July President's Message
I was speaking with a resident the other day about EMTALA, the unfunded mandate imposed on us back in—oh wait, you already know all about EMTALA. You already know the impact it has on the practice of medicine. You already know about medical screening exams, and appropriate signage, and appropriate paperwork for transfers, and so on. You already know all there is to know about EMTALA and how to avoid the rather draconian penalties associated with it. But what you may not know is how the law came to be and how a missed opportunity by physicians back then highlights the importance of advocacy today.
First of all, this was a law that had bipartisan support (this concept may be unfamiliar to many of us in this day and age). Heavyweights on both sides of the aisle supported the bill. And while I referenced “draconian penalties” above, the penalties in the bill’s final version are nothing compared to those considered in earlier drafts – penalties like classifying violations of the law as felonies and mandating individual financial penalties of $250,000.
Interestingly, many people felt that once it was enacted, the new law did exactly the opposite of what was intended. There were already existing guidelines, and in fact our own ACEP bylaws mirrored many of the provisions in EMTALA. But once this law was passed with its vague definitions, these rather definitive guidelines lost much of their effectiveness. A law designed—in theory—to protect the public did little to advance such protection and, in many ways, was counterproductive.
One of the most instructive aspects of EMTALA’s development is that there was seemingly little input from the medical community. Here was a law that has had incredibly far reaching implications for all of us in the house of medicine and our patients. But those of us who were most affected had little to say. Instead, the process was driven from start to finish by the press, by the legal beagles, by the politicians and by public emotion.
One of the things Ohio ACEP does well—very well—is advocate. We advocate in different ways and for different causes, but always with two groups in mind: the health care providers in the state of Ohio and their patients. Our most effective tool in positively affecting public policy on their behalf is to educate officials who will be making the laws which impact emergency health care delivery.
EMTALA was authored, argued and enacted by legislators who didn’t have the benefit of such education. As a result, the law is less effective and more burdensome than it needs to be. Its passage illustrates the importance of our expertise and input on legislation which impacts the delivery of health care. Your Chapter, your Board and your Government Affairs Committee, led by co-Chairs Dr. Matt Sanders and Dr. Brad Raetzke, are committed to this kind of advocacy. Without question, this is the most important reason for Ohio ACEP’s existence.
John L. Lyman, MD, FACEP
President, Ohio ACEP