Use and Abuse
Ruston, Louisiana has a closed community webpage and once you’ve proven your connection to Ruston as a current or previous resident, you can become a member of the group and join conversations. The page is called Ruston Rants and today one member asked the question, “Based on the economic hardship the state face (SIC), should Medicaid recipients be forced to pay a deductible to see dr and for ER visits?” Answers in the discussion were mixed and some of the participants got a little heated - the subject of money has that affect on people, you know.
The federal government enacted the EMTALA law in 1986 that requires all emergency departments to screen every patient who perceives themselves to have an emergency. The ER is mandated by law to stabilize or transfer patients with emergencies regardless of their ability to pay. These emergent conditions include women in labor. This law assures that everyone with an emergency is treated and stabilized; this screening process has to be done prior to any hospital employee asking about ability to pay or insurance status. So rest assured, anyone who comes to the ER with a true emergency will receive care.
That being said, remember that the ER medical provider (Physician, Nurse Practitioner or Physician Assistant) is required to screen and stabilize EMERGENCIES. The ER, however, is not obligated to treat any and every medical condition. ERs nationwide handle the non-emergent patients according to their individual corporation’s or hospital’s policy. Some ERs, once an emergency is ruled out, will declare that no emergent condition exists and advise the patient to follow up with their own medical provider of choice. Other ERs rule out emergency then offer to complete the medical care for a fee. Many ERs just evaluate and treat whatever condition or complaint that comes through the door.
My answer to the Facebook question today is “Yes, if you have no emergency, you should have to pay a fee” - even if only a nominal amount. No, I haven’t become callous and without compassion, but I have grown tired of people shirking their responsibility for obtaining consistent and appropriate healthcare for themselves and their family members. Using public assistance funds for an ER visit instead of buying your own supply of Tylenol and Ibuprofen to treat your child’s fever is inexcusable. A patient came into ER once with a complaint of abdominal pain and dizziness and a medical workup worth thousands of dollars ensued. At the end of her third hour in ER, after a battery of lab work, and after CTs of the head and abdomen, the patient asked if she was pregnant, which prompted me to ask if that was her true reason for presenting to ER that day. Without hesitation, without remorse, and without the slightest bit of embarrassment, she replied, “yes, but it’s okay; I have Medicaid and all this is free.” This person was one of our regular clients - numerous visits, numerous workups. Pregnancy tests cost a dollar or two at the discount stores.
A co-pay would deter this sort of misuse. If that ER case isn’t ridiculous enough, I could tell about the college student who let her ex-boyfriend lick her nipple ring and came to the ER to see if we thought she could get an STD from that type of interaction. I could also tell you about the lady who came in by ambulance and asked if I’d look in her nose for boogers. Then there was the girl whose new shoes rubbed (not blistered) her toes necessitating, in her opinion, a prescription for her 10/10 pain. As we say in ER, you can’t make this shit up.
Any member of the ER staff can tell ludicrous tales such as these; my answer for decreasing their numbers is co-pays or fees. Make the $4 laxative, the $3 bottle of Tylenol and the $2 pregnancy test the cheaper option. Free up the ER staff to care for the car wrecks, strokes, lacerations, heart attacks, broken bones, overdoses; that’s what we do best.
Your thoughts?
““Freedom makes a huge requirement of every human being. With freedom comes responsibility. For the person who is unwilling to grow up, the person who does not want to carry his own weight, this is a frightening prospect.” - Eleanor Roosevelt”