care but that being followed by immediate deportation ? Revocation of the 14th amendment granting citizenship by birth geography (never intended by its authors to be used to bypass immigration laws) ? Any ideas ??????????

(1) Madeline Pelner Cosman, "The Seen and Unseen", Journal of American Physicians and Surgeons 10, no. 1 (Spring 2005).

(2) Rep. Tom Tancredo, "In Mortal Danger", Cumberland House pub., 2006, Chap. 15 page 164.

(3) Cosman, Ibid.

(4) Pat Buchanan, "State of Emergency", St. Martin's Press, 2006, Chapter 3, pg. 31.

(5) Ibid.

As regards the first source, it is definitely true that treating undocumented patients can be a burden on hospitals. However, they definitely aren't the only thing causing hospitals to close. And recent data indicates that their ER use is lower than for citizens.

Undocumented immigrants are primarily here because economic opportunities are better than in their home countries. Trying to cut them off from what few social services they can access will not stop them from trying to work here.

Additionally, requiring hospitals to determine citizenship or legal residency imposes costs through additional administrative requirements. And especially vulnerable Americans, like persons with mental illness, those who are homeless, or the poor in general, may have difficulty producing the needed documentation. This will delay their receiving care, which will cause their conditions to worsen.

Lastly, there's the ethical issue. EMTALA effectively defines emergency care as something close to a human right in the United States. It would be deeply unethical to leave someone to die if a hospital could at least stabilize them.

I somehow doubt the author of the above screed is in the healthcare industry or has any significant knowledge of that industry. However, it is very human to feel resentment at the issue of undocumented immigrants, especially when there aren't really enough resources to go around. Even if state or federal laws were passed to provide compensation to hospitals for treating the undocumented population, there wouldn't quite be enough money to even cover their costs. This is an issue that has to be dealt with, which is probably all that Bob and I agree on.

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