Ronald Reagan as Hospital Bomber

by lizard

Ronald Reagan planted a bomb and it’s still blowing up hospitals. That bomb’s name is EMTALA:

The Emergency Medical Treatment and Active Labor Act (EMTALA) is an act of the United States Congress, passed in 1986 as part of the Consolidated Omnibus Budget Reconciliation Act (COBRA). It requires hospitals to provide emergency health care treatment to anyone needing it regardless of citizenship, legal status, or ability to pay. There are no reimbursement provisions. Participating hospitals may not transfer or discharge patients needing emergency treatment except with the informed consent or stabilization of the patient or when their condition requires transfer to a hospital better equipped to administer the treatment.

The recent closure of another Georgia hospital has combined modern day Republican cruelty of denying Federal medicaid dollars with a Reagan-era BIG GOVERNMENT mandate to just say yes to the uninsured.

The policy is one thing, the reality in the ER is something else.

Here in Missoula, I don’t think it’s a secret St. Pat’s ER is the triage center for the chronically homeless, especially during the winter. The combination of EMTALA and medicaid no-thankya from foot-shooting ideologues in Montana’s legislature will continue negatively impacting one of Missoula’s largest employers.

I have seen and participated in the burnout of useless triage. I have seen how difficult it can be to convince an ER doctor that the chronic drunk he’s seen a hundred times really might do it this time. Of course taking the drunk’s threat of self-harm seriously means waiting the time it takes to sober him/her up so that a mental health professional can properly assess risk. Today I learned if your BAC is around .3 that means about 8 hours in an ER bed.

Forget the whole bleeding-heart liberal appeal to improving services. Broken systems are incredibly expensive. It would be fiscally conservative to find a cheaper fix to what we’re doing now, right?

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  1. There are many jurisdiction have sleep off centers which are a hell of a lot more effective than taking up those hospital beds.

    It’s not a new model. I saw it in Sweden over 40 years ago.

    They often involve aggressive outreach to get chronic inebriates into programs.

    Hospitals also have an obligation under Hill-Burton funding to provide services to the indigent. The idea is to divert those in need of services to those providers more able to deal with their problems in a more economic fashion.

    • lizard19

      it’s certainly not a new concept, I know, which makes it even more frustrating that we don’t have a comparable service.

  2. P.S. When I saw the headline I thought it referred to Reagan’s troops bombing the mental hospital in Grenada, in retaliation for the bombing of the Marine barracks in Beirut.

    (Wag that dog!)

  3. Craig Moore

    It is so much more complex than pointing fingers and saying it’s those somabitches fault. Did you know how Medicaid/Medicare have restricted the treatment protocols in terms of time spent with a patient and treatment procedures allowed for reimbursement? This even involves the admitting protocol. A resident ER doc I know expressed his frustration to me how they are pressured to treat people as slabs of meat. It’s not why he became a doctor. BTW, resident ER docs like this young man are paid from Medicare. Residency is the apprentice process after med school. If M&M says that a particular treatment doesn’t fit their protocols, neither the hospital nor the resident doc gets paid for that patient. BTW, it ‘s not just the govt M&M doing it, the commercial insurers are doing the same thing.

    Instead of pointing fingers at those somabitches, it’s time to focus on the problems and get action. Just MHO.

    • Steve W

      Craig, would you mind translating what you wrote? I didn’t get what the problem and what the solution is out of your ramble.

      Who are the somabitches that you think Liz is pointing a finger at?

      What exactly is your HO (humble opinion) because I don’t understand?

      So are you saying that the ideologue right-wing Montana Legislature is going to make sure that unnamed resident loses his job? is that the problem?

      Or what? Thanks in advance.

      • Craig Moore

        Steve, read Liz’s post until it sinks in. You are welcome.

    • lizard19

      Benghazi.




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