Emergency Rooms as the Urban Safety Net
In 1986 an anti-dumping law, the Emergency Medical Treatment and Active Labor Act (EMTALA), was added to that year’s COBRA act without hearings or debate. It required that any woman in active labor or any other person so requesting service had to be screened by an emergency department to determine whether a medical emergency did exist. If it was an emergency the patient had to be treated and stabilized before transfer.
Little additional funding was provided, and while the law was weakened in 2003, it is still in effect with $50,000 fine per violation and potential loss of Medicare reimbursement.
1. What have been the intended and unintended consequences of this law?
2. What is the social contract behind it?
3. Who gets served because of it?
4. What coalitions are working to keep, or to expand, or to contract its requirements?
(A history of the development of emergency medicine in the U.S. and some discussion of the impact of EMTALA can be found in B. Hoffman, “Emergency Rooms: The Reluctant Safety Net,” in Stevens et al. (2006).
