Emergency Rooms Get Eased Rules on Patient Care

I just read this article in the NY Times on changes to laws governing ERs and though I’d post it. I’d be interested in hearing what people think. To me it generally sounds like a good thing. I do not however like that it makes it easier for one hospital to turf a patient to another hospital for care after stabilization. I am generally a bleeding heart liberal though and I don’t actually know what the rules were before. Here it is Emergency Rooms Get Eased Rules on Patient Care

Sorry for the pain in the ass link. I double checked it at work and it took me straight to the article but I geuss that was because I have a cookie with my info. Here is the article pasted if any one is interested.
September 3, 2003
Emergency Rooms Get Eased Rules on Patient Care

ASHINGTON, Sept. 2 — The Bush administration is relaxing rules that say hospitals have to examine and treat people who require emergency medical care, regardless of their ability to pay.
Under the new rule, which takes effect on Nov. 10, patients might find it more difficult to obtain certain types of emergency care at some hospitals or clinics that hospitals own and operate.
The new rule makes clear that hospitals need not have specialists “on call” around the clock. Some patients might have more difficulty winning damages in court for injuries caused by violations of the federal standards.
“The overall effect of this final rule will be to reduce the compliance burden for hospitals and physicians,” the administration says in a preamble to the regulation, to be published next Tuesday in The Federal Register.
The administration drafted the new rule after hearing complaints from scores of hospitals and doctors who said the old standards were onerous and confusing, exposed them to suits and fines and encouraged people to seek free care in emergency rooms. Courts have often ruled for patients, and against hospitals.
In an interview, Thomas A. Scully, administrator of the federal Centers for Medicare and Medicaid Services, said tonight that the new standards would reduce the costs of compliance for hospitals and doctors without weakening patients’ protection.
The new rule limits the scope of a law from 1986 that defines hospital obligations. It expands the situations in which hospitals are exempt from the federal requirements.
Mr. Scully said the 1986 law did "a lot of wonderful things, but also does some perverse things that cause a lot of heartburn for doctors and hospitals."
For example, Mr. Scully said, if a hospital has a cancer center or a dialysis center three blocks from its main building, the employees of the center have to be trained to deal with emergency cases, duplicating the work of the emergency room.
But Dr. Robert A. Bitterman, an emergency physician at the Carolinas Medical Center in Charlotte, N.C., said: "The new rule could aggravate an existing problem. Specialists are not accepting on-call duties as frequently as we would like. As a result, hospital emergency departments lack coverage for various specialties like neurosurgery, orthopedics and ophthalmology. The new rule could make it more difficult for patients to get timely access to those specialists."
Mr. Scully’s deputy, Leslie V. Norwalk, said: "The old rules contributed to the overcrowding of emergency rooms. Hospitals were afraid to move patients out of the emergency department for fear of violating the rules."
The new rule, while not a wholesale return to the situation before 1986, scales back regulations that specify when and where hospitals have to provide emergency services. Patients turned away or refused emergency care can still sue, but hospitals will, in many cases, have stronger defenses.
Dr. Douglas L. Wood, a cardiologist at the Mayo Clinic in Rochester, Minn., said hospital duties under the 1986 law had grown because of court decisions and the "layering of regulation on regulation."
In the last five years, the government has collected more than $4 million from 164 hospitals and doctors accused of violating the law.
The new rule narrows the definition of “hospital property” where patients are entitled to emergency care. In addition, it says the 1986 law does not apply to emergency patients after a hospital has admitted them.
The 1986 law, the Emergency Medical Treatment and Labor Act, or Emtala, applies to all hospitals that participate in Medicare and offer emergency services.
Under the law, if any person — not just a Medicare beneficiary — goes to the emergency department of a hospital for treatment, the hospital has to provide a “medical screening examination.”
If the examination shows an emergency medical condition, the hospital has to provide treatment to stabilize the patient’s condition. Alternatively, the hospital can have the patient transferred to another institution if the expected benefits outweigh the risks.
Under the new rule, the administration says, “Emtala no longer applies to any individual who is admitted as an inpatient.”
Hospitals and doctors who violate a requirement of the 1986 law can be fined $50,000 for each violation and can be excluded from Medicare. In addition, patients have a right to sue hospitals that violate the law. Some patients have recovered hundreds of thousands of dollars.
The American Hospital Association and other industry groups have long sought changes in the emergency room standards. In 1999, when Mr. Scully was president of the Federation of American Hospitals, he complained that the government was using the 1986 law in ways never intended by Congress.
Maureen D. Mudron, Washington counsel for the American Hospital Association, welcomed the new rule today, saying that it provided "clear and practical guidance."
Under federal law, each hospital participating in Medicare also has to keep a list of doctors who are available, on call, to treat emergency room patients.
The new rule gives hospitals greater discretion in arranging such coverage. A hospital can legally exempt senior members of the medical staff from on-call duty, it says. Moreover, the new rule says federal law does not require all hospitals to have doctors on call 24 hours a day seven days a week.
In addition, the rule says, doctors can have simultaneous on-call duties at two or more hospitals and can schedule elective surgery or other medical procedures when they are on call.
The old rules applied to all hospital departments, even those not at the main hospital site. The new rule applies to an “off-campus” site only if it is specifically licensed as an emergency room, if the site is held out to the public as a place that provides emergency care or if emergency cases accounted for at least one-third of all outpatient visits in the prior year.
The old rules provided protection to anyone seeking care on hospital property, meaning “the entire main hospital campus.”
The new rule makes clear that the law does not apply to doctors’ offices, rural health clinics, nursing homes or other “nonhospital entities,” even if they are adjacent to the main hospital building and are owned or operated by the hospital.