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jimallyn
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Joined: 31 Jan 2003
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Location: Wenatchee, Washington, USA
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 Posted: Mon Jun 22, 2009 1:45 pm Post subject: |
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Hey Bob, you ever hear of the Emergency Medical Treatment and Active Labor Act? I came across it while trying to determine what the law said regarding emergency treatment. You may be interested in this summary of it:
| Quote: | | The most significant effect is that, regardless of insurance status, everyone in need of urgent medical assistance is now legally guaranteed to receive it. Currently EMTALA only requires that hospitals stabilize the emergency. |
(Emphasis added.)
Urgent medical assistance, Bob. Stabilize the emergency. That's it. Not offer complete treatment.
Anyway, I've got it on my list of things to do to contact the hospital in your area, Southwest Memorial Hospital, and ask them about their emergency room policies.
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bobf
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Joined: 17 Dec 2002
Posts: 1428
Location: Cortez Colorado USA
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| Posted: Mon Jun 22, 2009 1:51 pm Post subject: |
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| jimallyn wrote: | | bobf wrote: | | Right now Australia, Canada, UK, and the US are all in the top 20% so how can the US be so bad as it is reported. |
Just curious, Bob: does the U.S. rank higher than or lower than Australia, Canada, and the UK, all of which have universal health care plans? |
You are cutting a fine line here. Whether we are above or below UK, Australia, or Canada makes little difference. We are after all three and the range is all less that 10% apart with UK leading. We did get a top ranking in fastest service. The big difference is that we do not have some clerk deciding what we get and what we don't get. There is no rationing due to age. We have some of the best technologies available right here.
We pay more being who? Our government pays dam little for our medical stuff. Medicare barely pays anything toward the charges. Emergency Room law pay nothing toward charges. Read about Emergency Room as over half of the services go unpaid at all. For me and the wife the emergency room got a pittance as it was Medicare that paid.
And again I wonder about WHO that makes such a big deal about the ones that pay less are better. In reality, how can that be good. You only get what you are willing to pay for. That means that either the government or the individual must pay more to get faster, reliable, service.
I think that the plan Obama has been spouting would make some improvements. His plan as stated would not have any government individuals between the doctor and patients. He plans to help everyone have access to insurance. The big problem is the far left radicals in Congress don't like his plan and want to make it a government run medical business. I guess they don't read about the Euro countries that tried that and have since reverted to private practices doing the medical things. Reasons being slow service, expensive, rationing, insufficient help, insufficient facilities.
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jimallyn
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Joined: 31 Jan 2003
Posts: 8151
Location: Wenatchee, Washington, USA
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| Posted: Mon Jun 22, 2009 1:57 pm Post subject: |
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You may find this interesting, Bob. Note especially the definition of emergency medical condition in section (e), definitions.
| Quote: | TITLE 42 > CHAPTER 7 > SUBCHAPTER XVIII > Part E > § 1395dd
§ 1395dd. Examination and treatment for emergency medical conditions and women in labor
(a) Medical screening requirement
In the case of a hospital that has a hospital emergency department, if any individual (whether or not eligible for benefits under this subchapter) comes to the emergency department and a request is made on the individual’s behalf for examination or treatment for a medical condition, the hospital must provide for an appropriate medical screening examination within the capability of the hospital’s emergency department, including ancillary services routinely available to the emergency department, to determine whether or not an emergency medical condition (within the meaning of subsection (e)(1) of this section) exists.
(b) Necessary stabilizing treatment for emergency medical conditions and labor
(1) In general
If any individual (whether or not eligible for benefits under this subchapter) comes to a hospital and the hospital determines that the individual has an emergency medical condition, the hospital must provide either—
(A) within the staff and facilities available at the hospital, for such further medical examination and such treatment as may be required to stabilize the medical condition, or
(B) for transfer of the individual to another medical facility in accordance with subsection (c) of this section.
(2) Refusal to consent to treatment
A hospital is deemed to meet the requirement of paragraph (1)(A) with respect to an individual if the hospital offers the individual the further medical examination and treatment described in that paragraph and informs the individual (or a person acting on the individual’s behalf) of the risks and benefits to the individual of such examination and treatment, but the individual (or a person acting on the individual’s behalf) refuses to consent to the examination and treatment. The hospital shall take all reasonable steps to secure the individual’s (or person’s) written informed consent to refuse such examination and treatment.
(3) Refusal to consent to transfer
A hospital is deemed to meet the requirement of paragraph (1) with respect to an individual if the hospital offers to transfer the individual to another medical facility in accordance with subsection (c) of this section and informs the individual (or a person acting on the individual’s behalf) of the risks and benefits to the individual of such transfer, but the individual (or a person acting on the individual’s behalf) refuses to consent to the transfer. The hospital shall take all reasonable steps to secure the individual’s (or person’s) written informed consent to refuse such transfer.
(c) Restricting transfers until individual stabilized
(1) Rule
If an individual at a hospital has an emergency medical condition which has not been stabilized (within the meaning of subsection (e)(3)(B) of this section), the hospital may not transfer the individual unless—
(A)
(i) the individual (or a legally responsible person acting on the individual’s behalf) after being informed of the hospital’s obligations under this section and of the risk of transfer, in writing requests transfer to another medical facility,
(ii) a physician (within the meaning of section 1395x (r)(1) of this title) has signed a certification that [1] based upon the information available at the time of transfer, the medical benefits reasonably expected from the provision of appropriate medical treatment at another medical facility outweigh the increased risks to the individual and, in the case of labor, to the unborn child from effecting the transfer, or
(iii) if a physician is not physically present in the emergency department at the time an individual is transferred, a qualified medical person (as defined by the Secretary in regulations) has signed a certification described in clause (ii) after a physician (as defined in section 1395x (r)(1) of this title), in consultation with the person, has made the determination described in such clause, and subsequently countersigns the certification; and
(B) the transfer is an appropriate transfer (within the meaning of paragraph (2)) to that facility.
A certification described in clause (ii) or (iii) of subparagraph (A) shall include a summary of the risks and benefits upon which the certification is based.
(2) Appropriate transfer
An appropriate transfer to a medical facility is a transfer—
(A) in which the transferring hospital provides the medical treatment within its capacity which minimizes the risks to the individual’s health and, in the case of a woman in labor, the health of the unborn child;
(B) in which the receiving facility—
(i) has available space and qualified personnel for the treatment of the individual, and
(ii) has agreed to accept transfer of the individual and to provide appropriate medical treatment;
(C) in which the transferring hospital sends to the receiving facility all medical records (or copies thereof), related to the emergency condition for which the individual has presented, available at the time of the transfer, including records related to the individual’s emergency medical condition, observations of signs or symptoms, preliminary diagnosis, treatment provided, results of any tests and the informed written consent or certification (or copy thereof) provided under paragraph (1)(A), and the name and address of any on-call physician (described in subsection (d)(1)(C) of this section) who has refused or failed to appear within a reasonable time to provide necessary stabilizing treatment;
(D) in which the transfer is effected through qualified personnel and transportation equipment, as required including the use of necessary and medically appropriate life support measures during the transfer; and
(E) which meets such other requirements as the Secretary may find necessary in the interest of the health and safety of individuals transferred.
(d) Enforcement
(1) Civil money penalties
(A) A participating hospital that negligently violates a requirement of this section is subject to a civil money penalty of not more than $50,000 (or not more than $25,000 in the case of a hospital with less than 100 beds) for each such violation. The provisions of section 1320a–7a of this title (other than subsections (a) and (b)) shall apply to a civil money penalty under this subparagraph in the same manner as such provisions apply with respect to a penalty or proceeding under section 1320a–7a (a) of this title.
(B) Subject to subparagraph (C), any physician who is responsible for the examination, treatment, or transfer of an individual in a participating hospital, including a physician on-call for the care of such an individual, and who negligently violates a requirement of this section, including a physician who—
(i) signs a certification under subsection (c)(1)(A) of this section that the medical benefits reasonably to be expected from a transfer to another facility outweigh the risks associated with the transfer, if the physician knew or should have known that the benefits did not outweigh the risks, or
(ii) misrepresents an individual’s condition or other information, including a hospital’s obligations under this section,
is subject to a civil money penalty of not more than $50,000 for each such violation and, if the violation is gross and flagrant or is repeated, to exclusion from participation in this subchapter and State health care programs. The provisions of section 1320a–7a of this title (other than the first and second sentences of subsection (a) and subsection (b)) shall apply to a civil money penalty and exclusion under this subparagraph in the same manner as such provisions apply with respect to a penalty, exclusion, or proceeding under section 1320a–7a (a) of this title.
(C) If, after an initial examination, a physician determines that the individual requires the services of a physician listed by the hospital on its list of on-call physicians (required to be maintained under section 1395cc (a)(1)(I) of this title) and notifies the on-call physician and the on-call physician fails or refuses to appear within a reasonable period of time, and the physician orders the transfer of the individual because the physician determines that without the services of the on-call physician the benefits of transfer outweigh the risks of transfer, the physician authorizing the transfer shall not be subject to a penalty under subparagraph (B). However, the previous sentence shall not apply to the hospital or to the on-call physician who failed or refused to appear.
(2) Civil enforcement
(A) Personal harm
Any individual who suffers personal harm as a direct result of a participating hospital’s violation of a requirement of this section may, in a civil action against the participating hospital, obtain those damages available for personal injury under the law of the State in which the hospital is located, and such equitable relief as is appropriate.
(B) Financial loss to other medical facility
Any medical facility that suffers a financial loss as a direct result of a participating hospital’s violation of a requirement of this section may, in a civil action against the participating hospital, obtain those damages available for financial loss, under the law of the State in which the hospital is located, and such equitable relief as is appropriate.
(C) Limitations on actions
No action may be brought under this paragraph more than two years after the date of the violation with respect to which the action is brought.
(3) Consultation with peer review organizations
In considering allegations of violations of the requirements of this section in imposing sanctions under paragraph (1) or in terminating a hospital’s participation under this subchapter, the Secretary shall request the appropriate utilization and quality control peer review organization (with a contract under part B of subchapter XI of this chapter) to assess whether the individual involved had an emergency medical condition which had not been stabilized, and provide a report on its findings. Except in the case in which a delay would jeopardize the health or safety of individuals, the Secretary shall request such a review before effecting a sanction under paragraph (1) and shall provide a period of at least 60 days for such review. Except in the case in which a delay would jeopardize the health or safety of individuals, the Secretary shall also request such a review before making a compliance determination as part of the process of terminating a hospital’s participation under this subchapter for violations related to the appropriateness of a medical screening examination, stabilizing treatment, or an appropriate transfer as required by this section, and shall provide a period of 5 days for such review. The Secretary shall provide a copy of the organization’s report to the hospital or physician consistent with confidentiality requirements imposed on the organization under such part B.
(4) Notice upon closing an investigation
The Secretary shall establish a procedure to notify hospitals and physicians when an investigation under this section is closed.
(e) Definitions
In this section:
(1) The term “emergency medical condition” means—
(A) a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in—
(i) placing the health of the individual (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy,
(ii) serious impairment to bodily functions, or
(iii) serious dysfunction of any bodily organ or part; or
(B) with respect to a pregnant woman who is having contractions—
(i) that there is inadequate time to effect a safe transfer to another hospital before delivery, or
(ii) that transfer may pose a threat to the health or safety of the woman or the unborn child.
(2) The term “participating hospital” means a hospital that has entered into a provider agreement under section 1395cc of this title.
(3)
(A) The term “to stabilize” means, with respect to an emergency medical condition described in paragraph (1)(A), to provide such medical treatment of the condition as may be necessary to assure, within reasonable medical probability, that no material deterioration of the condition is likely to result from or occur during the transfer of the individual from a facility, or, with respect to an emergency medical condition described in paragraph (1)(B), to deliver (including the placenta).
(B) The term “stabilized” means, with respect to an emergency medical condition described in paragraph (1)(A), that no material deterioration of the condition is likely, within reasonable medical probability, to result from or occur during the transfer of the individual from a facility, or, with respect to an emergency medical condition described in paragraph (1)(B), that the woman has delivered (including the placenta).
(4) The term “transfer” means the movement (including the discharge) of an individual outside a hospital’s facilities at the direction of any person employed by (or affiliated or associated, directly or indirectly, with) the hospital, but does not include such a movement of an individual who
(A) has been declared dead, or
(B) leaves the facility without the permission of any such person.
(5) The term “hospital” includes a critical access hospital (as defined in section 1395x (mm)(1) of this title).
(f) Preemption
The provisions of this section do not preempt any State or local law requirement, except to the extent that the requirement directly conflicts with a requirement of this section.
(g) Nondiscrimination
A participating hospital that has specialized capabilities or facilities (such as burn units, shock-trauma units, neonatal intensive care units, or (with respect to rural areas) regional referral centers as identified by the Secretary in regulation) shall not refuse to accept an appropriate transfer of an individual who requires such specialized capabilities or facilities if the hospital has the capacity to treat the individual.
(h) No delay in examination or treatment
A participating hospital may not delay provision of an appropriate medical screening examination required under subsection (a) of this section or further medical examination and treatment required under subsection (b) of this section in order to inquire about the individual’s method of payment or insurance status.
(i) Whistleblower protections
A participating hospital may not penalize or take adverse action against a qualified medical person described in subsection (c)(1)(A)(iii) of this section or a physician because the person or physician refuses to authorize the transfer of an individual with an emergency medical condition that has not been stabilized or against any hospital employee because the employee reports a violation of a requirement of this section. |
Source: http://www.law.cornell.edu/uscode/42/1395dd.shtml
Are you now ready to admit that you're wrong (as usual) Bob, or shall I get it from the administrators of your local hospital as well?
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I refuse to live in a country like this - and I'm not leaving. - Michael Moore |
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bobf
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Joined: 17 Dec 2002
Posts: 1428
Location: Cortez Colorado USA
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| Posted: Mon Jun 22, 2009 2:06 pm Post subject: |
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Hell no. I am not wrong. Read the summary I will post below. This is the same words only without all the legal mumbo jumbo words. Oh yes, while you are calling hospitals, call the one in Casa Grande Arizona and ask what they do with all those people in the ER waiting room. Many do not even speak English.
I have been through the ER visit and so has my wife. The ER does plenty to make sure the persons are not well and won't release you until you are well. Just to do as you say, go in and demand something won't work. You could go in and get an basic exam for sure.
http://en.wikipedia.org/wiki/Emergency_Medical_Treatment_and_Active_Labor_Act
Hospital obligations
Hospitals have three obligations under EMTALA:
1. Individuals requesting emergency care, or those for whom a representative has made a request if the patient is unable, must receive a medical screening examination to determine whether an emergency medical condition (EMC) exists. Examination and treatment cannot be delayed to inquire about methods of payment or insurance coverage, or a patient's citizenship or legal status. The hospital may only start the process of payment inquiry and billing once the patient has been stabilized to a degree that the process will not interfere with or otherwise compromise patient care.
2. The emergency room (or other better equipped units within the hospital) must treat an individual with an EMC until the condition is resolved or stabilized and the patient is able to provide self-care following discharge, or if unable, can receive needed continual care. Inpatient care provided must be at an equal level for all patients, regardless of ability to pay. Hospitals may not discharge a patient prior to stabilization if the patient's insurance is canceled or otherwise discontinues payment during course of stay.
3. If the hospital does not have the capability to treat the condition, the hospital must make an "appropriate" transfer of the patient to another hospital with such capability. This includes a long-term care or rehabilitation facilities for patients unable to provide self-care. Hospitals with specialized capabilities must accept such transfers and may not discharge a patient until the condition is resolved and the patient is able to provide self-care or is transferred to another facility.
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Hunter
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Posts: 114
Location: Colorado
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jimallyn
Site Admin
Joined: 31 Jan 2003
Posts: 8151
Location: Wenatchee, Washington, USA
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| Posted: Mon Jun 22, 2009 2:24 pm Post subject: |
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I can see there is no point to continuing this discussion. The law is clear, they must provide emergency care only, nothing further. You have been presented with the facts and you choose to deny them.
“When a man who is honestly mistaken hears the truth, he will either quit being mistaken, or cease to be honest.”
You've made your choice Bob.
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bobf
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Joined: 17 Dec 2002
Posts: 1428
Location: Cortez Colorado USA
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| Posted: Mon Jun 22, 2009 2:24 pm Post subject: |
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| molgen wrote: | The turns that threads take! What fun! Here's what I think is a relevant article from my hometown rag:
http://www.ajc.com/cherokee/content/metro/stories/2009/06/20/insure_individual.html
This is an article investigating complaints filed with the Georgia insurance commissioner. A disproportionate number of complaints come from people who have individual insurance policies.
| Quote: | As more Georgians are forced to seek health insurance on their own, many are learning painful lessons about the difference between the familiar company-based group coverage and the individual policies that sometimes replace them.
Policies are suddenly canceled. Monthly premiums rival the size of mortgage payments. Huge bills go unpaid because of surprising gaps in coverage. |
Then there are those who simply cannot purchase health insurance on the private market, because of pre-existing chronic conditions.
Tell us again, how our current system is wonderful? Tell us how it is fair? I have excellent insurance through my employer, but I feel for the tens of millions who have to fend for themselves.
Insurance has to be mandatory for everyone (since we cannot deny care to those who need it). If we stay with multiple private insurers, there have to be some drastic reforms such as: no insurer can refuse to offer coverage to anyone for any reason; premiums have to be affordable. Then we get into questions of who determines what fair rates are for different categories of people. Since private insurance companies won't want to play under these rules, we may have no better option than a government-run insurance system.
Not sure if Bobf is saying that our current system is not broken (the facts are that we spend more per capita on health than any other country in the world, but certainly don't rank at the top), or whether he's saying that private insurance companies can be trusted to come up with solutions on their own, without further regulation (then why haven't they done so already?), or whether he's saying that there are better solutions than the Canadian and European models (then let's hear what these better solutions are). |
We certainly are in at the top along with UK, Australia, Canada, and we don't have as many problems as they do. You get what you pay for.
If you are worried about insurance you better hope for Obama's plans to be implemented. Employer insurance would be made permanent and transfer from one employer to another.
Yes you are catching on a bit I think. I have been saying all along over the last couple years that we can improve the US medical system but only if we do not copy the failed systems of the Europeans, and others, that failed so badly for various reasons. Many of the European countries have restructured their systems recently and went back to private practices. Don't believe that then look up the UK NHS changes, Netherlands medical system changes. Sweden has also made changes and tightened the availability to limit unregistered persons coverage.
Just because I keep saying don't go to a government run medical system does not mean there can be no more improvements in our system. As Obama has offered there will be a government regulated medical system. Insurance protection. Private practices. No person between the doctor and the patient. Just keep the far left radicals like Pelosi and her lefty gang out of the decisions. Her last stated idea was just like the ones the the Euros have gone back over and changed.
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bobf
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Joined: 17 Dec 2002
Posts: 1428
Location: Cortez Colorado USA
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| Posted: Mon Jun 22, 2009 2:29 pm Post subject: |
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| jimallyn wrote: | I can see there is no point to continuing this discussion. The law is clear, they must provide emergency care only, nothing further. You have been presented with the facts and you choose to deny them.
“When a man who is honestly mistaken hears the truth, he will either quit being mistaken, or cease to be honest.”
You've made your choice Bob. |
As long as you continue to misread and not adjust your thinking as to what is printed, you are right. No future for you I guess. ER actually states in item one that they must take and at least exam all who enter the area.
They can determine you to be well and dismiss you. If any problems exist they will take care of it and if not possible in their area will forward you to another medical center. You will not be released until you are well.
Why are so many ER areas so overwhelmed with patients and they don't get paid for half that effort? Because they do take in anyone that bothers to enter the ER.
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panther86
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bobf
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Posts: 1428
Location: Cortez Colorado USA
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| Posted: Mon Jun 22, 2009 4:08 pm Post subject: |
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OK for France, but I don't think you would really like it as you must buy public insurance and pay plenty for the privilege. These are two articles by comparing UK NHS with the French health system. Best hang loose and see if Obama can make his wishes come true.
http://www.civitas.org.uk/pubs/bb2France.php
Health Care in France
David G. Green, Ben Irvine and Ben Cackett (2005)
To qualify for health cover it is necessary to have paid a social insurance premium calculated as a percentage of income. In addition, fees are payable at the time of use and can be claimed back from the insurer or waived for the poor (people earning less than 6,600 euros per year do not have to contribute). The outcome in France has been that a very high standard of care is available to everyone without the waiting lists that characterise the NHS.
<Clip>
To a central planner the French system looks like a chaotic mess, but in reality the mess is a pragmatic blend of consumer choice, professional autonomy, central regulation and a government-backed guarantee for the poor which exceeds the NHS standard by far. Like the Belgians, the Dutch and the Germans, the French in their own way have discovered how to universalise the benefits of a competitive market. The NHS, by comparison, has universalised the drawbacks of public sector monopoly.
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In addition the French system apparently is not cheap to run but it is very cheap on the doctors etc.
http://www.jeremyjosephs.com/health.htm
FRENCH NHS SICK AND NO ROLE MODEL FOR UK
by Jeremy Josephs, Freelance Writer and Journalist, josephs@crit.univ-montp2.fr, www.jeremyjosephs.com
It’s a sure sign that something is seriously wrong with the NHS when the French system is constantly held up as a system for us to emulate. ‘There are no waiting lists in France, you know.’ ‘I know of someone who went over to Bordeaux to have a hip replacement operation’. Everyone, apparently, has an Anglo-French health tale to tell. And the economic journals compound the misery by reliably reporting that the French spend almost twice as much as a percentage of GDP on health care. The message coming across the Channel is that France is at the cutting edge of modern medicine whilst Britain continues to drift relentlessly into a position of third world decline. Which leads one to conclude, does it not, that the French system is the next best thing to sliced baguette. And yet the truth is that whilst French patients have little cause to complain, health professionals are on the brink of despair.
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No one gets free medical help. It is always paid in fees and taxes. I think France ha a near 50% tax, much higher than the US.
And about your claim that the US ranking is crappy, think it through this way.
UK is ranked 18 or about 9%
Canada is ranked 30 or about 15%
Australia is ranked 32 or about 16%
US is ranked 37 or about 18.5%
As I said before we are all in the top 20% and only 10% apart. So we are really not a crappy medical system after all. There are near 160 countries behind us. And the money spent is probably not the best measure anyway. WHO used some formula that they created based on a cost of living for a day in each country to be the measure and basis for dollar ranking. It really has nothing to do with actual dollars. When folks can live on a dollar a day or week, there is no actual comparison to how we live in the US where it takes several dollars to buy a sandwich.
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Erich-H
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Joined: 01 Dec 2006
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Location: United States Of America
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| Posted: Mon Jun 22, 2009 5:14 pm Post subject: |
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| Hunter wrote: | | Come on Bob, you know darn well what I mean.. The way Palin, that cocky arrogant nose in the air chick from Alaska, that had her |
Sorry I like her and want her to run in 2012. She has courage and guts while drawing big crowds to her rallies. Sheś not afraid to stand up for what she believes even if the mainstream media and David Letterman want to tear her down and destroy her. That just fires me up all the more. Time to start pumping some oil out of Alaska! In fact she was the only spark that the McCain team had. McCain was in her way! We cant afford all the social programs Obama wants nor should we. People need to learn to take care of themselves- if at all possible. I don't want rationed health care. I don't want the government telling me what I can eat what car to drive what doctor to see etc etc etc. After quadrupling the national debt he (Obama) is STILL??!! looking to spend money we don't have! Even the socialism we do have is a failure. Social security is going broke. I heard in 2025 there will be no money left. California is broke because of all the social program spending that has taken place and Arnie is toying with the idea of legalizing pot- maybe taxing it to balance the bottom line. If government would just provide for the common defence we'd be better off. 
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kona0197
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Joined: 09 Aug 2005
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Location: Albany, OR
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| Posted: Mon Jun 22, 2009 8:16 pm Post subject: |
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| Quote: | | Hell no. I am not wrong |
Your always wrong Bob I mean TROLL!
Get a life...
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